Iran Journal of Nursing

Introduction
Clinical reasoning is the logical process of collecting cues, understanding of a patient's problems or situation, planning and implementing interventions, evaluating outcomes and reflect on the care process. Nursing is a dynamic and practical profession that is involved in caring for patients with different conditions; therefore, not only clinical reasoning, but also innovation is important in nurses. Innovation is a kind of thinking that leads to new perspectives, emerging approaches and new methods to understand concepts and situations. Innovation in nursing means the transformation of ideas into new methods and solutions in patient care, which ultimately leads to the improvement of the quality of care.  Nurses are expected to have the skill of clinical reasoning in order to use their science and show the art of care with their innovation. This issue is more important in the emergency departments, where patients with unstable clinical conditions require nurses with appropriate decision-making ability and high thinking skills. This study aims to determine clinical reasoning level and its relationship with innovation in nurses working in the emergency departments of hospitals in Tabriz, Iran.

Method
This descriptive-correlational study was conducted in 2021 on 180 nurses working in the emergency departments of hospitals affiliated to Tabriz University of Medical Sciences. The sampling was done using a stratified random sampling method. To collect data, a sociodemographic form, Liou’s nurse clinical reasoning scale (NCRS), and the Hurt-Joseph-Cook innovativeness scale. The data analysis was done using descriptive and inferential statistics. The data distribution was normal. Thus, independent t-test, analysis of variance, and Pearson correlation test were used to analyze data in SPSS software, version 26. Multivariate regression analysis was used to find the predictors of clinical reasoning including innovation and sociodemographic factors. 

Results
Ten questionnaires were excluded due to incompleteness. Therefore, the data of 170 questionnaires were analyzed. The mean age and work experience of nurses were 34.54±6.97 and 9.91±6.41 years, respectively. Their mean experience of working in the emergency departments and the number of work shifts per week were 6.29±4.85 years (ranged 1-26) and 6.1±1.32 (ranged 1-12), respectively. The mean score of clinical reasoning and innovation were 60.91±7.079 (ranged 34-75) and 102.11±10.26 (ranged 72-135), respectively.
According to the findings, innovation had a positive and significant relationship with the fixed morning shift (P=0.002), and clinical reasoning had a positive and significant relationship with the history of attending clinical reasoning classes (P=0.028). Multivariate linear regression analysis showed that, after adjusting the effect of confounders, for every one unit increase in clinical reasoning, innovation increased significantly by 0.35 units.

Conclusion
The clinical reasoning and innovation in nurses working in the emergency departments of hospitals in Tabriz are not at a favorable level. The relationship between clinical reasoning and innovation in nurses working in the emergency departments of hospitals is statistically significant. It is recommended that the authorities provide the conditions to strengthen and improve these two important concepts in nurses and evaluate the outcomes. Nursing professors should provide the ground for learning and strengthening these two important concepts in nursing students.

Ethical Considerations
Compliance with ethical guidelines
This research has ethical approval from the Ethics Committee of Tabriz University of Medical Sciences (Code: IR.TBZMED.REC.1400.607). Informed consent was obtained from all participants.

Funding
This study was funded by Tabriz University of Medical science.

Authors' contributions
Study design: Elnaz Asghari; Data collection: Amir Saberi Kajabadi; Data analysis: Parvin Sarbakhsh; Supervision: Faranak Jabarzade; Writing: Elnaz Asghari, Amir Saberi Kajabadi and Faranak Jabarzade; Final approval: All authors.

Conflict of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank all the nurses who participated in this study, the personnel of the charity organization for cardiac and cancer patients belonged to Shahid Madani Heart Hospital in Tabriz for their spiritual support, and the research committee of Sina Hospital in Tabriz for facilitating the sampling process.

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