Nursing Students’ Approaches to Learning and Clinical Decision-making

The present and categorical correspondence between how students approach their learning and the way such approaches impact on the acquisition and augmentation of clinical decision-making skills is neither well understood, nor yet clearly established, in nurse education research. To address this gap, this study investigated the approaches to learning and the clinical decision-making of adult nursing students in their final year of training on two separate campuses of a central London university. Approaches to Learning Theory, promulgated by Martin and Sӓljö in 1976, and subsequently expanded and updated by Entwistle and colleagues, provided a theoretical lens and explanatory framework for this study. Acknowledging that the Approaches to Learning Theory adopts a hierarchy of three domains of approach, surface, strategic, and deep, it is argued that students’ clinical decisionmaking should be improved by changing their predominant approach to learning from the surface or strategic to the deep approach. To test this hypothesis, a research intervention was implemented for a purposive sample of participants who adopted either the surface or strategic approach to learning. Consistent with the underpinning principles of the deep approach to learning, the intervention focused on enhancing engagement with learning, problem-solving, and critical thinking skills. A second survey of approaches to learning and clinical decision-making was administered after the intervention, and semi-structured interviews were conducted to further corroborate the statistical findings. Instruments for data collection comprised the Approaches to Study Skills Inventory for Students, known as the ASSIST (Tait et al, 1998), Jenkins’ (1985) Clinical Decision-making Nursing Scale (CDMNS), and a short demographic questionnaire designed by the researcher. This research found that by altering the learning approach, consequent on the researchintervention, the adoption of the deep approach to learning enhanced clinical decision-making. Post-intervention findings revealed a strong positive correlation between the deep approach and clinical decision-making. Participants’ disposition for the surface approach also decreased significantly. Male participants indicated an affinity for the deep approach in comparison to female students who predominantly adopted the strategic approach. The study concluded that by cultivating students’ deeper engagement, underpinned by the intention to seek meaning and understand their learning, clinical decision-making was improved.