Acquisition of clinical reasoning skills by undergraduate nursing students in Malawi; towards development of a middle-range theory : A qualitative study

Introduction: Acquisition of clinical reasoning skills is essential in nursing for patient safety. Lack of clinical reasoning skills in nursing can impose harmful consequences on the patient. However, teaching and learning clinical reasoning skills is not easy due to its complexity. Without a model, clinical reasoning is taught intuitively. Therefore, this study aimed at investigating how undergraduate nursing students acquire clinical reasoning skills, towards development of a middle-range theory. Methods: This study employed Grounded theory of systematic design underpinned by a social constructivism paradigm. The participants were undergraduate nursing students and nurse educators. Purposive sampling was used to sample the participants. Data were collected in six months using numerous methods of interviews, observations, and document review Twelve individual in-depth interviews and six focus group discussions were conducted. Data collection and initial data analysis occurred concurrently using a coding process, with comparative analysis. Results: The study revealed that undergraduate nursing students acquired clinical reasoning skills through automation while utilizing the nursing process. Through the themes, a new theory called ‘a middle-range theory for the acquisition of clinical reasoning skills’, was generated in this current study. The associated concepts were environmental setting, type of curriculum, anchors and expected outcomes which included individual and health care system indicators. Conclusion: Teaching undergraduate nursing students how to reason clinically will develop nurses who can adjust and solve problems in changing patient’s situations. Based on the findings of this study, it is recommended that nursing students be equipped with adequate clinical reasoning skills before they graduate. Therefore, implementing the new model called ‘a middle range theory for the acquisition of clinical reasoning skills’ could foster the development of clinical reasoning skills from the start of the nursing training program.