CLINICAL REASONING OF HOME HEALTH NURSES: A VERBAL PROTOCOL ANALYSIS.
Contributors: University of South Carolina.
Published: 1994
Number of pages: 147
Subjects: Health Sciences, Nursing.; Education, Educational Psychology.; Psychology, General.
Description: With the constant change in health care delivery inherent in a growing informational-technological society, nurses' reasoning ability is vitally important. A professional nurse's clinical reasoning skills and expert judgment are the key ingredients affecting client outcomes in today's changing health scene. The current focus on community-based health care calls for nurses to be better prepared to make judgments in home care situations. The purpose of this study was to describe clinical reasoning in the context of home health nursing practice. Research findings have implications for nursing practice, education, and research.

This study describes the cognitive operators and strategies used by five experienced, baccalaureate prepared home health nurses. Verbal protocols were obtained by audiotaping each nurse while reasoning about two new client situations. The verbal data sample included 24,248 words from 10 pre-visit and 10 post-visit taped interviews. The researcher used verbal protocol analysis (VPA), a repetitive step-wise interpretive strategy to discern the meaning of the data. Using VPA proved to be a valuable research method for discerning cognitive processes of clinical reasoning. To describe the context of each client situation, the researcher used field notes.

The researcher discovered six cognitive operators used during clinical reasoning: connect, describe, evaluate, explain, judge, and plan. Additional strategies found in this study include: framing, induction, deduction, hypothesizing, reflexive comparing, and use of prototypes. The researcher developed a model of clinical reasoning, which includes the multiple integrative cognitive processes, both linear and non-linear, involved in clinical reasoning. This model describes three approaches nurses used in approaching situations: cue logic, framing, and testing. Nurses' use of these processes was influenced by contextual factors, i.e., written information vs. home visit information. The researcher compared reasoning pre- and post-visit. Analysis revealed that nurses consistently made more evaluations, connections, judgments and plans after visiting clients at home. The findings support an emerging theory of clinical reasoning, emphasizing the (a) integration of analytical and intuitive thinking, (b) influence of contextual factors and (c) retrieval of experiential knowledge.
Notes: Source: Dissertation Abstracts International, Volume: 56-01, Section: B, page: 0170.

Thesis (PH.D.)--UNIVERSITY OF SOUTH CAROLINA, 1994.

School code: 0202.