This paper is only available as a PDF. To read, Please Download here.
Purpose
The purpose of the paper is to discover the patterns and processes of decision-making in clinical nursing practice.
Methods
A set of think-aloud data from five critical care nurses during 40 to 50 minutes of caregiving in intensive care units were obtained and analyzed by applying the procedures recommended by Ericsson and Simon for protocol analysis.
Results
Four thinking processes before acting were identified to constitute various sorts of thoughts in which the nurses were engaged during patient care: reviewing, validation, consideration, rationalization, and action. In addition, three patterns of sequential streaming of thinking (short, intermediate, long) were identified to reveal various ways the nurses dealt with clinical situations involving nursing tasks and responsibilities.
Conclusion
This study specifies the initial categories of thoughts for each of the processes and various patterns with which these processes are sequentially combined, providing insights into the ways nurses think about problems and address their concerns. The findings suggest that the thinking in clinical practice involves more than focused decision-making and reasoning, and needs to be examined from a broader perspective.
Key Words
References
- Knowledge structure and problem representations: How do novice and expert home care nurses compare?.Southern Online Journal of Nursing Research. 2003; 4: 26
- From novice to expert: Excellence and power in clinical nursing practice. Addison-Wesley, Menlo Park, CA1984
- Classifying clinical decision making: A unifying approach.Journal of Advanced Nursing. 2000; 32: 981-989
- Classifying clinical decision making: Interpreting nursing intuition, heuristics and medical diagnosis.Journal of Advanced Nursing. 2000; 32: 990-998
- Clinical decision-making in critical care.Australian Journal of Advanced Nursing. 1995; 13: 10-17
- The clinical landscape of critical care: Nurses' decision-making.Journal of Advanced Nursing. 2003; 43: 310-319
- Quantifying qualitative analyses of verbal data: A practical guide.The Journal of the Learning Sciences. 1997; 6: 271-315
- Expertise in nurses' clinical judgments: The role of cognitive variables and experience. (Doctoral dissertation, The University of British Columbia).Dissertation Abstracts International B. 1996; 57/12: 7718
- Clinical decision-making by midwives: Managing case complexity.Journal of Advanced Nursing. 1997; 25: 265-272
- Telling what we know: The use of verbal report methodologies in psychological research.Psychological Science. 1994; 5: 241-244
- Clinical decision-making styles of home healthcare nurses.Journal of Nursing Scholarship. 1994; 26: 222-226
- Nursing gaze as framework for nursing practice: A study from acute care settings in Korea, Norway and the USA.Scandinavian Journal of Caring Sciences. 2007; 21: 98-104
- Elstein A.S. Shulman L.S. Sprafka S.A. Medical problem solving: An analysis of clinical reasoning. Harvard University Press, Cambridge, MA1978
- Verbal reports as data.Psychological Review. 1980; 87: 215-251
- Protocol analysis: Verbal reports as data. Bradford Books/MIT Press, Cambridge, MA1984
- Protocol analysis: Verbal reports as data. Revised edition. Bradford Books/MIT Press, Cambridge, MA1993
- How to study thinking in everyday life: Contrasting think-aloud protocols with descriptions and explanations of thinking.Mind, Culture, and Activity. 1998; 5: 178-186
- Clinical reasoning strategies used during care planning.Clinical Nursing Research. 1997; 6: 349-361
- Gilovich T. Griffin D. Kahneman D. Heuristics and biases: The psychology of intuitive judgment. Cambridge University Press, Cambridge2002
- Nursing scripts and the organizational influences on critical thinking: Report of a study of neonatal nurses' clinical reasoning.Journal of Advanced Nursing. 2000; 31: 1106-1114
- Diagnostic process and decision making in nursing: A literature review.Journal of Professional Nursing. 1994; 10: 154-163
- Clinical decision making in nursing: Theoretical perspectives and their relevance to practice.Journal of Advanced Nursing. 2001; 35: 126-133
- The effect of verbalization of cognitive processes on clinical decision making.Research in Nursing & Health. 1989; 12: 187-193
- Critical thinking and clinical decision making in critical care nursing: A pilot study.Heart & Lung. 2003; 32: 169-180
- Thinking processes used by nurses in clinical decision making.Journal of Nursing Education. 2002; 41: 145-153
- Trends in the use of verbal protocol analysis in software engineering research.Behavior & Information Technology. 2003; 22: 127-140
- Kahneman D. Slovic P. Tversky A. Judgment under uncertainty: Heuristics and biases. Cambridge University Press, Cambridge1982
- Putting theory into practice: Problems and prospects.Journal of Advanced Nursing. 1993; 18: 1632-1639
- A study of clinical decision making by certified registered nurse anesthetists.American Association of Nursing Anesthetists Journal. 2002; 70: 391-397
- The effects of paradigm on cognitive activities in design.International Journal of Human-Computer Studies. 1994; 40: 577-601
- Schemas in problem solving. Cambridge University Press, Cambridge1995
- Human problem solving. Prentice-Hall, Englewood Cliffs, NJ1972
- Decision-making in primary care: outcomes from a study using patient scenarios.Journal of Advanced Nursing. 2002; 40: 532-541
- Thinking aloud: Insights into information processing.Psychological Science. 1994; 5: 241, 245-248
- Clinical decision making by nurses when faced with third-space fluid shift: How well do they fare?.Gastroenterology Nursing. 2001; 24: 182-191
- Intuition in critical care nursing practice.Dimensions of Critical Care Nursing. 1990; 9: 30-37
- An analysis of expert nurse practitioners' diagnostic reasoning. (Doctoral dissertation, University of San Francisco).Dissertation Abstracts International-A. 2000; 61/04: 1279
- An analysis of expert nurse practitioners' diagnostic reasoning.Journal of American Academy of Nurse Practitioners. 2003; 15: 137-141
- Clinical reasoning in experienced nurses.Western Journal of Nursing Research. 2003; 25: 701-724
- A conceptual treadmill: the need for ‘middle ground’ in clinical decision making theory in nursing.Journal of Advanced Nursing. 1999; 30: 1222-1229
- Journal of Advanced Nursing Forum: Clinical decision making in nursing: Theoretical perspectives and their relevance to practice–a response to Jean Harbison.Journal of Advanced Nursing. 2001; 35: 134-137
- An exploratory study into a methodology for the examination of decision making by nurses in the clinical area.Journal of Advanced Nursing. 1994; 20: 351-360
- Content and process in clinical decision-making by nurse practitioners.Journal of Nursing Scholarship. 1992; 24: 153-158
- The proper protocol: Validity and completeness of verbal reports.Psychological Science. 1994; 5: 249-252
Article info
Identification
Copyright
© 2007 Korean Society of Nursing Science. Published by Elsevier Inc.
User license
Creative Commons Attribution – NonCommercial – NoDerivs (CC BY-NC-ND 4.0) | How you can reuse
Elsevier's open access license policy

Creative Commons Attribution – NonCommercial – NoDerivs (CC BY-NC-ND 4.0)
Permitted
For non-commercial purposes:
- Read, print & download
- Redistribute or republish the final article
- Text & data mine
- Translate the article (private use only, not for distribution)
- Reuse portions or extracts from the article in other works
Not Permitted
- Sell or re-use for commercial purposes
- Distribute translations or adaptations of the article
Elsevier's open access license policy