Mediation in learning clinical nursing reasoning to limit errors of judgment

Stéphanie HOYELLE-PIERRE, Doctor, CY Cergy Paris Université, BONHEURS Laboratory, France

The clinical nursing approach is an active, continuous and evolving intellectual process that structures and organizes the steps necessary to identify the diagnosis of a patient's situation in order to implement appropriate and individualized care. Our brain, contrary to what Jean Piaget thought, is not as logical as he thought, it is even illogical. We have two systems of thought that take turns, complementing each other and causing our errors of judgement, which are often the product of heuristics: system 1 ("automatic" and intuitive thinking, unreliable, but very fast) and system 2 ("logical-mathematical" reflective thinking, more reliable, but less fast) developed by Daniel Kahnemann. However, there is a way to favour this analytical thinking and thus to short-circuit the intuitive thinking, thanks to an arbitration system that is the inhibition system developed by Olivier Houdé. The goal would be to teach students to use this inhibition system by becoming aware of their own clinical reasoning, to make it visible by making it conscious. Simulation-based teaching allows the debriefing to verbalize and raise awareness of the clinical reasoning process of nursing students and thus work on the identification of reasoning biases. In the context of promoting patient safety, while respecting the realism of a situation as close as possible to the patient, the use of a high-fidelity mannequin during tutorials on clinical reasoning makes it possible to work on the quality, relevance and efficiency of nursing clinical reasoning and thus limit the occurrence of errors of judgement that can lead to errors in patient care.