Indiana University-Purdue University Indianapolis (IUPUI) / A quasi-experimental design was undertaken to explore the possibility of utilizing electrodermal activity as a marker of intuitive decision making in nursing. This study compared 11 senior female nursing students to 10 female nurses with more than five years of nursing experience completing a clinical decision making task utilizing MicroSim© program software while measuring skin conductance response (SCR). The clinical decision making task chosen was based on the cognitive continuum theory. The somatic marker hypothesis is also a theoretical base for this study. This theory suggests that physiological markers are present during decision making. An independent t-test was conducted in SPSS comparing the total number of skin conductance responses generated and overall score in the card task and clinical scenario between the two groups. According to the Somatic Marker Hypothesis, the researcher’s definition of intuition, and the results of this experiment, SCR generation shows promise as a marker of intuitive decision making in nursing.

D.Cur. / With the dawn of the new democratic dispensation in South Africa, numerous structural changes in the form of new legislation on health care were introduced by government. The purpose hereof is to transform health care delivery in order to bring about equality, accessibility, availability and applicability of health care to the citizens of South Africa. However, such changes have given rise to rationalization and the restructuring of health care services and health care personnel. Against the background of the so-called brain drain of health care personnel, it possibly contributed to a situation where numerous health care services find themselves with a shortage of expert human and material resources. These changes have influenced the quality of decisionmaking in health care services in general, and nursing in particular. Furthermore, based on an investigation of disciplinary case studies of the SANe, it appears that there is an increase in the number of disciplinary cases against nurses. These disciplinary cases reflect the nature of the decisions made by nurses. From these disciplinary case studies, it appears that decision-making by nurses do not comply with the reasonable expectations as stipulated in the legal-ethical framework of the nursing profession. Furthermore, it appears that decisions made by nurses in order to promote the health of the individual, group and/or community, are unsafe, ineffective and unacceptable in terms of the reasonable expectations as stipulated in the legal-ethical framework of the nursing profession. It can be concluded, that decision-making by these nurses no longer complies with the regulation in terms of the Nursing Act (Act 50 of 1978, as ammended), namely to deliver safe nursing to the citizens of South Africa. As a possible solution to the aforementioned problem, the researcher sees the description of a system for quality decision-making as being necessary in nursing. This goal can be achieved by the following objectives: the exploration and description of the expectations of the stakeholders with regard to quality decision-making in nursing, the integration of these expectations during iv the conceptualization of quality decision-making in nursing, as well as the formulation of standards for quality decision-making in nursing.Based on a qualitative, explorative, descriptive and standard-generation design, the study was conducted in four phases to achieve the objectives of the study. During the first phase, the expectations ofthe stakeholders with regard to quality decision-making in nursing were explored and described. In phase two, the identified themes on quality decision-making were conceptualized. In phase three standards for quality decision-making in nursing were formulated through inductive and deductive reasoning from the results of the previous two phases. In phase four a system for quality decision-making in nursing was described based on a theoretical foundation of the systems theory.

Thesis (Ed.D)--Teachers College, Columbia University. / Typescript; issued also on microfilm. Sponsor: M. Frances Frazier. Dissertation Committee: Mary T. Ramshorn. Includes tables. Includes bibliographical references.

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Many researchers have failed to find a relationship between experience and judgment accuracy. In this study the purpose was to understand the relationship between experience and expertise in clinical judgment. Common sense suggests that experienced subjects make better quality judgments, compared to novices. Clinical judgments, however, are ill-structured and characterized by uncertainty; they take place in a dynamic context, with delayed or nonexistent feedback and are difficult to learn. Cognitive operations that translate "cues" (such as risk factors, signs, and symptoms) into judgments are not fully understood. Cognitive constructs (conceptual structure, sensitivity to patterns in data, and judgment process) and individual differences in age, education, and experience were explored to identify their relationship to judgment expertise. Indicators of judgment quality were: accuracy, consistency, latency, confidence, calibration, and knowledge accessibility. In phase 1 of this study, cues were identified that best predicted healing time for 258 surgical patients with abdominal incisions. In Phase 2, the subjects were 36 nurses with a range of experience caring for surgical patients. Generating both quantitative and qualitative data, subjects made judgments about incisional healing on the basis of information from actual patients. Multidimensional scaling was used to reveal conceptual structure, and lens modeling was applied to assess sensitivity to broad patterns. An information board task with think-aloud protocols demonstrated judgment process. The selection of tasks was based on their analysis- or intuition-inducing features, using K. R. Hammond's (1990) cognitive continuum theory. Experience accounted for a only a small proportion of variance in performance, whereas confidence in judgment was more strongly related to experience. Taken together, these findings replicated previous research. Protocol data showed that metacognition, knowledge accessibility, and reflectivity increased with experience. Conceptual structure predicted judgment accuracy under intuitive conditions. Support was found for Dreyfus and Dreyfus' (1986) hypothesized transition in cognition, from deliberate processing of discrete cues, to intuitive processing of patterns of cues encoded in memories for specific cases. This study has theoretical significance by adding to knowledge about clinical judgment, and by increasing understanding of cognitive changes associated with expertise. This study has practical significance in providing direction for the development of teaching methods aimed to increase learning from experience in probabilistic contexts.

Clinical decision making is essential to clinical practice, yet research into the cognitive processes underlying clinical decision making is limited. The purpose of this study was to investigate the cognitive processes utilized by nurses in actual clinical decision making situations. Using a criterion sampling technique, eight experienced medical and surgical nurses from an acute care community hospital were selected as participants for in-depth interviews about clinical decision making in nursing practice. Actual clinical data documented by the eight nurses were obtained from a review of 100 randomly selected hospital records of patients discharged over a one year period. The study examined the influence of contextual factors (nursing subgroup, Problem Oriented Recording [POR] charting system and primary nursing system), task variables (complexity of clinical problems), and clinician characteristics (nursing expertise) on clinical decision making. The dependent variables included the accuracy of nursing diagnosis documentation and the utilization of specific thinking processes. Donald's model of thinking processes provided a framework for the analysis of the data. / The results suggest that clinical decision making is a complex cognitive process requiring numerous thinking skills and operations. Five different categories of thinking skills and 14 different operations were identified in the narrative notes. The clinical situations were categorized into three types based on the complexity of clinical problems. Nurses from both hospital units documented a wider range of thinking skills and operations in situations of greater complexity. The findings also suggest that structured charting formats such as SOAP narrative notes encouraged the use of higher order thinking processes. The introduction of the primary nursing patient assignment system did not result in significant changes in the documentation of nursing diagnoses or thinking processes utilized by nurses. The nurses were grouped into two levels of expertise according to Benner's categories: expert and proficient, with differences more evident in the medical nurses. An important outcome of this study was the development of nursing exemplars and illustrations of thinking processes that can provide a working vocabulary to describe the underlying cognitive processes used in clinical decision making.

Report (Ed. D.)--Teachers College. / Issued also on microfilm. Includes bibliographical references.

Report (Ed. D.)--Teachers College. / Issued also on microfilm. Includes bibliographical references.

Thesis (D.N. Sc.)--Catholic University of America. / Typescript. Bibliography: leaves 109-113.