Holistic Nursing Process Maps: a Tool for Student Nurses to Operationalize the Nursing Process to Increase Clinical Reasoning

Abstract

Clinical reasoning (CR) has been identified as a required skill for nursing graduates as a part of the broader term of clinical judgment (Benner et al., 2010). The nursing process is a critical thinking framework unique to nursing and designed to support CR. The ability to use CR in nursing is tested in the United States through high-stakes licensure examination. As a response to the high-stakes testing required to enter the profession of nursing, nursing education has sought to identify ways to improve students’ development of CR. The concept map (CM) has been introduced into nursing education as a tool to increase the development of CR. There is abundant research on the efficacy of the CM as a learning tool in many professional fields. Existing literature does not define the key components of the CM or the relationship to the nursing process. There is very little evidence of nursing students’ experiences in using the CM during nursing school. Novice nursing students lack the understanding or expertise to identify the key components of the CM that are essential to their learning. Overlaying the nursing process with a concept map that guides the novice student through the key components of the nursing process will allow the student to operationalize the nursing process and develop essential clinical reasoning skills. Incorporating and developing a student-friendly nursing-specific Holistic Nursing Process Map (HNPM) in nursing education will contribute to the overall improvement of nursing education. The purpose of this study is to introduce an author-developed concept map titled the HNPM to nursing students to identify a correlation between operationalizing the nursing process in the HNPM and the development of clinical reasoning skills in the pre-licensure nursing students’ first semester in the program of medical surgical nursing. Results indicate an inability to conclusively correlate the use of the HNPM and the development of clinical reasoning in the first semester medical surgical nursing student. There was no significant effect for the intervention group in development of clinical reasoning. There were differences in the development of clinical reasoning as measured by the health sciences reasoning test between campuses and between ethnicities, as well as prior healthcare experience without relationship to the use of the HNPM. Future research is recommended with a larger number of participants, increased fidelity of the use of the HNPM, and completion of the health sciences reasoning post-test by addressing identified challenges to increase participation. Qualitative research may be valuable in identifying differences in the development of clinical reasoning among different demographic groups.