Background:
New graduate nurses (NGN) in critical care require to develop constantly a strong clinical reasoning in context of uncertainty and ambiguity. The Learning-by-Concordance (LbC) tool is an innovative and online educational modality. The LbC involves using authentic clinical situations, mirroring elements of uncertainty and incompleteness of clinical practice, along with a series of possible hypotheses that learners must reflect upon. Then, online automated feedback is provided to learners, which includes nursing experts' reasoning. Relatively new in nursing education program, we design a LbC tool to trigger NGN’ clinical reasoning in critical care.

The aim was to design an online and synchronous LbC tool to support the integration of NGN in critical care.

Methods:
We use a collaborative participatory approach with nurse educators (n=3), preceptors (n=5) and NGN (n=2) to design a LbC tool. Then, five qualified nurses in critical care were asked to act as experts in the LbC tool.

Results:
With the collaboration of NGN, we identify clinical situations (n=3) that represented challenges in intensive care, i.e., clinical assessment and monitoring using specific devices with an intubated patient, interventions in a context of neurological deterioration and dealing with cardiac instability. We incorporated these situations in clinical vignettes in the format of the LbC tool in the Wooclap web platform. The vignettes were then validated by three nurse educators. Finally, five qualified nurses, also preceptors in critical care, were asked to act as experts, by answering each vignette.

Conclusion:
Our collaborative approach allowed the design of an LbC tool targeted nursing clinical reasoning in critical care. Subsequently, we implemented the use of the online LbC tool synchronously with NGN (n=7). The NGN were encouraged to answer each question and explain aloud their clinical reasoning. Then, the experts' responses were shown as feedback to encourage discussion. Overall, the NGN appreciated the LbC tool, especially the varied and formative feedback of experts to situations related to professional life.

Keywords: Critical care, clinical reasoning, decision-making, nursing education, script concordance, uncertainty.