BEGINNING NURSES' DIAGNOSTIC REASONING BEHAVIORS DERIVED FROM OBSERVATION AND VERBAL PROTOCOL ANALYSIS (NURSES).
Contributors: University of San Francisco.
Published: 1990
Number of pages: 252
Subjects: Health Sciences, Nursing.; Health Sciences, Education.; Education, Educational Psychology.
Description: This phenomenological qualitative study describes beginning nurses' diagnostic reasoning behaviors. Data were derived from both subject observation and content analyses of subject's retrospective verbal protocols in which they described their reasoning in selected observed critical incidents. Contextual analysis of protocol transcripts was designed to compare subjects' reasoning behaviors, to the Elstein, Shulman, and Sprafka (1978) model of diagnostic reasoning, and the Dreyfus and Dreyfus (1986) model of skill acquisition.

Observations and interviews of seven volunteer beginning baccalaureate nurses who had worked from two to nine months as licensed professional nurses in two acute care hospitals in a large Northern California urban area generated the data. Subjects were observed during two work shifts and interviewed after each shift to explicate their reasoning behaviors using researchers' observation notes for stimulated recall of selected incidents.

Transcripts from protocol interviews were analyzed using a theme coding unit, to code reasoning categories emerging from the data. Code-recode and intercoder reliability was 94% and 86% respectively.

Analysis of subjects' critical incident reasoning revealed eight major reasoning behavior categories with 25 related subcategories. Four subcategories representing 34% of all coded behaviors described the four processes in the Elstein medical reasoning model. While subjects used all four processes, they used them in ways different from physicians and in ways that represent memory processing limits imposed by few prior experiences. Thirty-two percent of the coded behaviors exemplify the Dreyfus skill acquisition model at the advanced beginner level. Reasoning behaviors not described in either model were identified in 34% of themes, of which 25% described actions resulting from uncertainty. Subjects demonstrated significant problems in independent diagnostic reasoning. A model developed from coded behaviors describes the beginner's reasoning as a short, simple, nonpersistent reasoning process demonstrating a constant need for consultation and a high level of beginner uncertainty.

Since diagnostic reasoning is an essential, professional, nursing function, this study points to a need not only for further study, but for developing more effective instruction in diagnostic heuristics and reasoning skill development. The findings also suggest a need for carefully planned new-nurse mentoring.
Notes: Source: Dissertation Abstracts International, Volume: 52-01, Section: B, page: 0160.

Thesis (ED.D.)--UNIVERSITY OF SAN FRANCISCO, 1990.

School code: 6019.