Pursuing Improvement in Clinical Reasoning: The Integrated Clinical Education Theory

摘要

Background: The link between clinical education and development of clinical reasoning is not well supported by one theoretical perspective. Learning to reason during clinical education may be best achieved in a supportive sociocultural context of nursing practice that maximizes reasoning opportunities and facilitates discourse and meaningful feedback. Prelicensure clinical education seldom incorporates these critical components and thus may fail to directly promote clinical reasoning skill. Method: Theoretical frameworks supporting the development of clinical reasoning during clinical education were evaluated. Analysis of strengths and gaps in each framework's support of clinical reasoning development was conducted. Commensurability of philosophical underpinnings was confirmed, and complex relationships among key concepts were elucidated. Results: Six key concepts and three tenets comprise an explanatory predictive theory-the integrated clinical education theory (ICET). Conclusion: ICET provides critical theoretical support for inquiry and action to promote clinical education that improves development of clinical reasoning skill.