Title: An exploration of the effect of mindfulness on the development of clinical reasoning in undergraduate nursing students

Abstract:

This pilot study explored the effect of mindfulness based training, with its attributes of being present, aware, attentive and accepting on the development of clinical reasoning ability.

Background. The working world of a nurse is complex. Nurses are expected to manage multiple patients and their complicated, competing, and unpredictable situations. The work requires coping with multiple shifts in cognitive focus. The result can seem chaotic, particularly to a student already feeling challenged from the stress of providing patient care while immersed in the learning process.

Methods. A mixed method design with an intervention only student group of 15 was used. Quantitative assessments of mindfulness, stress and clinical reasoning ability were conducted. Qualitative focus groups evaluated response to mindfulness based training (MBT) and the clinical reasoning learning activities. Five clinical reasoning learning activities and three mindfulness based trainings were embedded in an acute care seminar. Participant learners committed to 10 minutes a day, 4 days a week of personal mindfulness practice. Clinical reasoning ability was assessed through analysis of the student’s ability to receive a patient handoff report and track salient data in 5 categories. The handoff report information was further analyzed for organization and the presence of errors.

Results. Data was analyzed using the paired-samples t-test. There was no statistical change in mindfulness (t (7) = .373, p = .720) or stress (t (7) = .351, p = .736) from pre-test to post-test. However, there were statistically significant improvements in students ability to track and organize salient data, with a decrease in errors. Qualitative data analysis revealed consistent theme of student appreciation of the clinically focused learning activities as well as improvement in confidence in their ability to listen to report and prepare to care for a patient.

Table 1. Quantitative analysis of clinical reasoning handoff data by category

Implications. The MBTs implemented in this study focused on purpose and benefit; the clinical application arm was lost secondary to COVID surge. Results from this pilot study support deliberate teaching of the ability to notice and organize patient data. Replication in conditions where theory and clinical practice can be integrated is warranted.

Audeince Take Away:

• Analysis of a handoff memory aid can provide nurse educators evidence of a students’ noticing capacity.
• As noticing initiates clinical reasoning, deliberate practice that will improve accuracy, organization and scope is beneficial to students.
• Clinical reasoning learning activities can be intentionally designed to focus on prioritization of bedside safety checks, focused physical assessments and essential follow up care.
• Further research is needed examining the integration of deliberate teaching of clinical reasoning with clinical practice applications overlayed with mindfulness.

Biography:

Dr. Sideras studied nursing at St. Louis University in the United States of America and attained both her undergraduate and master’s degrees there. Her PhD in nursing education was awarded in 2008 from Oregon Health & Sciences University. She has been engaged in clinical education since 1989 and immersed in teaching with simulation since 2005. Her current position is an Assistant Professor for the University of Portland. Her research has a dual focus – development and assessment of clinical reasoning and also examining the effect of simulation practice on student nurse’s professional attitudes and values. Her publications reflect her research interests.