Exploring nursing knowledge by using digital photography

Clinical decision making is in part, an interpretation of visual cues manifested by the patient. The colour of a patient's skin, his or her degree of mobility, or the posture adopted by the patient are examples. Clinicians compare presenting cues with previous representations of those cues to determine significant change. Literature suggests that the sources of data for this comparison are; the long term memory of the clinician, verbal interaction with colleagues and patient, and professional documentation. This paper describes findings of a study based on the assertion that contemporary documentation systems fail to provide sufficient information for nurses to make accurate comparisons between currently presenting visual cues and cues from the past. It is argued that interpretation of visual cues is primarily a visual/spatial activity (Gardiner, 1983) and, as current documentation systems rely on language they cater for linguistic rather than the visual/spatial activities. For example, subtle shades of red exhibited by the skin surrounding a surgical wound are reduced to the word "inflamed". Digital photography was explored as a documentation format that addressed this deficit. Forty nine nurse clinicians were asked to assess and plan management for one of four external sternotomy wound. Subjects were given access to a range of documentation formats including sequential daily wound photographs. Findings demonstrated that nurse clinicians are willing to use digital photographs and there is beginning evidence that photographic documentation may decrease the differences between novice and expert when comparing visual cues.