Development and Evaluation of Nursing Process Education Protocol in Undergraduate Nursing

Abstract

Abstract Background: The nursing process is the core of nursing practice and the organizer of care and problem solving in the nursing profession. Nowadays various methods are used in the nursing process education to undergraduate nursing students, but these trainings are not based on a basic structure such as a model, pattern, guideline or specific and written protocol. Also, the expected educational outcomes of each method and its effectiveness are also different from each other. While considering the importance of the nursing process in nursing education, there is a need for a comprehensive and holistic structure that can guide the teaching and learning process in a purposeful manner and lead to the development of care planning and thinking skills including critical thinking, clinical reasoning and clinical judgment. Therefore, considering the void of such a structure in nursing education in Iran and all over the world, the present study was conducted with the aim of development and evaluating of the nursing process education protocol in undergraduate nursing. Methods: This research was conducted as a sequential exploratory mixed method study. For this purpose, at the first phase of the research, a qualitative study including the conventional qualitative content analysis with the aim of determining the current status of nursing process education by 16 interviews with students, graduates and professors during August 2021 to February 2022 for 18 months. Systematic and scoping review in 10 databases to determine the characteristics of effective methods for the nursing process education used in Iran and the world; development of the nursing process education protocol based on the findings of two previous stages, then determining the scientific and operational capability of the obtained protocol using the Delphi method was carried out in 2 phases through the viewpoint of nursing process education instructors and experts. Then to conduct the quantitative phase of the study, three interventional studies were designed during April to September 2022. A total of 102 undergraduate nursing students were included in the intervention and comparison groups of these these studies. Furthermore, in order to evaluate the effectiveness of the designed protocol on learning outcome as nursing care planning skill and thinking skills including critical thinking, clinical reasoning and clinical judgment in undergraduate nursing students. Findings: Analysis the data of conventional qualitative content analysis led to the identification of three main categories including "barriers affecting the education and application of the nursing process", "facilitators of the education and application of the nursing process" and "proposed solutions to improve the education and application of the nursing process". After clarifying the current status of nursing process education, a total of 51 studies, including 35 studies in systematic review and 16 studies in scoping review, were reviewed and the methods of nursing process education and it’s required skills were identified and their characteristics were determined. Based on the findings of these two stages, the initial nursing process education protocol was compiled in 3 components including “nursing process education prerequisites”, “the main content of nursing process education and delivering it during schooling” and “proposed reforms to facilitate nursing process education” and the necessary amendments were made after the pilot implementation and determination of its scientific and executive capability. Hypotheses of three interventional studies on the effectiveness of the protocol was confirmed in three quantitative studies on different dimensions of the expected outcomes of learning and thinking skills, especially in the field of clinical reasoning. Then the nursing process education protocol was finalized based on the experts’ consensus in the second phase of the Delphi study in the protocol review process. Conclusion: The present study led to develop the nursing process education protocol in 3 main components including (1) nursing process education prerequisites in terms of people, knowledge base and resources; (2) the main content of nursing process education in theoretical nursing process education situations, in theoretical specialized courses and in internship and internship courses in the clinical field and (3) proposed reforms to facilitate nursing process education in the field of educational curriculum, development of innovative research-based projects and the educational settings. This protocol provides a comprehensive, accurate and written structure for educating the nursing process in different educational situations, considering the executive and target groups, which provides the ability to be used in smaller and more practical dimensions as a meta-protocol. By the way, there is a field prepared for educating and applying the nursing process in the nursing profession as the essence of nursing care.