THE USE OF CLINICAL JUDGMENT BY CRITICAL CARE NURSES IN THE CARE OF A PATIENT WITH ANGINA.
Contributors: University of Texas at Austin.
Published: 1992
Number of pages: 300
Subjects: Health Sciences, Nursing.
Description: Critical care nurses (CCNs) continually assess, synthesize, and evaluate information from many sources. They must select pertinent information and make clinical judgments that best meet patients' needs. Few nursing research studies have been completed about clinical judgment. The two purposes for this naturalistic study were to: (a) identify and describe elements of clinical judgments made by CCNs and, (b) identify factors which influence the clinical judgments made by CCNs. The focused inquiry was guided by the components of clinical judgment (knowledge, observations, perceptual awareness and interpretation) and factors which influence clinical judgment (task, context, nurse/clinician variables).

Thirty-five CCNs watched three short, simulated videotaped interactions portraying a nurse with a patient experiencing varying degrees of angina. They responded to a written question after each scenario. In addition, two questions were asked in an interview following viewing of the videotape.

Analysis of the data indicated that theoretical and practical knowledge were important in the formation of clinical judgment. Context of the situation also had a definite influence on clinical judgment. Many questions were asked to clarify and define what was happening. Contingencies were an important component for making clinical judgments and initiating interventions. Nonverbal/verbal cues influenced clinical judgments and interventions. The CCNs responded to the patient's appearance and descriptions of her pain when deciding what to do.

Years of critical care experience had the most influence on clinical judgments made by the CCNs. As years of critical care experience increased, the CCNs asked more questions, required more information, and considered more options. The nursing process was less evident as a stepwise approach to clinical judgment in those with more than seven years critical care experience. Educational preparation of the CCNs did not appear to influence clinical judgment. It did not affect the types of interventions chosen.

Emphasis on clinical judgment in nursing education and practice would allow the introduction of situations with increasing complexity. This may reduce the time needed for nurses to become independently-functioning practitioners which may enhance patient care.
Notes: Source: Dissertation Abstracts International, Volume: 53-04, Section: B, page: 1791.

Thesis (PH.D.)--THE UNIVERSITY OF TEXAS AT AUSTIN, 1992.

School code: 0227.