2.50
Hdl Handle:
http://hdl.handle.net/10755/158059
Type:
Presentation
Title:
Evidence & Expertise at the Bedside: Credibility in Nursing Discourse
Abstract:
Evidence & Expertise at the Bedside: Credibility in Nursing Discourse
Conference Sponsor:Western Institute of Nursing
Conference Year:2006
Author:Hagler, Debra, PhD, APRN, BC, CCRN
P.I. Institution Name:Arizona State University
Title:Clinical Associate Professor
Contact Address:College of Nursing, Box 872602, Tempe, AZ, 85287-2602, USA
Contact Telephone:480-965-7882
Purpose: The purpose of this study was to identify how nurses evaluate evidence and a peer's expertise during discourse about authentic health issues of critically ill persons. Significance: The context for communication and problem-solving in clinical nursing is critically important: context shapes identified problems, permissible actions, satisfactory solutions, and potential consequences. Context includes tacit knowledge of who has expert information, what evidence is relevant, what underlying assumptions and values connect evidence to claims, and how to persuade others to follow a particular course of action. Background: Change of shift report (CSR) is a form of informal argumentative dialogue where nurses justify clinical decisions that they have made under conditions of uncertainty. The CSR is an event of intense communication and social cognition with an expectation of accountability for decisions and actions. Nursing CSR as a form of socially situated cognition illustrates the potential benefits and challenges that come with division of labor and cooperative practice. Elaboration of evidence through nursing dialogue helps explain the underlying assumptions and may lead to changes in claims about what care should be provided. Nursing CSRs provide an opportunity to identify how nurses use a sociopolitical approach to cognition in their important everyday work. Methods: Forty registered nurses from 4 critical care units in 3 hospitals volunteered to participate. Each pair of nurses was audio recorded and observed during a regularly scheduled CSR. The offgoing nurse was interviewed while the oncoming nurse completed a brief written survey. Observation field notes, audio recorded shift reports and interviews, and written surveys were transcribed and qualitatively analyzed using Atlas TI to organize open coding via a line-by-line analysis, axial coding and hierarchical coding. Argument structures were examined by clustering data related to individual issues of concern to the nurses in the report, then classifying data within each issue of concern using definitions of types of evidence, warrants, and claims. Argument structures were illustrated for clarification using Inspiration 7.5 software. Data coding reached 90-93% inter-rater agreement for types of argument claims. Data collection and analysis followed federal guidelines for the protection of human subjects and the confidentiality of health information.
Findings: Analysis of the relationships among clinically-based descriptions of nursing expertise and preferences for particular types of argument structure and evidence used to justify clinical decisions is currently in process. Themes and patterns will be identified and described, then shared with study participants for member verification, reaction, and comments. Relevant findings and potential implications for practice and future research will be presented.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleEvidence & Expertise at the Bedside: Credibility in Nursing Discourseen_GB
dc.identifier.urihttp://hdl.handle.net/10755/158059-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Evidence &amp; Expertise at the Bedside: Credibility in Nursing Discourse</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2006</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Hagler, Debra, PhD, APRN, BC, CCRN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Arizona State University</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Clinical Associate Professor</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">College of Nursing, Box 872602, Tempe, AZ, 85287-2602, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">480-965-7882</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">dhagler@asu.edu</td></tr><tr><td colspan="2" class="item-abstract">Purpose: The purpose of this study was to identify how nurses evaluate evidence and a peer's expertise during discourse about authentic health issues of critically ill persons. Significance: The context for communication and problem-solving in clinical nursing is critically important: context shapes identified problems, permissible actions, satisfactory solutions, and potential consequences. Context includes tacit knowledge of who has expert information, what evidence is relevant, what underlying assumptions and values connect evidence to claims, and how to persuade others to follow a particular course of action. Background: Change of shift report (CSR) is a form of informal argumentative dialogue where nurses justify clinical decisions that they have made under conditions of uncertainty. The CSR is an event of intense communication and social cognition with an expectation of accountability for decisions and actions. Nursing CSR as a form of socially situated cognition illustrates the potential benefits and challenges that come with division of labor and cooperative practice. Elaboration of evidence through nursing dialogue helps explain the underlying assumptions and may lead to changes in claims about what care should be provided. Nursing CSRs provide an opportunity to identify how nurses use a sociopolitical approach to cognition in their important everyday work. Methods: Forty registered nurses from 4 critical care units in 3 hospitals volunteered to participate. Each pair of nurses was audio recorded and observed during a regularly scheduled CSR. The offgoing nurse was interviewed while the oncoming nurse completed a brief written survey. Observation field notes, audio recorded shift reports and interviews, and written surveys were transcribed and qualitatively analyzed using Atlas TI to organize open coding via a line-by-line analysis, axial coding and hierarchical coding. Argument structures were examined by clustering data related to individual issues of concern to the nurses in the report, then classifying data within each issue of concern using definitions of types of evidence, warrants, and claims. Argument structures were illustrated for clarification using Inspiration 7.5 software. Data coding reached 90-93% inter-rater agreement for types of argument claims. Data collection and analysis followed federal guidelines for the protection of human subjects and the confidentiality of health information. <br/>Findings: Analysis of the relationships among clinically-based descriptions of nursing expertise and preferences for particular types of argument structure and evidence used to justify clinical decisions is currently in process. Themes and patterns will be identified and described, then shared with study participants for member verification, reaction, and comments. Relevant findings and potential implications for practice and future research will be presented.</td></tr></table>en_GB
dc.date.available2011-10-26T20:28:07Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:28:07Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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