Clinical reasoning and decision-making in home health care. Towards a knowledge-based education and municipal healthcare.

This PhD project aims at understanding nurses’ clinical reasoning in the context of home care. Furthermore, it aims at using a theoretical and empirical understanding of clinical reasoning to strengthen students’ development of clinical reasoning and to improve conditions for clinical reasoning and decision-making in clinical practice.

The project is planned in four scientific studies of which the first one is currently started. The overarching methodological design follows principles of Designed-based educational research (Anderson & Shattuck). This means that the research takes point of departure in stakeholders’ needs and that these are involved in the research and implementation. This project will involve stakeholders from nursing education as well as policymakers and practitioners from municipal home care. Each study will employ research methods relevant to the specific aim, and stakeholder involvement will gradually increase as the project progresses.

Studies:

I: Characteristics of nurses’ clinical reasoning towards decision-making in home care settings: a systematic review with thematic analysis.

A systematic review of studies on nurses clinical reasoning in home care. See study protocol for more details. 

II: Characteristics of complex situations and nurses’ clinical reasoning in home health care

An observation and interview study employing an interpretive description design (Thorne, 2016). Nurses in the context of home care in two municipalities will be observed and interviewed during field visits in home care. Complex situations in which nurses reason and make decisions will be mapped and characterized. The findings will be discussed in relation to theories and models of clinical reasoning. Prototypical situations from this study will be used in study III.

III: Campus-based home health care: students’ clinical reasoning and decision-making in simulated environments.

Simulation-based learning activities will be developed using theoretical and empirical knowledge from studies I and II (above), i.e. based on theories on clinical reasoning contextualized in Swedish home care settings to strengthen students’ development of professional competencies.

IV: Knowledge support for clinical reasoning and decision-making in home health care.

The project will support increased awareness of conditions for nurses’ clinical reasoning and decision-making in home care for policymakers and practitioners. Interventions such as training sessions and knowledge support will be developed in collaboration with municipal stakeholders. 

References: