Responding in Writing to Clinical Cases: The Development of Clinical Reasoning in Nursing

Introduction The purpose of this article is to describe and illustrate, by presenting a sample case, the concept of clinical reasoning examinations used in the baccalaureate nursing program at the University of Loui-siana at Lafayette (UL Lafayette). Clinical reasoning exams have been developed by faculty for use in all four major upper division nursing courses in the curriculum. In each of these ten credit hour courses, five credit hours is allocated to the didactic component of the course and five credits is assigned to the related clinical practicuum. The student receives one grade for the course-the letter grade earned in the didactic portion. In the clinical component, the students are evaluated as satisfactory or unsatisfactory. In order to successfully complete the course, the student must earn at least a 74 average in the didactic portion and must also be evaluated by faculty as satisfactory in the clinical component. In the theory portion of the course, students are most often evaluated using multiple choice unit exams which are structured in content and presentation (format) as similarly as possible to the National Council Licensure Examination for Registered Nurses (the NCLEX-RN) format. Questions on these exams are developed by the faculty and are focused primarily at the cognitive levels of application and analysis. One exam per course, the clinical reasoning exam, is not a multiple choice examination. In its current iteration, the clinical reasoning exam is a " paper and pencil " exam, however, it may be structured in different ways including computerized formats allowing free text entry by students. There are several reasons for the incorporation of the clinical reasoning exams in the curriculum. One intent of the exam is to allow students the opportunity to write and to present knowledge in a method other than the multiple choice format. In addition, the clinical