Registered nurses' clinical reasoning in home healthcare clinical practice: A think-aloud study with protocol analysis

Johnsen, Hege Mari; Slettebø, Åshild; Fossum, Mariann

doi:10.1016/j.nedt.2016.02.023

Cited by 36 publications

(48 citation statements)

References 17 publications

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“…In this scenario, the observer (armed with a rubric detailing procedural and cognitive considerations, which could be updated and modified depending on findings) would observe the ‘client/tester interaction’ as the tester practiced the skill using the TA method. Procedural concerns and/or the incomplete explanation of thinking strategies, as previous work has shown that the TA method can identify similar cognitive processes, 11 could be noted on the rubrics and discussed amongst the small group following the test. The classroom instructor and laboratory assistants could selectively observe and participate in these interactions.…”

Section: Discussionmentioning

confidence: 99%

Using a novel assessment of procedural proficiency provides medical educators insight into blood pressure measurement

et al. 2016

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ObjectiveThis investigation was performed to determine how students in a health sciences program utilize and explain techniques within blood pressure measurement using a novel assessment, and changes associated with greater curricular exposure. MethodsAn exploratory, qualitative and quantitative study was conducted using a ‘Think Aloud’ design with protocol analysis. Following familiarization, participants performed the task of measuring blood pressure on a reference subject while stating their thought processes. A trained practitioner recorded each participant’s procedural proficiency using a standardized rubric. There were 112 participants in the study with varying levels of curricular exposure to blood pressure measurement. ResultsFour trends are noted. Specifically, a trend was observed wherein a marked increase in procedural proficiency with a plateau occurred (e.g. released cuff pressure 2-4 mmHg, 10%, 60%, 83%, 82%). Secondly, a trend was observed with improvement across groups (e.g. cuff placed snugly/smoothly on upper arm, 20%, 60%, 81%, and 91%). Other trends included a marked improvement with subsequent decrease, and an improvement without achieving proficiency (e.g. palpation of the brachial pulse, 5%, 90%, 81%, 68%, appropriate size cuff, 17%, 40%, 33%, 41%, respectively). Qualitatively, transcript interpretation resulted in a need for clarification in the way blood pressure procedure is instructed in the curriculum. ConclusionsThe current investigation provides a snapshot of proficiency in blood pressure assessment across a curriculum and highlights considerations for best instructional practices, including the use of Think Aloud. Consequently, medical educators should use qualitative and quantitative assessments concurrently to determine achievement of blood pressure skill proficiency.

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Section: Discussionmentioning

confidence: 99%

Using a novel assessment of procedural proficiency provides medical educators insight into blood pressure measurement

et al. 2016

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“…Focus group findings will be embedded into test (ie, simulated) clinical scenarios, representing CaVS recovery issues. Using think-aloud [102,103] protocols and task completion checklists, this usability testing cycle—conducted twice, once at each site—will have SVNs and patients rehearse all scenarios wherein information coming from either player can be communicated, via automated monitoring or self-report. Scheduled for 2 hours in the hospital and 2 hours in the patient’s home soon after, but not on the same day, rehearsals will be observed by the human factors analyst and the RA.…”

Section: Methodsmentioning

confidence: 99%

Technology-Enabled Remote Monitoring and Self-Management — Vision for Patient Empowerment Following Cardiac and Vascular Surgery: User Testing and Randomized Controlled Trial Protocol

McGillion¹,

Yost²,

Turner³

et al. 2016

JMIR Res Protoc

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BackgroundTens of thousands of cardiac and vascular surgeries (CaVS) are performed on seniors in Canada and the United Kingdom each year to improve survival, relieve disease symptoms, and improve health-related quality of life (HRQL). However, chronic postsurgical pain (CPSP), undetected or delayed detection of hemodynamic compromise, complications, and related poor functional status are major problems for substantial numbers of patients during the recovery process. To tackle this problem, we aim to refine and test the effectiveness of an eHealth-enabled service delivery intervention, TecHnology-Enabled remote monitoring and Self-MAnagemenT—VIsion for patient EmpoWerment following Cardiac and VasculaR surgery (THE SMArTVIEW, CoVeRed), which combines remote monitoring, education, and self-management training to optimize recovery outcomes and experience of seniors undergoing CaVS in Canada and the United Kingdom.ObjectiveOur objectives are to (1) refine SMArTVIEW via high-fidelity user testing and (2) examine the effectiveness of SMArTVIEW via a randomized controlled trial (RCT).MethodsCaVS patients and clinicians will engage in two cycles of focus groups and usability testing at each site; feedback will be elicited about expectations and experience of SMArTVIEW, in context. The data will be used to refine the SMArTVIEW eHealth delivery program. Upon transfer to the surgical ward (ie, post-intensive care unit [ICU]), 256 CaVS patients will be reassessed postoperatively and randomly allocated via an interactive Web randomization system to the intervention group or usual care. The SMArTVIEW intervention will run from surgical ward day 2 until 8 weeks following surgery. Outcome assessments will occur on postoperative day 30; at week 8; and at 3, 6, 9, and 12 months. The primary outcome is worst postop pain intensity upon movement in the previous 24 hours (Brief Pain Inventory-Short Form), averaged across the previous 14 days. Secondary outcomes include a composite of postoperative complications related to hemodynamic compromise—death, myocardial infarction, and nonfatal stroke— all-cause mortality and surgical site infections, functional status (Medical Outcomes Study Short Form-12), depressive symptoms (Geriatric Depression Scale), health service utilization-related costs (health service utilization data from the Institute for Clinical Evaluative Sciences data repository), and patient-level cost of recovery (Ambulatory Home Care Record). A linear mixed model will be used to assess the effects of the intervention on the primary outcome, with an a priori contrast of weekly average worst pain intensity upon movement to evaluate the primary endpoint of pain at 8 weeks postoperation. We will also examine the incremental cost of the intervention compared to usual care using a regression model to estimate the difference in expected health care costs between groups.ResultsStudy start-up is underway and usability testing is scheduled to begin in the fall of 2016.ConclusionsGiven our experience, dedicated industry partners, an...

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“…The most commonly seen method, and the one used in the study was the method of think aloud observations, followed by semi-structured interviews. (Thackray & Roberts, 2017;Johnsen, Slettebø, & Fossum, 2016;Lee et al, 2016;Lundgrén-Laine, 2015;Pirret, Neville, & La, 2015;Gegenfurtner & Seppänen, 2013;Hoffman, Aitken, & Duffield, 2009;Funkesson, Anbäcken, & Ek, 2007;Simmons, Lanuza, Fonteyn, Hicks, & Holm, 2003;Prime & Le Masurier, 2000;Greenwood, Sullivan, Spence, & McDonald, 2000;Fonteyn & Grobe, 1992).…”

Section: Methods Of Data Collectionmentioning

confidence: 99%

“…In all the studies, the researchers used this information to look for patterns within the populations of their studies. For example, Johnsen, Slettebø and Fossum (2016) found that the more inexperienced participants used a large number of concepts when making decisions with a greater portion of them being reactive rather than pro-active. Similarly, the study by Greenwood, Sullivan, Spence and McDonald (2000) yielded some interesting results around the use of biases by junior members of staff.…”

Section: Profession Specific Modelsmentioning

confidence: 99%

“…The research questions in this study sought to gain an in depth understanding of the cognitive processes used and so protocol analysis is widely accepted as the method of choice when this is the aim (Johnsen, Slettebø, & Fossum, 2016;Ericsson & Simon, 1993;Hoffman, Aitken, & Duffield, 2009). Built on the early work by Ericsson and Simon (1980), it was first proposed by Kuipers and Kassirer (1988) and further developed by Fonteyn and Grobe (1992).…”

Section: Analysis Of Observational Datamentioning

confidence: 99%

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Clinical reasoning in image guided radiotherapy: A multimethod study

Collins¹

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Cone Beam Computer Tomography CT Computer Tomography CTV Clinical Target Volume Relevance Include Exclude Studies that specifically investigated the processes used during clinical decision-making. These can be carried out in the natural or simulated environment. Studies that specifically investigated image interpretation during diagnostic review and reporting. Seminal texts related to general decision-making theory to be read to inform the wider discussion. Decision-making studies unrelated to the clinical setting. Ethics Include Exclude Studies where ethical approval has been sought and granted where relevant. Studies where consideration of ethical approval is not evident. The search process is shown in Figure 2.0 using a PRISMA flow diagram (Moher, Liberati, Tetzlaff, & Altman, 2009). The search identified 82 articles that met the search criteria. The majority of articles were discussion papers and non-systematic literature reviews (n=58). These articles were used to form some of the underpinning theoretical descriptions in the chapter, but did not meet the minimum requirements of the relevant SIGN quality checklist. The remaining 24 articles were case studies that typically investigated clinical reasoning in a specific setting and these underwent full review. Despite being outside of the inclusion criteria on the basis of date, Fonteyn and Grobe (1992) was identified as a seminal article during the review process and so was included for full review. An overview of the articles that underwent full review are shown in Appendix 1.

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Registered nurses' clinical reasoning in home healthcare clinical practice: A think-aloud study with protocol analysis

Cited by 36 publications

References 17 publications

Using a novel assessment of procedural proficiency provides medical educators insight into blood pressure measurement

Using a novel assessment of procedural proficiency provides medical educators insight into blood pressure measurement

Technology-Enabled Remote Monitoring and Self-Management — Vision for Patient Empowerment Following Cardiac and Vascular Surgery: User Testing and Randomized Controlled Trial Protocol

Clinical reasoning in image guided radiotherapy: A multimethod study

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