Article

Clinical reasoning in experienced nurses

University of San Francisco, San Francisco, California, United States
Western Journal of Nursing Research (Impact Factor: 1.38). 11/2003; 25(6):701-19; discussion 720-4. DOI: 10.1177/0193945903253092
Source: PubMed

ABSTRACT As an essential component of nursing practice, clinical reasoning is used to assimilate information, analyze data, and make decisions regarding patient care. Little is known about the reasoning strategies of experienced nurses who are not yet experts. This qualitative descriptive study explored the cognitive strategies used by experienced nurses as they considered assessment findings of assigned patients. To date, few studies of nurses' clinical reasoning have been conducted in a practice setting during actual patient care. A small group research design was employed using the think-aloud (TA) method with protocol analysis. A total of 15 experienced nurses were asked to "think aloud" about patient assessment findings. Data were audiotaped, transcribed, and analyzed using the three steps of protocol analysis. The results suggest that experienced nurses used a conceptual language to reason about assessment findings and used heuristics to reason more quickly and efficiently.

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    • "• Novice: less than two years of experience (Simmons, Lanuza, Fonteyn, Hicks, & Holm, 2003) • Advanced beginner: over two years of experience (Simmons et al., 2003) • Competent: able to decide on the matter, those with a deep knowledge on a subject, capable, expert, qualified (Weiszflog, 2010) • Proficient: an intellectual and scientific authority that can be understood as an association between theoretical knowledge and clinical practice (Lopes & Lourenco, 1998); skilled, capable, apt (Ferreira, 2010) • Expert: (Latin) peritus, those with experience, knowledgeable ; doutos, knowledgeable, skillful, practical in some science or art, very experienced or with great expertise in a given field of knowledge (Ferreira, 2010) Two studies that defined the criteria for expert selection were found: Fehring's (1994) and Benner et al.'s (1992). "
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    • "• Novice: less than two years of experience (Simmons, Lanuza, Fonteyn, Hicks, & Holm, 2003) • Advanced beginner: over two years of experience (Simmons et al., 2003) • Competent: able to decide on the matter, those with a deep knowledge on a subject, capable, expert, qualified (Weiszflog, 2010) • Proficient: an intellectual and scientific authority that can be understood as an association between theoretical knowledge and clinical practice (Lopes & Lourenco, 1998); skilled, capable, apt (Ferreira, 2010) • Expert: (Latin) peritus, those with experience, knowledgeable ; doutos, knowledgeable, skillful, practical in some science or art, very experienced or with great expertise in a given field of knowledge (Ferreira, 2010) Two studies that defined the criteria for expert selection were found: Fehring's (1994) and Benner et al.'s (1992). "
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    • "Even in medicine, experts´clinical reasoning tends to be condensed (Audétat and Laurin, 2010). The nurses in the study seemed to rely on earlier experiences and intuition, both important components for clinical reasoning (Simmons et al., 2003). Cook and Triola (2009) determined that for the exam it is not only an accurate diagnosis that is important, but also the steps that are taken to get there. "
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