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Title: A case study of how nursing students learn clinical decision-making in practice placements
Author: Mitchell, Joanna
ISNI:       0000 0004 7224 6915
Awarding Body: London South Bank University
Current Institution: London South Bank University
Date of Award: 2015
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decision-making is a crucial component of being a health care professional and is essential for a registered nurse. Therefore it is a key competence for nursing students to achieve during their pre-registration programme. There is a dearth of research about how nursing students learn clinical decision-making in practice, and most of the previous studies sought students’ opinions about their practice learning. The aim of the research was to explore how nursing students learn to make clinical decisions in practice placements and the influences that affect learning clinical decision-making in practice placements. Using Yin’s (2009) case study approach, the thesis explored the influences on first and third year nursing students learning of clinical decision-making on a female medical ward in a hospital. Ethical approval was obtained. A complex consent process included students, mentors, ward staff and patients, prior to data collection. Six students’ learning in practice was observed on two occasions each (n=12) and they were interviewed at the time of the observations about their learning of clinical decision-making (n=12). Mentors supporting the students’ learning were also interviewed (n=4) and students’ practice assessment documents analysed (n=4). The data was analysed using Richie and Spencer’s (1994) framework approach. The findings showed that the ward’s community approach to supporting students’ learning enhanced their experience and supported the learning of clinical decision-making. Ensuring patient safety and delivery of dignified compassionate care was paramount through role modelled behaviour and safe supervision. A structured approach to learning clinical decision-making was evident by mentors and students, who were highly motivated and demonstrated a heutagogical approach (Hase and Kenyon 2000) to their learning. First and third year students were supported differently by mentors with third year students having close supervision to enable them to make clinical decisions about higher risk patients. First year students were sometimes in decision-making situations that caused them anxiety. Students needed to be self-regulating in their decision-making, seeking support from other staff when decisions might compromise patient safety. Synthesis of the findings with established tools informed the generation of a proposed framework to support students’ learning clinical decision-making and to facilitate their mentors supporting their learning in the future. The study has brought new understanding to the subject of learning clinical decisionmaking through real life evidence from observation of students and mentors in practice placements.
Supervisor: Curzio, Joan ; Ellis, Judith Sponsor: Not available
Qualification Name: Thesis (D.Prof.) Qualification Level: Doctoral