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Assessing Clinical Reasoning Under Uncertainty Through the Post-anesthesia Nursing Script Concordance Test: A
Lara Daniela Matos Cunha1, Pardis Rahmatpour2, Filipa Ventura3
1ICBAS School of Medicine and Biomedical Sciences - University of Porto, Porto, Portugal; Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal; Fundação para a Ciência e a Tecnologia (FCT), Lisboa, Portugal.
Purpose:
Clinical reasoning is essential in nursing for making informed decisions in complex health care environments. Frameworks such as Script Theory assist nurses in organizing knowledge into "scripts," which support pattern recognition, data interpretation, and uncertainty handling. While Script Concordance Tests have proven effective in nursing education, their application in the ongoing professional development, particularly in specialized areas such as postanesthesia care, has not been widely explored. The purpose of this study was to develop the Postanesthesia Nursing Script Concordance Test (PaNSCT) and to assess its validity.
Design:
Multimethod methodological study.
Methods:
The study was conducted in three phases: Phase I focused on construction and construct validity; Phase II assessed reliability, acceptability, and appropriateness through PaNSCT scores and qualitative feedback from two groups-clinical experts and nurses in perioperative settings; and Phase III concentrated on sustainability, including intellectual property registration. Data analysis included descriptive statistics, Pearson's correlation, Cronbach's α, and content analysis.
Findings:
The contruct validity of the PaNSCT, with 20 cases and 60 items on postanesthesia care, was established through expert consensus, making only minor semantic adjustments. PaNSCT exhibited Cronbach's α of 0.92 and effectively differentiated mean scores of clinical experts (44.8 ± 4.7) from nurses (39.9 ± 6.1, P = .01). Nurses' scores showed a positive correlation with postanesthesia care unit experience (r = 0.58, P = .009), while no significant correlations were found for experts. Panelists highlighted PaNSCT's value in clinical training, the importance of preliminary Script Concordance Tests education, and opportunities for expanding vignettes. PaNSCT showed strong reliability and validity in assessing clinical reasoning under uncertainty in postanesthesia care, with clinical experts outperforming nurses, emphasizing the importance of advanced training and specialization. Nurses with more postanesthesia care unit-specific experience scored higher, highlighting the value of context-specific knowledge.
Conclusions:
PaNSCT is a valuable tool for assessing clinical reasoning under uncertainty, with the potential to advance nursing education and foster the development of reasoning skills in postanesthesia care.
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