L’apprentissage du raisonnement clinique infirmier par une stratégie éducative numérique basée sur la concordance de scripts
This doctoral thesis focuses on learning clinical reasoning in nursing using a digital educational strategy based on the notion of script concordance. The thesis is based on a multi-method research design aimed at developing, testing and evaluating an educational strategy for undergraduate students in nursing at the University of Montreal. The thesis, which has five chapters, is written according to the mode of presentation by journal articles. This study was guided by a framework based on script theory, from cognitive science, and the pedagogical approach of cognitive companionship. A multi-method research design integrating a research-development approach, a descriptive qualitative study and a multiple case study was used. Collaborative experts (n=5), expert panellists (n=12) and students (n=45) participated in the study. The results show that the research-development approach enriched the development of a digital education strategy based on script concordance (DESBCS) while ensuring its validation. Overall, students appreciated the DESBCS, especially the varied and formative feedback received from experts while learning how to prioritize nursing hypotheses. A descriptive qualitative study design facilitated the identification of student learning strategies. Results demonstrate that when using a DESBCS, students used certain cognitive apprenticeship strategies for data processing and execution as well as for metacognitive self-monitoring. The results from the multiple case study show that students practised certain cognitive processes of clinical reasoning in nursing, using the vignettes from the script concordance test (SCT) and a think aloud approach, in particular: the early representation of a clinical situation, the semantic transformation of data and the confrontation of hypotheses. The DESBCS improves the visibility of expert knowledge usually absent in a traditional class or even in clinical training. It is a definite advancement to consider the contribution of digital educational strategies in university nursing education programs, or in other programs, to support the development of clinical reasoning. This study highlights the use of a wealth of scientific documentation surrounding the development of DESBCS. Study results inform instructors about effective DESBSC use to make it complementary to other educational strategies by supporting the complexities of learning clinical reasoning in nursing. Implications for the five domains of nursing practice emerge from this study and offer avenues to promote learning and development of clinical reasoning in nursing. One of these aims to promote knowledge articulation and the frequent solicitation of microjudgments to confront and differentiate hypotheses that arise from the uncertainty of clinical practice, implying learning in successive layers.
e-Learning Clinical reasoning in nursing Educational strategy Script theory Script concordance test Digital environment Think aloud Learning strategies Cognitive companionship Nursing education