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.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:QMM.34733 |
| Date | January 1997 |
| Creators | Higuchi, Kathryn A. Smith. |
| Contributors | Donald, Janet G. (advisor) |
| Publisher | McGill University |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | English |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Format | application/pdf |
| Coverage | Doctor of Philosophy (Department of Educational and Counselling Psychology.) |
| Rights | All items in eScholarship@McGill are protected by copyright with all rights reserved unless otherwise indicated. |
| Relation | alephsysno: 001617048, proquestno: NQ44452, Theses scanned by UMI/ProQuest. |
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