Experienced and Less‐Experienced Nurses Diagnostic Reasoning: Implications for Fostering Students' Critical Thinking

Ferrario, Catherine G.

doi:10.1111/j.1744-618x.2003.tb00059.x

Cited by 25 publications

(19 citation statements)

References 27 publications

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“…However, other studies show that experts do not use hypothetico-deductive process of reasoning (Patel et al 2001c). It has further been shown that experienced nurses in medical-surgical units use heuristics rather than guidelines to rapidly and accurately form initial impressions of new patients (Simmons et al 2003;Ferrario 2003). Similar effects take hold in triage, where it has been recognized that less experienced nurses look for textbook signs and symptoms to reach their diagnosis, whereas more experienced nurses base their decision on specific pieces of information provided by the patient as well as their past experiences (Cioffi 1998).…”

Section: Nurse Factorsmentioning

confidence: 93%

“…Research has shown that experienced nurses make decisions more efficiently than less experienced nurses (e.g., Marsden 1998;Ferrario 2003). In triage, experienced nurses are able to quickly determine the most appropriate triage category whereas the inexperienced nurses take their time individually assessing every piece of data, not knowing what the optimal triage category will be until the very last step of their evaluation; an inherently less efficient process.…”

Section: Triage Nursing Training and Educationmentioning

confidence: 98%

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Calibrating urgency: triage decision-making in a pediatric emergency department

Patel

Gutnik

Karlin

et al. 2007

Adv in Health Sci Educ

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Triage, the first step in the assessment of emergency department patients, occurs in a highly dynamic environment that functions under constraints of time, physical space, and patient needs that may exceed available resources. Through triage, patients are placed into one of a limited number of categories using a subset of diagnostic information. To facilitate this task and standardize the triage decision process, triage guidelines have been implemented. However, these protocols are interpreted differently by highly experienced (expert) nurses and less experienced (novice) nurses. This study investigates the process of triage; the factors that influence triage decision-making, and how the guidelines are used in the process. Using observations and semi-structured interviews of triage nurses, data was collected in the pediatric emergency department of a large Canadian teaching hospital. Results show that in emergency situations (1) triage decisions were often non-analytic and based on intuition, particularly with increasing expertise, and (2) guidelines were used differently by nurses during the triage process. These results suggest that explicit guideline information becomes internalized and implicitly used in emergency triage practice as nurses gain experience. Implications of these results for nursing education and training, and guideline development for emergency care are discussed.

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Section: Nurse Factorsmentioning

confidence: 93%

Section: Triage Nursing Training and Educationmentioning

confidence: 98%

Calibrating urgency: triage decision-making in a pediatric emergency department

Patel

Gutnik

Karlin

et al. 2007

Adv in Health Sci Educ

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“…In addition, the possibilities within human behavior and ways to help people improve their health are so numerous for nurses (1,147 concepts) that nurses are not likely to recall the most appropriate concepts. The availability of SNLs decreases nurses' cognitive demand (Ferrario, 2003) and makes it possible to select the terms that best apply in a particular situation so that high quality care can be achieved and communicated.…”

Section: Improved Quality and Patient Safetymentioning

confidence: 99%

Standardized Nursing Languages Essential for the Nursing Workforce

Jones¹,

Lunney²,

Keenan³

et al. 2010

Annu Rev Nurs Res

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The evolution of standardized nursing languages (SNLs) has been occurring for more than four decades. The importance of this work continues to be acknowledged as an effective strategy to delineate professional nursing practice. In today's health care environment, the demand to deliver cost-effective, safe, quality patient care is an essential mandate embedded in all health reform policies. Communicating the contributions of professional nursing practice to other nurses, health providers, and other members of the health care team requires the articulation of nursing's focus of concern and responses to these concerns to improve patient outcomes. The visibility of the electronic health record (EHR) in practice settings has accelerated the need for nursing to communicate its practice within the structure of the electronic format. The integration of SNLs into the patient record offers nurses an opportunity to describe the focus of their practice through the identification of nursing diagnosis, interventions and outcomes (IOM, 2010). Continued development, testing, and refinement of SNLs offers nursing an accurate and reliable way to use data elements across populations and settings to communicate nursing practice, enable nursing administrators and leaders in health care to delineate needed resources, cost out nursing care with greater precision, and design new models of care that reflect nurse-patient ratios and patient acuity that are data driven (Pesut & Herman, 1998). The continued use of nursing languages and acceleration of nursing research using this data can provide the needed evidence to help link nursing knowledge to evidence-driven, cost-effective, quality outcomes that more accurately reflect nursing's impact on patient care as well as the health care system of which they are a part. The evaluation of research to support the development, use, and continued refinement of nursing language is critical to research and the transformation of patient care by nurses on a global level.

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“…The standout concept stemming from all of the literature on remote robotics in health care [25,28,29] is that the technology has great potential in improving the clinical reasoning skills of health-care professionals allowing the clinician to practice a task and skill in a risk free environment, developing confidence and building competence [17,30,31].…”

Section: B Nursing and Ralmentioning

confidence: 99%

Enhancing Nursing Education with Remote Access Laboratories

Bowtell¹,

Moloney²,

Kist³

et al. 2012

Int. J. Onl. Eng.

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Abstract-Given the vast coverage area and dispersed population centres in which nursing professionals practice in Australia, Remote Access Laboratory (RAL) based learning activities would seem to be an ideal match. However while they are commonplace in engineering faculties; in other disciplines such activities are not widely used. This may well be due to the intricacies of these practicals not being as straightforward and readily reproducible as typical physics or science experiments.In our chosen case, the safe practice of intravenous pump driver operations and related clinical reasoning skills are important components for the training of both registered nurses and nursing students. The aim of this research project is to develop and trial remote access technologies that enable nursing students to test their knowledge, skills, and clinical reasoning with intravenous infusion pump drivers. This has been possible by extending the concept of RAL from a physical and tangible experiment, to more conceptual experimentation in any form conducted remotely. In such a context clinical reasoning becomes possible. This paper discusses a prototype system that has been built with collaborative input from the Faculty of Engineering and Surveying and the Department of Nursing and Midwifery. An initial evaluation with a group of nursing students has been completed to assess if such activities can assist with the training of student nurses. Previous work has identified the need to scaffold learning activities that rely on RAL technology; the key conclusion in this paper is that in the context of nursing this has to be taken a step further. RAL activities here require contextualisation to become an effective learning tool.

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Experienced and Less‐Experienced Nurses Diagnostic Reasoning: Implications for Fostering Students' Critical Thinking

Cited by 25 publications

References 27 publications

Calibrating urgency: triage decision-making in a pediatric emergency department

Calibrating urgency: triage decision-making in a pediatric emergency department

Standardized Nursing Languages Essential for the Nursing Workforce

Enhancing Nursing Education with Remote Access Laboratories

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