The two studies described here address the question of how District Nurses determine patients' nursing problems and plan care. The theoretical framework for the investigation is derived from Information Processing Theory. A process tracing methodology was used to capture the content of District Nurses' thinking during an assessment visit to a newly referred patient. Data was collected in the natural setting to ensure ecological validity. The assessment visits were tape recorded and immediately following the visit a stimulated recall session was conducted in which the nurse was asked to describe her thinking during the assessment, prompted by the tape recording. This session was itself tape-recorded. Thus two verbal protocols were elicited for each assessment: a visit protocol and a recall protocol. Data were analysed by content analysis. The verbal protocols were assessed to ensure that they met the criteria for validity and reliability of the coding schedules was established using two measures or interrater reliability. The first study sought evidence of hypothetico-deductive reasoning by nurses and describes the type of decisions made by nurses. Although evidence of hypothesis generation and testing was found, nurses' knowledge was found to determine how they interpreted data initially and what data they sought. It was therefore concluded that a model of diagnostic reasoning that focused on cognitive processes alone was insufficient to explain the dynamics of clinical problem solving. The second study, therefore, sought to establish the structure and content of District Nurses knowledge and the cognitive processes they used during an assessment. The results suggest that nurses attend to both clinical and personal phenomena in order to make a judgement about the state of the patient and that their knowledge is organised internally as schema. This provides an explanation of how nurses recognise salient information and determine what further data is required. Four key cognitive activities were identified: search, inference, action and plan. The study concludes by drawing a line of reasoning to show how nurses integrate knowledge and reasoning processes to accomplish clinical problem solving.

published_or_final_version / Psychology / Master / Master of Philosophy

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The purpose of this study was to develop, implement, and evaluate a comprehensive interpersonal problem solving training program with four and five year old children. The goal of the program was to teach children the necessary skills to successfully resolve problems with their peers. The interpersonal problem solving training program consisted of the following core components: language, perception, problem identification, empathy, alternative generation, consequential thinking, and integration. The sample consisted of 46 children, 23 children in the experimental group and 23 children in the control group. Both experimental and control group subjects met for ten weeks (15-20 minutes a day) with trained graduate students. Control group subjects participated in reading story sessions while experimental group subjects participated in the interpersonal problem solving training sessions. Experimental and control group subjects were assessed at pretest and posttest on two measures. The BPIPS (a behavioral assessment of interpersonal problem solving ability) and the BOS (a behavioral observation scale). Analysis of variance of gain scores demonstrated significant differences between experimental group subjects and control group subjects on: (a) ability to generate solutions in interpersonal problem solving situations and (b) frequency of positive verbal and nonverbal interaction with peers. Analysis of variance of gain scores indicated no significant differences between experimental and control groups on: (a) the frequency of positive interactions with adults or (b) the frequency of negative interactions with either peers or adults. Discussion focused on the measured and observed results from training in the interpersonal problem solving program, possible explanations for insignificant differences relative to adult interactions, and program generalizability.

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