CLINICAL JUDGMENT BY CRITICAL CASE NURSES: AN ETHNOGRAPHIC STUDY.
Contributors: Harvard University.
Published: 1990
Number of pages: 199
Subjects: Psychology, Industrial.; Education, Adult and Continuing.; Health Sciences, Nursing.
Description: The clinical judgment processes of critical care nurses working in an open heart surgery intensive care unit were studied using an ethnographic approach. This study, carried out over two years' time produced field notes of observations of twenty critical care nurses as they cared for patients. It also included ten clinical interviews, explored the content, the processes and the context of clinical judgment from the point of view of the nurses themselves. The specific research questions were: (1) What kinds of knowledge do critical care nurses develop as a result of their clinical experience? (2) How do critical care nurses use their knowledge in forming judgments about the clinical condition of their patients? (3) In what ways do critical care nurses vary in their use of clinical judgment?.

Findings of the research include a description of the types of knowledge that critical care nurses develop as a result of their experience. This knowledge includes the importance of technology in critical care judgment, physiologic knowledge, and patient trajectories. Clinical judgment occurs in a multidisciplinary context, and the group process of clinical judgment is described. Additionally, the study describes different levels of clinical judgment used by the nurses, ranging from evaluating individual pieces of data, making sense of trends in the values of physiologic variables to ways that nurses consider the patient status as a whole, including the metaphor of movement. Finally, the language of the nurses, the vast majority of whom are female, provides a means of exploring the meaning of care in a highly technical environment. The ethics of care and justice from the point of view of both male and female nurses are described.

Educational implications of this descriptive research are developed. Orientation to critical care settings should provide nurses with support in gaining all the types of knowledge used by nurses in actual practice. This knowledge includes the use of technology, physiologic and pharmacologic principles, expected trajectories of patient recovery, group communication skills, unit specific protocols and the meaning of caring in the critical care environment. Further, unit support for the multiple levels of judgment that nurses learn as part of their orientation can be developed.

The use of an ethnographic approach to research into what has been seen as an individual cognitive process has shown the influence of the group context and has allowed the exploration of meanings of judgment activities.
Notes: Source: Dissertation Abstracts International, Volume: 51-06, Section: B, page: 3170.

Thesis (ED.D.)--HARVARD UNIVERSITY, 1990.

School code: 0084.