Time is the Essence: A Grounded Theory Study of Registered Nurse's Experiences with Clinical Reasoning.

摘要

Theoretical applications from Patricia Benner, Donald Schon, John Dewey and David Rigoni provided the theoretical framework for data analysis in this qualitative study of clinical reasoning. Registered nurses, (n=10) described their lived experiences with clinical reasoning in two personal interviews. All the participants had been registered nurses for at least 2 years at the time of the interviews, although the educational backgrounds of the participants included initial preparation from practical, associate and baccalaureate programs. The participants described their experiences with clinical reasoning from a variety of rural and larger urban settings including hospitals, home care and long term care. Clinical reasoning was found to be continuously engaged and centrally embedded in nursing practice. Prior clinical experiences impacted and contributed to the development of nursing expertise over time. The grounded theory which emerged from the findings described the complexity and interrelatedness of time, inquisitiveness, motivation and experience. The multidimensionality of time within the process of clinical reasoning was a central finding. Time emerged as having characteristics of both a resource to nurses and a spatial container in which clinical reasoning occurs. The availability of adequate time, the individual nurse's levels of personal inquisitiveness and motivation, and the depth of clinical experiences attained over time were all significant factors. It was the combination, adequacy and interchange of time, inquisitiveness, motivation and experience which allowed clinical reasoning to be experienced positively. The study included leadership recommendations to facilitate adequate time, encourage inquisitiveness, support individual motivation and acknowledge that clinical reasoning requires experiences over time to be fully developed and expressed.;Keywords: Clinical reasoning, Registered Nurses, RN, time, inquisitiveness, motivation, experience, grounded theory, lived experiences, urgent experiences, tacit curriculum, clock time, time to think. Nursing education, qualitative research, US nurses, Rural nursing, Practical Nursing, Associate Degree Nursing, Baccalaureate Nursing..