CLINICAL DECISION-MAKING IN NURSING: A COMPARISON OF SIMULATIONS AND PRACTICE SITUATIONS.
Contributors: Oregon Health Sciences University.
Published: 1990
Number of pages: 206
Subjects: Health Sciences, Nursing.; Psychology, General.
Description: Currently, much of the research related to clinical decision making in nursing has used some type of simulation to stimulate the thinking processes of subjects. No comparisons of the thinking processes stimulated by simulation and those used in actual practice have been conducted.

The purpose of this investigation was to compare the decision making processes that hospice nurses used on simulations with those used in practice. The variables used to measure decision making were: (1) the initial approach used in making the decision; (2) whether or not the appropriate alternatives were considered; (3) the information reporting strategy; and (4) the overall approach used. The situation variables which may explain differences were: (1) the complexity of the situation; (2) the degree to which the subject felt engaged with the patient; (3) the difficulty that the subject felt making the decision; and (4) the uncertainty that the subject had in recalling the practice situation.

Verbal protocols were collected from a convenience sample of 34 hospice nurses on three written simulations and on three clinical situations in which they made a decision about the patient's pain control regimen. Subjects were interviewed in one or two sessions which were tape recorded and transcribed for analysis.

A content analysis of the verbal protocols using categories based on research by Tanner et al. (1987); Corcoran (1986a, 1986b); Elstein et al. (1978); and Newell and Simon (1972) was conducted. Paired t-tests were calculated on each of the process variables summed across the simulations and across the practice situations. Stepwise multiple regressions were completed with the situation variables regressed on the process variables.

There were four major findings from the study. First, there was no difference between practice and simulation on the initial approach. Second, there were significant differences between practice and simulation on the alternatives considered, the reporting strategy, and the overall approach. Third, the situation variables did not account for much of the variance of the process variables. Fourth, there were no differences between different levels of experience or education on the process variables.

The findings from this study have implications for nursing, especially future research on clinical decision making. If there is a difference between practice and simulation on decision making processes used, then more research on clinical decision making should be conducted in practice. Findings from simulations may not be generalizable to practice. However, further research should be conducted to determine if the difference between simulation and practice is replicable.
Notes: Source: Dissertation Abstracts International, Volume: 50-10, Section: B, page: 4455.

Thesis (PH.D.)--OREGON HEALTH SCIENCES UNIVERSITY, 1990.

School code: 0368.