Clinical reasoning in experienced nurses
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.
- SourceAvailable from: Camila Takao Lopes
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ABSTRACT: Objective To propose new criteria for expert selection for validation studies in nursing in Brazil.Methods(a) Literature review on terms related to expertise and criteria for expert selection; and (b) development of new consensus criteria for expert selection and consensus building.ResultsDefinitions for the terms novice, advanced beginner, competent, proficient, and expert were found. In the second phase, criteria to rank the experts (junior, senior, and master) were developed and validated according to a score of 5–20.Conclusion and Implications for Nursing PracticeThe new criteria valued clinical experience over academic experience. The use of these criteria by researchers in the country should reduce uncertainties, difficulties, and limitations imposed by the modification/current adaptation of already existing criteria.ObjetivoPropor novos critérios para seleção de experts para estudos de validação em enfermagem no Brasil.Metodos(a) Revisão de literatura sobre termos relacionados a expertise e critérios de seleção de experts; (b) elaboração e consenso quanto a novos critérios para seleção de experts.ResultadosEncontraram-se definições para principiante, principiante avancado, competente, proficiente e perito. Foram elaborados critérios classificando os experts em júnior, master e sênior, de acordo com escore de 5 a 20.Conclusão e Implicações Para a Prática ClínicaOs novos critérios valorizaram experiência clínica sobre a acadêmica. O uso desses critérios por pesquisadores no país deve diminuir incertezas, dificuldades e limitações impostas pela modificação/adaptação de critérios já existentes.International Journal of Nursing Terminologies and Classifications 03/2015; n/a(n/a):n/a. DOI:10.1111/2047-3095.12089 · 0.90 Impact Factor
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ABSTRACT: In health-care education, it is important to assess the competencies that are essential for the professional role. To develop clinical reasoning skills is crucial for nursing practice and therefore an important learning outcome in nursing education programmes. Virtual patients (VPs) are interactive computer simulations of real-life clinical scenarios and have been suggested for use not only for learning, but also for assessment of clinical reasoning. The aim of this study was to investigate how experienced paediatric nurses reason regarding complex VP cases and how they make clinical decisions. The study was also aimed to give information about possible issues that should be assessed in clinical reasoning exams for post-graduate students in diploma specialist paediatric nursing education. The information from this study is believed to be of high value when developing scoring and grading models for a VP-based examination for the specialist diploma in paediatric nursing education. Using the think-aloud method, data were collected from 30 RNs working in Swedish paediatric departments, and child or school health-care centres. Content analysis was used to analyse the data. The results indicate that experienced nurses try to consolidate their hypotheses by seeing a pattern and judging the value of signs, symptoms, physical examinations, laboratory tests and radiology. They show high specific competence but earlier experience of similar cases was also of importance for the decision making. The nurses thought it was an innovative assessment focusing on clinical reasoning and clinical decision making. They thought it was an enjoyable way to be assessed and that all three main issues could be assessed using VPs. In conclusion, VPs seem to be a possible model for assessing the clinical reasoning process and clinical decision making, but how to score and grade such exams needs further research.Nurse education today 07/2013; DOI:10.1016/j.nedt.2013.07.010 · 1.46 Impact Factor