2.50
Hdl Handle:
http://hdl.handle.net/10755/159345
Type:
Presentation
Title:
Emergency Nurses' Diagnostic Reasoning and Clinical Experience
Abstract:
Emergency Nurses' Diagnostic Reasoning and Clinical Experience
Conference Sponsor:Midwest Nursing Research Society
Conference Year:2003
Author:Ferrario, Catherine
Contact Address:CON, 302 N. James St,, Plainfield, IL, 60544, USA
Problem Shortages and medical-technological advances challenge diagnostic reasoning. Emergency nurses use mental shortcuts or heuristics for rapid decision-making in lifesaving situations. Because heuristics require multiple, context-dependent experiences to develop, nurses with more emergency experience were hypothesized to use heuristics more than less experienced nurses. Theoretical Framework Tversky and Kahneman’s theory of representativeness heuristics and O’Neill’s application to community health nurses trace diagnostic decisions from patient cues and signs and symptoms, stored as composites from nurses’ experience (educational and clinical), to create a decision frame (symbolic representation) of the patient’s problem. Heuristics – Perceived Modal Frequency (Type 1), Essential Similarity (Type 2), Subset Variability (Type 3), and Causal Systems (Type 4) – prompt diagnostic decisions. Subjects and Methods Vignettes of emergency situations, tested for validity and reliability, were mailed to a computerized random sample of the Emergency Nurses Association. Generally women (n=183; 85.9%) with a mean age of 42.4 years (SD=8.3), the 219 participants’ experience in emergency nursing averaged 11.5 years (range 1 to 40 years). Substantial proportions of both groups – 38.4% of those with less than five years’ experience and 50.7% of those with five or more years experience – were certified in emergency nursing. Responses were classified into the four heuristics that were used, and nonparametric analogs differentiated the two experience subgroups (p < .05). Results Both experienced and less experienced emergency nurses used all four types of heuristic. Experienced emergency nurses used the Judging by Causal Systems heuristic, where diagnostic inferences are deduced from networks of etiologic factors, more than less experienced nurses (chi-square=3.98, df=1, p=.046). Conclusions Fewer between-group differences than expected were found. Advanced preparation (certification) may forge heuristics, but errors can occur when causal links are weak or used indiscriminately. Structured care approaches may spare cognitive reserves for individualizing cases that deviate from expected courses. AN: MN030151
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Midwest Nursing Research Society

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleEmergency Nurses' Diagnostic Reasoning and Clinical Experienceen_GB
dc.identifier.urihttp://hdl.handle.net/10755/159345-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Emergency Nurses' Diagnostic Reasoning and Clinical Experience</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Midwest Nursing Research Society</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2003</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Ferrario, Catherine</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">CON, 302 N. James St,, Plainfield, IL, 60544, USA</td></tr><tr><td colspan="2" class="item-abstract">Problem Shortages and medical-technological advances challenge diagnostic reasoning. Emergency nurses use mental shortcuts or heuristics for rapid decision-making in lifesaving situations. Because heuristics require multiple, context-dependent experiences to develop, nurses with more emergency experience were hypothesized to use heuristics more than less experienced nurses. Theoretical Framework Tversky and Kahneman&rsquo;s theory of representativeness heuristics and O&rsquo;Neill&rsquo;s application to community health nurses trace diagnostic decisions from patient cues and signs and symptoms, stored as composites from nurses&rsquo; experience (educational and clinical), to create a decision frame (symbolic representation) of the patient&rsquo;s problem. Heuristics &ndash; Perceived Modal Frequency (Type 1), Essential Similarity (Type 2), Subset Variability (Type 3), and Causal Systems (Type 4) &ndash; prompt diagnostic decisions. Subjects and Methods Vignettes of emergency situations, tested for validity and reliability, were mailed to a computerized random sample of the Emergency Nurses Association. Generally women (n=183; 85.9%) with a mean age of 42.4 years (SD=8.3), the 219 participants&rsquo; experience in emergency nursing averaged 11.5 years (range 1 to 40 years). Substantial proportions of both groups &ndash; 38.4% of those with less than five years&rsquo; experience and 50.7% of those with five or more years experience &ndash; were certified in emergency nursing. Responses were classified into the four heuristics that were used, and nonparametric analogs differentiated the two experience subgroups (p &lt; .05). Results Both experienced and less experienced emergency nurses used all four types of heuristic. Experienced emergency nurses used the Judging by Causal Systems heuristic, where diagnostic inferences are deduced from networks of etiologic factors, more than less experienced nurses (chi-square=3.98, df=1, p=.046). Conclusions Fewer between-group differences than expected were found. Advanced preparation (certification) may forge heuristics, but errors can occur when causal links are weak or used indiscriminately. Structured care approaches may spare cognitive reserves for individualizing cases that deviate from expected courses. AN: MN030151</td></tr></table>en_GB
dc.date.available2011-10-26T21:55:45Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T21:55:45Z-
dc.description.sponsorshipMidwest Nursing Research Societyen_GB
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