The information content of the nurse change of shift report: a comparative study This study examines the role which the nursing change of shift report may have in aiding nurses to process information and plan care. It also aims to identify whether any of the information found in the shift report can be considered as 'forceful feature' information, the key features of a situation which allow an individual to access appropriate knowledge within their long-term memory store. The content of the medical notes, nursing documentation and shift reports for a total of 60 patients, selected from two acute medical and two acute surgical wards across two National Health Service Hospital Trusts in south-east England were subjected to content analysis. The types and amount of information contained in each source were examined, along with the order of information given in the shift reports. A multidimensional scalogram analysis (MSA) was also carried out on the data to examine the patterns of information content across sources. In general, more information was recorded in the patients' notes than communicated during the shift report. However, both the frequency data and the MSA plots indicated that particular types of information (identified here as global judgements) were often communicated in the shift report but not recorded in the patient notes. The results suggest that there is evidence that the change of shift report contains 'forceful feature' information. The presence of such 'forceful features' may facilitate the processing of patient information during the shift report communication, leading to more efficient care planning.

This paper presents an analysis of the cognitive component of nursing assessment, complimenting the growth in knowledge of other important aspects of assessment. The purpose of the paper is to provide a framework for understanding how nurses structure assessment problems and the types of judgements they make. The thrust of the analysis is based on a comparison between nursing assessment and medical diagnosis, since the cognitive component and judgements formed in medical diagnosis have been more fully articulated. The results suggest that there may be similarities between the cognitive strategies used in nursing assessment and those used in medical diagnosis, particularly in relation to the gathering and organization of information. But the purpose of the information search appears to be different. In medical diagnosis the aim is to establish an explanation for the patient's presenting problem. In nursing assessment, on the other hand, the aim appears to be to provide an accurate picture of the patient's current condition or situation. The assessments formulated fit the definition of a judgement and, in common with medical diagnoses, include some form of prediction. Unlike the medical diagnoses, however, which usually remain stable throughout treatment, the assessments need to change as the patient's condition changes. The cognitive component of assessment has significant implications for nurse education and clinical practice. Further understanding of how nurses structure assessment problems and formulate judgements is therefore needed. The findings may also help to clarify the meaning of nursing diagnosis.

The knowledge experts have and the way it is organized is thought to affect their decision accuracy and the information they use to make decisions. This exploratory study examines the information used by experts, the way they organize their knowledge and their decision accuracy when considering treatments for pressure sores. A convenience sample of 14 subjects (seven experts and seven novices) were given a card sorting task and a decision task. The cards for the sort contained photographs of pressure sores and various dressings, which the subjects had to place into meaningful categories. In the decision task they were given a photograph of a pressure sore, together with various items of information which could be used to make a decision about the appropriate treatment for the pressure sore. The accuracy of the subjects' decisions were compared to a 'gold standard' decision formulated by an expert panel. Results indicated that experts were more accurate in their choice of treatments in the decision task, and also focused on specific items of information to make their decisions. The accuracy of their decisions was not linked to the categorization strategy used in the card sorts. The findings from this study indicate that more research into the way in which such treatment decisions are undertaken needs to be carried out. Specifically, the way in which education into wound care treatments affects decision accuracy needs to be identified, and ways of aiding individuals to focus on relevant information explored.

A systematic approach to decision making in health care is needed, so that both health professionals and patients have a means for knowing the basis of decisions about treatment.

No abstract