Liz Ditzel

901 – Teaching clinical reasoning: the ‘klinky’ box activity


In this presentation I will demonstrate how I use two teaching tools; a set of small wooden boxes that cannot be opened but make a ‘klinky’ sound when moved; and a children’s picture storybook called The Box to teach first-year nurses clinical reasoning and reflective thinking skills.
First, students are placed in small groups and each presented with a box. Using only observational skills, they are asked to infer and list the box’s contents. Second, I read aloud a children’s story and ask students to reconsider the contents of the box, given the reading. Third, I invite students to examine the box through touch and sound and reach a consensus about its contents using this information. They then draw a picture of what they have agreed is in the box.

I debrief this activity by using Tanner’s conceptualisation of ‘thinking like a nurse’ and a four-stage process following the steps of the clinical reasoning cycle. We conclude by discussing how the skills used in this activity can be applied to a nursing context that requires evaluation and judgment. I also explore how this activity can be adapted and used in a variety of problem-solving contexts.

This hands-on, ‘device-free’ activity enables educators to do something different, engaging student curiosity and interest. The simple task of evaluating the contents of the box requires patience, collaboration and challenges to those wanting instant answers.
Clinical reasoning, reflective thinking.

Key words: Nurse education; clinical reasoning; reflective thinking.