The Effect of Case-Based Education on the Development of Nursing Students' Clinical Reasoning Skills

The Effect of Case-Based Education on the Development of Nursing Students' Clinical Reasoning Skills in Critical Illness: A Pilot Randomized Controlled Trial

Aim: This study was conducted to determine the effect of case-based education on the development of clinical reasoning skills of nursing students in critical illnesses. Methods: The study was conducted between January 20 and June 30, 2021 using a pilot randomized controlled trial design. In the study, 22 volunteer students were assigned to the experimental and control groups by simple randomization. The experimental group was given case-based education to improve their clinical reasoning skills, and the control group continued the standard education process. Data were collected using a Student Information Form, the Clinical Reasoning Case Form (CRCF), the Student Satisfaction with Education Questionnaire, and a Form for Views on the Education. In the evaluation of data, frequency values, Fisher exact test, Mann-Whitney U, and Wilcoxon tests, Cohen's d coefficient for effect size, ITT analysis, and covariance analysis were used.

Aim of the study This study was conducted to determine the effect of case-based education on the development of nursing students' clinical reasoning skills in critical illnesses. Research hypotheses H01: There is no difference between the experimental group and the control group in terms of their CRCF scores. H02: Case-based education on clinical reasoning has no positive effect on student satisfaction.

Students in both experimental groups were applied the student information form and the pretest of the CRCF between May 18 and 20, 2021 before the education. The schedule of the education intervention was determined according to the convenience of the students in the experimental group. Accordingly, the experimental group was given education between June 8 and 11, 2021. After the education sessions were completed, experimental groups were applied the CRCF as a posttest on June 28, 2021. The students in the experimental group were asked to fill out the "Student Satisfaction with Education Questionnaire" and the "Form for Views on the Education" online.

Students in control groups were applied the student information form and the pretest of the CRCF between May 18 and 20, 2021 before the education. The students in the control group continued their current standard education process. After the education sessions were completed, control groups were applied the CRCF as a posttest on June 28, 2021.

The education phase This stage included the explanation of the CR process, the analysis of CR cases, the drafting of new cases suitable for the CR process by students, and the analysis process. The education program was carried out on a web platform (Zoom) consistent with the changes in the COVID-19 pandemic process. The CR cases to be used in case-based education were sent to the students via e-mail before the group interview to make sure students came prepared for the group discussion. In case-based education, after the students read the case, they were asked some questions to determine their decisions and reasoning.

This form consists of 9 questions, including students' nicknames, age, gender, duration of clinical experience, level of school success, and views on the nursing process

There were 10 clinical cases on the CRCF prepared for the objectives of these three steps in students' clinical reasoning process. The cases involved critical illness, and early warning findings that show worsening in critical illness and are used to determine priority nursing diagnosis. Five people, who were experts in the field of medical nursing and had clinical experience, were consulted between February 15 and 28, 2021 to confirm the clinical accuracy and reality of CR cases and their content and comprehensibility. The content validity index of expert opinions evaluated with the Davis technique was determined as 1.

The first measurement was collected one week before education. The second measurement was collected 3 weeks after education.

A questionnaire adapted from the study of Lee et al. (2010) was used to evaluate students' satisfaction with the education given. A 6-point Likert-type scale (1= strongly disagree, 6= strongly agree) was used to evaluate the ten items of the questionnaire. The 10th item on the questionnaire is reverse coded. High scores on the questionnaire indicate a high level of satisfaction.

The effectiveness of the education model was evaluated by the researchers with a SWOT analysis (strengths, weaknesses, opportunities, and threats) based on data collected from students in the experimental group without obtaining nicknames or personal information after the completion of the education via an online questionnaire that consisted of 4 questions about the strengths, weaknesses, perceived threats, and opportunities of the education model.

Inclusion Criteria: Having completed the "Medical Nursing" and Surgical Nursing" courses, Volunteering to participate in the study, Participate in "Case-Based Education" Exclusion Criteria: Not being willing to participate in the study, Abandoning the "Case-Based Education" practice Not taking one or two of the "Medical Nursing" and "Surgical Nursing" courses at all, or to have taken them but unsuccessfully

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