Clinical Decision-Making Regarding the Management of Pain: Differences Between Novice, Intermediate, and Expert Nurses

2.50
Hdl Handle:
http://hdl.handle.net/10755/621584
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Clinical Decision-Making Regarding the Management of Pain: Differences Between Novice, Intermediate, and Expert Nurses
Other Titles:
Global Perceptions of Pain Management
Author(s):
Zlatkin, Igal; Gendler, Yulia
Lead Author STTI Affiliation:
Phi Gamma
Author Details:
Igal Zlatkin, MA, BA, RN, Professional Experience: 2009 - present -- Teacher, Emeq Izrael Academic College Teaching of Medical-Surgical Nursing and Clinical Thinking. Writing of simulation scenarios. Coordinator of clinical preceptors' course. 2009- present -- Coordinator of nursing staff professional development, Carmel Medical Center, Haifa, Israel. Responsible for development and implementation of educational programs for the nurses of the medical center. Use of active learning strategies such as simulation and PBL in different issues of nurses' training. 2007-2009 -- Coordinator of Critical Care Nursing Educational Program, Carmel Medical Center. 2001-2007 -- Clinical Preceptor, Carmel Medical Center. 4 presentations at international scientific meetings Author Summary: I'm the coordinator of nursing staff professional development and coordinator of pain management in Carmel Medical Center. In addition, I'm a teacher in Izrael Valley Academic College. My research is focused on nurses' decision-making in various clinical areas and implementation of active learning methods in nursing education and nurses' professional development.
Abstract:

Purpose:

Nursing pain management is closely related to decision making-process, which includes continuous estimate, intervention, monitoring the effect of treatment, identifying the need for changes and alternative treatment. It is generally assumed that education and practical experience increases accuracy in decision-making. Benner presented an extensive theory that suggests five levels of proficiency that nurses pass in acquisition and development of skills from novice to expert. However, this theory does not examine strategies of decision making during these stages. The purpose of the study: (1) to identify the cognitive processes used by nurses when making pain management decisions and the factors which have an influence on these processes. (2) to examine the difference between novice, intermediate and expert nurses, in their decision making about pain management.

Methods:

The subjects constitute a non-random sample of 65 registered nurses working in surgical wards in two academic teaching medical centers located in Israel. The study received approval from both hospitals' institutional review boards. The study is based on three tools: the self-assessment questionnaire of participants' pain management knowledge and skills; vignettes describing common situations which require nurse's decision making followed by questions examining basis of the decision; script concordance test evaluating decision making in common clinical situations. The tools were designed by the researches and validated by expert judgment.

Results:

The decision regarding pain management of expert nurses were mostly based on their experience and intuition, while novices and intermediates relied on guidelines or colleagues' advises. In comparison to novice, expert nurses reported that the decision making process was easier for them (α=0.013). Significantly better decision making was found among the nurses with Master degree (F=7.15, α=005) and among nurses who have participated in pain management educational programs (α=0.02). No association was found between seniority in a surgical ward and accuracy in decision making. The findings were consistent with vignettes and script concordance test.

Conclusions:

There is a substantial difference in the decision making regarding pain management between novices, intermediates and experts, both in quality of the decision and the cognitive process of the decision making. Well-developed guidelines may assist no novice to improve their decision making skills. The script concordance test seems to be an effective tool in evaluating nurses' clinical decisions. This study emphasized the benefit of nurses' higher education and participation in clinical educational programs.

Keywords:
Clinical; Academic; Both/Either
Repository Posting Date:
22-Jun-2017
Date of Publication:
22-Jun-2017
Other Identifiers:
INRC17Q07
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleClinical Decision-Making Regarding the Management of Pain: Differences Between Novice, Intermediate, and Expert Nursesen_US
dc.title.alternativeGlobal Perceptions of Pain Managementen
dc.contributor.authorZlatkin, Igalen
dc.contributor.authorGendler, Yuliaen
dc.contributor.departmentPhi Gammaen
dc.author.detailsIgal Zlatkin, MA, BA, RN, Professional Experience: 2009 - present -- Teacher, Emeq Izrael Academic College Teaching of Medical-Surgical Nursing and Clinical Thinking. Writing of simulation scenarios. Coordinator of clinical preceptors' course. 2009- present -- Coordinator of nursing staff professional development, Carmel Medical Center, Haifa, Israel. Responsible for development and implementation of educational programs for the nurses of the medical center. Use of active learning strategies such as simulation and PBL in different issues of nurses' training. 2007-2009 -- Coordinator of Critical Care Nursing Educational Program, Carmel Medical Center. 2001-2007 -- Clinical Preceptor, Carmel Medical Center. 4 presentations at international scientific meetings Author Summary: I'm the coordinator of nursing staff professional development and coordinator of pain management in Carmel Medical Center. In addition, I'm a teacher in Izrael Valley Academic College. My research is focused on nurses' decision-making in various clinical areas and implementation of active learning methods in nursing education and nurses' professional development.en
dc.identifier.urihttp://hdl.handle.net/10755/621584-
dc.description.abstract<p><strong>Purpose:</strong></p> <p>Nursing pain management is closely related to decision making-process, which includes continuous estimate, intervention, monitoring the effect of treatment, identifying the need for changes and alternative treatment. It is generally assumed that education and practical experience increases accuracy in decision-making. Benner presented an extensive theory that suggests five levels of proficiency that nurses pass in acquisition and development of skills from novice to expert. However, this theory does not examine strategies of decision making during these stages. The purpose of the study: (1) to identify the cognitive processes used by nurses when making pain management decisions and the factors which have an influence on these processes. (2) to examine the difference between novice, intermediate and expert nurses, in their decision making about pain management.</p> <p><strong>Methods:</strong></p> <p>The subjects constitute a non-random sample of 65 registered nurses working in surgical wards in two academic teaching medical centers located in Israel. The study received approval from both hospitals' institutional review boards. The study is based on three tools: the self-assessment questionnaire of participants' pain management knowledge and skills; vignettes describing common situations which require nurse's decision making followed by questions examining basis of the decision; script concordance test evaluating decision making in common clinical situations. The tools were designed by the researches and validated by expert judgment.</p> <p><strong>Results:</strong></p> <p>The decision regarding pain management of expert nurses were mostly based on their experience and intuition, while novices and intermediates relied on guidelines or colleagues' advises. In comparison to novice, expert nurses reported that the decision making process was easier for them (α=0.013). Significantly better decision making was found among the nurses with Master degree (F=7.15, α=005) and among nurses who have participated in pain management educational programs (α=0.02). No association was found between seniority in a surgical ward and accuracy in decision making. The findings were consistent with vignettes and script concordance test.</p> <p><strong>Conclusions:</strong></p> <p>There is a substantial difference in the decision making regarding pain management between novices, intermediates and experts, both in quality of the decision and the cognitive process of the decision making. Well-developed guidelines may assist no novice to improve their decision making skills. The script concordance test seems to be an effective tool in evaluating nurses' clinical decisions. This study emphasized the benefit of nurses' higher education and participation in clinical educational programs.</p>en
dc.subjectClinicalen
dc.subjectAcademicen
dc.subjectBoth/Eitheren
dc.date.available2017-06-22T20:22:08Z-
dc.date.issued2017-06-22-
dc.date.accessioned2017-06-22T20:22:08Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
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