| Objective:To explore the impact of multidisciplinary shared learning and structured reflection guided by Tanner model on clinical judgment ability of nursing undergraduates based on multimorbidity elderly cases.Methods:This study adopts qualitative and quantitative research methods.Stage 1:Collection and compilation of elderly patients with multiple diseases.Thirteen nurses in the affiliated teaching hospital who have been engaged in geriatric nursing for a long time and are responsible for clinical teaching were interviewed by semi-structured individuals.Based on the baseline interview,literature was reviewed to determine the dimensions of geriatric case collection and scenario setting.According to the above dimensions,collecting of the cases of the elderly with multiple diseases was conducted by observation.Then teaching cases was writing by the school full-time teachers,clinical medical teaching faculty staff,tube bed,and data collector.Case collection and write were at the same time.The research group compiled two test cases according to the teaching content.Stage 2:The teaching intervention of multidisciplinary shared learning and structured reflection guided by Tanner model.This stage is the experimental study design.From 230 junior grade nursing undergraduate students recruited 160 students,(80)were randomly divided into control group and experimental group(80 people).Students in the experimental group were randomly divided into two online classes and joined in the same group of 8 clinical medical students and 8 pharmacy students each.Each class was divided into 8 groups containing of 5 nursing students,1 clinical medical student and 1 pharmacy student.The control group received the "Geriatric Nursing" routine course and learned 30 academic hours by chapter through the network from April to July 2020.The experimental group added an online auxiliary course of "clinical case study and multidisciplinary discussion" on the basis of the control group,and learned it from May to July 2020 with the help of the learning channel and a conference platform.This course included 6 elderly cases with multiple diseases,each case lasts for 3-4 class hours,a total of 20 class hours.Students are divided into groups to carry out multidisciplinary case study,discussing and reflecting on typical situations in the cases according to Tanner’s clinical judgment model.Before intervention,nursing students’ general information questionnaire,LCJR and SACRR were distributed to obtain the baseline level of general information and measurement indexes of students in the two groups.After the intervention,the LCJR,SACRR and the Teaching Feedback Questionnaire were distributed.The statistical analysis was conducted by mathematical statistical method to test the effect of the assisted teaching intervention and examine the research hypothesis.Results:Stage 1:Collection and compilation of elderly patients with multiple diseases.Five themes and eight sub-themes were extracted from the semi-structured interview,and the dimensions of case collection and scenario setting were determined,including daily life nursing,effective communication skills,psychological nursing,safety management and first-aid skills,comprehensive assessment of the elderly,common chronic disease nursing and comorbiditic management,common rehabilitation nursing techniques and pipeline nursing.Based on the above dimensions,6 elderly cases and 18 scenarios were collected and compiled in the Affiliated Teaching Hospital.The primary diagnoses were essential hypertension,type II diabetes,coronary heart disease,stroke,osteoporosis,and spinal cord injury.Two situational cases of myocardial infarction and stroke were recompiled to evaluate clinical judgment ability.Stage 2:There was no significant difference in general data between the two groups(P>0.05).There was no statistical difference in the scores of LCJR and SACRR between the two groups before intervention(P>0.05).The scores of LCJR in the experimental group were statistical higher than those in the control group in interpreting,responding reflecting dimensions,and the total scores(P≤0.001).However,score was no statistically significant difference in the noticing dimension(P>0.05).After the teaching,the SACRR scores of experimental group were higher than that of the control group,but the difference was not statistically significant(P>0.05).77.5%of the subjects who received multidisciplinary shared learning and Tanner’s structured reflective instruction were more confident in geriatric care in the future,87.5%were satisfied with the teaching as a whole,and 93.8%thought the learning objectives of the curriculum were in line with the needs of their ability development.Conclusions:Multidisciplinary shared learning and group structured reflection based on multimorbidity elderly cases can improve the clinical judgment ability of nursing undergraduates,but the influence on clinical reasoning ability needs to be further explored in the furture.This online teaching activities provided students with opportunities to integrate knowledge,better understand and solve clinical problems of the elderly,and at the same time trains students’ clinical thinking.Targeted cultivation of clinical judgment ability in geriatric nursing will be beneficial to students’ transition from school to ever-aging nursing environment. |
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