Abstract

This qualitative descriptive study was designed to explore the relationship of cue identification and problem framing as part of the problem solving and decision making of medical surgical nurses as they thought-aloud while they performed an assessment of a human patient simulator. The most important aspect of problem solving is the identification of the correct problem. Nurses are expected to identify problems in complex, uncertain, unstable, and time-limited situations. Few studies have been conducted using a Human Patient Simulator to create a realistic situation while controlling for uniformity and consistency. The conceptual framework for the study was Information Processing Theory and Naturalistic Decision Making. Two scenarios were developed to depict complications that surgical patients could develop post surgically. These scenarios were programmed into the Human Patient Simulator, which was in an area set up as a patient room. The surgical procedures in the two scenarios were a gastrectomy and a total hip replacement complicated by the patient developing pneumonia in one scenario and congestive heart failure in the other. These two complications are among the most common causes of extended hospitalization and adverse outcomes for patients. Thirteen nurses of varying experience were asked to think aloud about the shift report for each patient and then while assessing the patient to identify the cues and explain how they used the cues to decide on a diagnosis for the patient. The nurse, in the study, was defined as a registered nurse with 1-5 years of experience, with no advanced certification or degrees, and employed on a medical surgical unit. The think-aloud data was audiotaped and transcribed verbatim and was then analyzed using the three parts of protocol analysis: Referring Phrase Analysis (RPA), Assertional Analysis (AA), and Script Analysis (SA). RPA organized the cues into categories, AA examined the relationships between the categories, and SA explored the cognitive processes and the use of heuristics. Since this study was done in real time, the transcripts reflected the information that the nurses were attending to in their short term memory as well as their use of extended memory and retrieval of information from their long term memory. The findings in this study suggested that nurses started to frame the problem as they listened to report, formed a dominance structure, problem frame, and this problem frame guided their additional search for cues to complete the frame.

Description

This dissertation has also been disseminated through the ProQuest Dissertations and Theses database. Dissertation/thesis number: 3261217; ProQuest document ID: 304850230. The author still retains copyright.

Author Details

Kereen F. Mullenbach, PhD, Faculty - Radford University

Sigma Membership

Epsilon Psi

Type

Dissertation

Format Type

Text-based Document

Study Design/Type

Descriptive/Correlational

Research Approach

Qualitative Research

Keywords:

Cognitive Processes, Clinical Decision Making, Problem-Solving, Human Patient Simulator

Advisors

Facione, Noreen||Hogan, Nancy||Janus, Linda

Degree

PhD

Degree Grantor

Loyola University Chicago

Degree Year

2007

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.

All permission requests should be directed accordingly and not to the Sigma Repository.

All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Proxy-submission

Date of Issue

2023-05-15

Full Text of Presentation

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