Page 94 - Encyclopedia of Nursing Research

CLInICAL JUDGMEnT n 61

effect of memory and the environment on reasoning used by nursing students and
problem solving. These theories hold that practicing nurses. They found that practicing
human information processing capacity is nurses were more likely to use a systematic C
restricted by short-term memory, and effec- approach and to be more accurate in diag-
tive problem-solving ability is dependent on nosis than the students. Henry (1991) exam-
adoption of strategies to overcome human ined the effect of patient acuity on clinical
limitations. Information processing theory decision making of experienced and inex-
and diagnostic reasoning have been applied perienced critical care nurses using comput-
widely to the study of clinical judgment and erized simulations. Findings suggest that
the use of information in the clinical judg- inexperienced nurses collected more data
ment process. The literature suggests that and had poorer patient outcomes than expe-
nurses and physicians use a similar process rienced nurses.
for clinical judgment, which involves infor- Salantera, Eriksson, Junnola, Salminen,
mation gathering, early hypothesis gen- and Lauri (2003) used simulated case descrip-
eration, and then additional information tions and the think-aloud method to compare
gathering to confirm or rule out a suspected and describe the process of information gath-
diagnosis or clinical problem. According to ering and clinical judgment by nurses and
the “rationalistic theories,” early hypothesis physicians working with cancer patients. The
generation “chunks” data and is an effective authors found that while nurses and physi-
strategy for conserving short-term memory cians identify similar problems, they use
(Corcoran, 1986; Elstein et al., 1978; Tanner divergent approaches to information gather-
et al., 1987). Although knowledge generated ing and knowledge base application for the
from work completed in the fields of infor- purposes of clinical judgment. They found
mation processing and diagnostic reasoning that nurses rely more on personal knowl-
has been descriptive in nature, decision anal- edge, whereas physicians rely more heavily
ysis is a prescriptive approach to decision on theory.
making and involves the process of weighing Unlike the objective, detached approach
cues and using mathematical models (gener- to the study of clinical judgment charac-
ally made possible through expert systems) teristic of the rationalistic perspective, the
to determine the course of action most likely phenomenological perspective holds that
to produce desired outcomes. intuition is a legitimate and essential aspect
Corcoran (1986) used an information of clinical judgment and is the feature that
processing approach and verbal protocol distinguishes expert human judgment from
technique to compare care-planning strate- that of expert systems (Benner & Tanner,
gies used by hospice nurses. She found that 1987). Benner’s work is based on the skill-
unlike novice nurses, the overall approach acquisition model advanced by Dreyfus and
of expert nurses differed by case complex- Dreyfus (1980). According to this model,
ity with a systematic method used for less there are six key aspects of intuitive judg-
complex cases and an exploratory approach ment: pattern recognition, similarity recog-
for cases of greater complexity. In addition, nition, commonsense understanding, skilled
expert nurses generated more alternative know-how, sense of salience, and deliberative
actions during the treatment planning pro- rationality (Benner & Tanner, 1987). Much of
cess, were better able to evaluate alternative the research related to Benner’s work and the
actions, and developed better care plans than novice to Expert Model relates to the rela-
did novices. tionships that exist between nursing knowl-
Tanner et al. (1987) used verbal responses edge, clinical expertise, and intuition.
to videotape vignettes to describe and com- The novice to Expert Model was devel-
pare the cognitive strategies of diagnostic oped using a phenomenological approach to