An exploratory mixed methods study of urban and rural registered nurses’ experience of clinical reasoning

Abstract

Background and objective: Engaging in clinical reasoning frequently occurs in busy, high pressured, stressful settings with competing demands. Patient outcomes are affected in part by RNs' clinical reasoning ability. This study aims to explore the extent to which the clinical context influences clinical reasoning among urban and rural registered nurses. Methods: In this exploratory study using a mixed method approach, 11 rural hospital RNs and 7 RNs practicing in urban medical or surgical units completed a survey and a semi-structured individual qualitative interview. Data were generated over a two month period in 2015. Descriptive statistics and Mann-Whitney U was used to test for differences among groups. Qualitative data analysis procedures were used to help identify two major themes. Results: The perceived lack of time influenced the participants' ability to engage in clinical reasoning. The findings also suggest that rule following hampered the participants' ability to confidently share their clinical reasoning. Conclusions: To deepen RNs clinical reasoning an examination of the clinical environment's structure and processes that support or impede engagement in clinical reasoning is required. Specific strategies that enhance clinical reasoning need to be unit specific and driven by RNs.