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. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

An experimental study was undertaken to answer the question posed by the problem: "Does a nursing intervention which utilizes a decisionmaking model to assist patients in establishing personal goals for adherence to fluid and potassium restrictions significantly decrease weight gains between dialyses and pre-dialysis serum potassium levels, compared with the values for these variables in a control group which does not have the intervention?" Sixteen chronic hemodialysis patients from one large teaching hospital were selected according to pre-established criteria, and then randomly assigned to either experimental or control conditions. The Experimental group was exposed to the nursing intervention, which was the independent variable. The nursing intervention consisted of an initial interview, during which the patients completed a Balance Sheet Procedure, and established personal goals for weight gain between dialyses and pre-dialysis serum potassium levels. Thereafter, for a period of five weeks, the patients in the Experimental group completed a Well-Being Rating Scale at each dialysis and charted their progress toward their goals on a Progress Sheet. The dependent variables were between dialyses weight gains and pre-dialysis serum potassium levels. Data Pertaining to the dependent variables were collected on both Experimental and Control patients in all three phases of the study: the six month Pre-Intervention Phase, the five week Intervention Phase, and the three week Follow-Up Phase. The Theoretical Framework on which the study was based is Jam's and Mann's Conflict Theory (1968), and their Balance Sheet Procedure, which was used to facilitate personal decision-making and goal setting by patients in relation to between dialyses weight gains and pre-dialysis serum potassium levels. The results indicated that the Experimental group obtained significantly lower pre-dialysis serum potassium levels during the Intervention Phase than the Control group, but there were no significant differences between the two groups in weight gains between dialyses. The Well-Being Rating Scales completed by the Experimental patients indicated that well-being tended to increase slightly over the study period, and was significantly related to the achievement of the goals the patient had established for weight gains and potassium levels. A negative correlation was found between well-being and weight gain. The implications of these findings for the nursing care of hemodialysis patients are discussed, and recommendations for further research are presented. / Applied Science, Faculty of / Nursing, School of / Graduate

Interest in developing critical thinking skills in nursing students has grown in proportion to the demand for thoughtful, capable nursing professionals in healthcare. The National League for Nursing has required schools of nursing to combine teaching styles and course content to develop critical thinking, decision making, and independent judgement. Limited research has been done regarding the relationship of critical thinking ability to clinical decision-making. The purpose of this study was to determine the relationship between these two variables, using a sample of senior baccalaureate students in four schools of nursing.Two research questions were addressed: What is the relationship between critical thinking and clinical decision-making of senior baccalaureate nursing students? and, what is the relationship between selected demographic variables and critical thinking and clinical decision-making in senior baccalaureate nursing students?McPeck's (1981, 1990) critical thinking theory, which guided the study, emphasizes consideration of multiple factors in reaching a decision, toleration of differing conclusions, and the importance of teaching and evaluating critical thinking within the context of a discipline. Critical thinking was measured by the California Critical Thinking Skills Test (CCTST, Facione, 1993), a standardized, 34-item, multiple choice test which targets critical thinking skills. Test items are designed to be discipline-neutral and jargon-free, and have a Kuder-Richardson internal reliability coefficient of .70. Judgement in making clinical decisions was measured by the Nursing Performance Simulation Instrument (NPSI, Gover, 1970), which is composed of four simulations that depict typical nursing situations and test problem-solving proficiency. Six-month test-retest reliability of the NPSI was found to be r=.63. Demographic information on age, gender, GPA, number of completed college credit hours, healthcare work experience, healthcare licensure was collected from subjects.The sample included senior baccalaureate nursing students from four universities (N=88). Nursing faculty at each site was contacted before testing for approval to administer the exam to students. Informed consent was obtained from each subject, and students were able to withdraw from the study at any time. Verbal instructions were given to subjects, and confidentiality was insured by the use of a number identifier on each test. The instruments were administered by, and remained in, the possession of the researcher. Results obtained were reported to test sites as group data only. No risks or benefits were identified in participation in the study.Data analysis was done by a combination of methods, using Pearson product-moment analysis, t-test procedures, and canonical correlation. Results indicated that no relationship existed between critical thinking and clinical decision-making, as measured by the CCTST and the NPSI. The only statistically significant relationship was a weak positive correlation between age and performance on the NPSI. Canonical correlation analysis indicated the older subjects, with a lower GPA and, to a lesser extent, fewer credit hours tended to score higher on the NPSI and lower on the CCTST.The study was significant, in that the results will broaden the knowledge of the relationship between critical thinking and clinical decision-making in nursing. / School of Nursing

Using an information processing approach, this study examines how nurses working in the area of continuing care for older people in Scotland use the Waterlow scale to inform their judgement and decision making in risk of pressure ulcers and plan of care. While assessment tools are commonly used, a number of assumptions surround their use for nurse practice and for patient care. To date, there appears to be no research which actually examines how nurses use assessment tools to assess patient's needs and plan care, despite the emphasis placed on evidence based practice. Assessment is a fundamental activity when caring for an older person where multipathology and the potential for health state deterioration are likely. This study consists of 3 parts. Part 1 identified the number and type of assessment tools that are routinely used within continuing care settings using a postal survey, revealing that the Waterlow scale is the most routinely used tool to assess pressure ulcer risk. Part 2 examined how continuing care nurses assess pressure ulcer risk through the use of observation and interview. Part 3 involved a detailed examination of the cognitive processes used by nurses when assessing pressure ulcer risk and planning care using simulation and a technique known as `Think aloud'. The results of this study indicate there were no differences between continuing care nurses working in either hospital wards or nursing homes in how the assessment was carried out, as neither group based their assessment or plan of care solely on the Waterlow scale. However, the Waterlow scale was found to be used differently according to the nurses' experience with those with more than 2 years experience, less likely to base their assessment of pressure ulcer risk or plan of care on Waterlow derived information.

Critical care nurses need finely honed critical thinking skills in order to be safe, competent, and skillful practitioners of their profession. If clinical nurses do not learn how to reason effectively, they may make inappropriate decisions about their patients' care, ultimately resulting in increased patient mortality (Fonteyn, 1991). In addition, increasing nurses' decision-making and autonomy has been shown to improve job satisfaction and retention (Prescott, 1986).There are many authors who write about the need for developing critical thinking skills among practicing professional nurses (Creighton, 1984; Jenkins, 1985; Levenstein, 1981, 1983, 1984). However, research assessing the impact of continued education and clinical experience on the development of critical thinking skills is sparse.The purpose of this exploratory study is to determine if there is a relationship between the level of critical thinking skills (as measured by the Watson-Glaser Critical Thinking Appraisal Tool, 1980) in critical care nurses and the length of nursing experience, amount of continuing education pursued annually, and the level of formal nursing education completed. The conceptual framework that provides the basis for this study is Patricia Benner's (1984) application of the Dreyfus Model of Skill Acquisition to clinical nursing practice.Participants (N = 61) were obtained on a voluntary basis from the population of critical care nurses working in the intensive Care Unit, Coronary Care Unit, Cardiac Catheterization Laboratory, or Emergency Care Center of a 600 bed midwestern acute care facility. Each participant in the study was asked to sign an informed consent agreeing to participate after receiving a written and oral explanation of the study. Confidentiality of the participants was maintained by substituting identification numbers for the subjects' names on the data collection instruments. The investigator supervised the administration of the critical thinking instrument and demographic questionnaire.The Pearson product-moment correlation coefficient and a two-tailed t-test for independent samples were used to determine if there were any significant relationships between the WGCTA score and the length of critical care experience, attendance of continuing education programs, or completion of additional formal education. This data analysis supported hypothesis one with the results revealing a significant positive correlation (r = .46, p = <.001) between the WGCTA scores and the length of critical care experience. In addition, a statistically significant but weak positive correlation was found between the WGCTA scores and the length of experience in CCU (r = .52, p = .001). No significant correlation existed between the WGCTA scores and length of experience in ECC, ICU, or CCL. Hypothesis two was supported with a significant difference (t = 3.58, df = 59, p = .001) found between the critical thinking ability of the two groups, with those who have completed an additional formal program of nursing education scoring higher. A significant but weak positive correlation (r = .30, p =.020) was found between the number of continuing education programs attended annually and the WGCTA scores. Multiple regression was performed with the total WGCTA score being the dependent variable and total critical care experience, completion of additional formal education, and attendance of continuing education programs being the independent variables. Only total critical care experience entered the equation (E = 16.03, p = <.001) explaining 21% of the variance.The information gained from this study will provide direction for the review of existing orientation, continuing education, and staff development programs provided at different levels of nursing experience and make suggestions for change to enhance critical thinking skill development. / School of Nursing

Thesis (Ed.D.) -- Teachers College, Columbia University, 1991. / Typescript; issued also on microfilm. Sponsor: Thomas A. Leemon. Dissertation Committee: Mary Mowrey-Raddock. Includes bibliographical references: (leaves 119-141).

Globalization has opened international borders thereby creating a culturally diverse healthcare environment worldwide. Skills necessary to manage this diverse group extend beyond technical knowledge, expertise or excellent leadership skills. This study sought to determine the role of Emotional Intelligence (EI) in leading a diverse nursing team. A Quantitative, exploratory and descriptive design was applied, using a questionnaire as data collection instrument, to collect data from 390 nurses working in a large training hospital in the United Arab Emirates. The aim was to ascertain subordinates’ views of their nurse managers’ personal competence (self-awareness and self-management skills), and social competencies (social awareness and relationship management skills). The results indicated that the majority of respondents considered their leaders to be effective and emotionally competent. A significant relationship was found between effective leadership and the nurse manager’s self-confidence, self control, empathetic skills and culturally sensitive communication. An in-service training programme was developed and recommended for the further development of emotional intelligence in all nursing managers at this hospital. / Health Studies / M.A. (Health Studies)

The purpose of this study was to determine the extent to which Neonatal Intensive Care Unit (NICU) nurses participate in ethical decision making, and to describe the role NICU nurses have in the ethical decision making process.This study replicated a 1991 study conducted by Elizondo. According to Lowe, 1991, replication research is the repeating of a study for the purposes of validating the findings of the original investigation. The traditional theory of utilitarianism provides the theoretical framework for this study, a goal-based approach to ethical decison making that focuses on consequences of actions. Findings provide information about satisfaction and conflicts related to nurse participation in ethical deecision making in the NICU.The Nurse Participation in Ethical Decision Making (NPEDM) questionnaire (Elizondo, 1991) was used for data collection. Of fifty NICU nurses, seventeen (34%) of the sample completed the questionnaire. Confidentiality was maintained. Results showed that all respondents were able to identify methods that are used for participation in ethical decision making. Informal conversations with physicians was identified as the primary method of participation. Forty-one percent of respondents were satisfied with the nurse's role in ethical decision making. Forty-seven percent were only somewhat satisfied.An indication of satisfaction demonstrated by 100% of the study sample was that nurses' ideas are respected by other health care professionals.Findings indicated that a significant positive relationship exists between role satisfaction and study variables. Eighty-eight percent of respondents stated that conflicts related to participation were experienced. Overwhelmingly, respondents felt that the primary source of conflicts were with physicians. These findings are consistent with results reported in the original study.When asked what factors impact on how decisions are made, 40% of respondents indicated that ethical decisions are often impacted by generalized decisions based on viability of the neonate as determined by the gestational age, and "quality of life."Seventy-six percent of respondents believed nurses should be more involved in the ethical decision making. Conferences with physicians and parents was identified by 69% of the study sample. This study found that the older the nurse, the more satisfied with role in the ethical decison making process. Length of employment also contributed positively to satisfaction in ethical decision making. The more educated the nurse, the more satisfied with role in the ethical decision making process. Nurses were less satisfied if conflicts were experienced or identified.Findings suggest that collaborative relationships exist between nurses and other health team members and that nurses feel some sense of fulfillment with their role in the ethical decision making process. It was concluded that many issues were unsolved and need to be discussed. / School of Nursing

Within the current context of the healthcare environment, the charge nurse role has become very important for safety and positive outcomes. There is little known about the role from the perspective of the charge nurse. This qualitative descriptive exploratory study examined the experience of being a charge nurse in acute care practice, and describes how charge nurses live caring in their support of nurses and patients. Ray's (1989, 2006) theory of Bureaucratic Caring, Swanson's (2008) caring attributes and leadership, and Boykin and Schoenhofer's (2001) theory of Nursing as Caring provided the theoretical lenses through which study findings were viewed. Semi-structured interviews were conducted with 20 charge nurses in 4 acute care facilities. Eight themes emerged from an inductive analysis of the data describing the experience of being a charge nurse in acute care practice: Creating a Safety Net, Monitoring for Quality, Showing the Way, Completing the Puzzle, Managing the Flow, Mak ing a Difference, Putting Out Fires, and Keeping Patients Happy. Participants also were asked questions about how they provide support to staff nurses and patients. Themes that reflected how charge nurses live caring in their support of staff and patients were: Jumping in the Trenches, Nurturing Staff Growth, Offering Authentic Presence, and Looking after Nurses. Additionally, the researcher used methods of narrative inquiry to get the participants to share stories of how they lived caring in their support of nurses and patients. Recommendations included the need to elevate the visibility of the charge nurse role and its importance to the organization, and provide support for leadership development. Job descriptions and competencies for charge nurses must reflect the complexity of the environment. / Charge nurse participants did not dialogue explicitly about their functions in terms of communication and intraprofessional team building. Since charge nurses have an increasing involvement with mentoring novice nurses and new staff, they would benefit from developing coaching skills. Given the current environment, their responsibilities in these areas may need to be better articulated so that they can focus on increasing these abilities. / by Terry L. Eggenberger. / Signature page missing one signature and the date. / Thesis (Ph.D.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.

The purpose of this study was to determine the relationships between the nurses' decision making model, frequency of Rapid Response Team (RRT) activation, and the nurse's skill at the early recognition of clinical deterioration. A descriptive, cross sectional quantitative design was used. The participants in this study were 167 acute care registered nurses who had activated the RRT at least once in the preceding 12 months. The participants first were asked to recall a time when they had made the decision to activate the RRT and then were asked to complete the instruments used in this study. Using the Nurse Decision-Making Instrument, the participant's decision making model then was categorized as analytic, intuitive, or mixed. The skill at early recognition of clinical deterioration was measured with the Manifestations of Early Recognition Instrument. Participant scores on the two instruments were significantly correlated with each other as well as to their frequency of RRT activation over the preceding 12 months. The findings of this study indicated that nurses who used analytical decision making activated the RRT with greater frequency than either the intuitive or mixed decision makers. In addition, registered nurses who used analytical decision making to activate the RRT tended to have higher levels of skill in the early recognition of clinical deterioration, as measured by the MER, than either the intuitive or mixed decision makers. Another finding of this study was that RNs with higher levels of skill in the early recognition of clinical deterioration tended to activate the RRT more frequently than RNs with lower levels of this skill. The implications of this study are that the use of analytical decision making may result in more frequent activation of the RRT. / Increased frequency of RRT activation has been linked in the literature with decreased patient mortality rates. The significance of the findings from this study is that the use of analytic decision making has the potential to reduce the incidence of the number one patient safety indicator, failure to rescue. / by Carlo G. Parker. / Thesis (Ph.D.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.