Clinical problem-solving in nursing: insights from the literature

Area of Science:

• Cognitive Psychology
• Nursing Science
• Healthcare Research

Background:

• The nursing process is often described as a problem-solving approach but may not reflect actual clinical reasoning.
• Understanding clinicians' problem-solving processes is crucial for professional development and improved patient care.
• Existing literature reveals complexities in uncovering cognitive processes during problem-solving.

Purpose of the Study:

• To review existing literature on problem-solving theories and approaches in clinical practice.
• To increase awareness among nurses and nurse academics regarding problem-solving in healthcare.
• To identify gaps in knowledge concerning the cognitive processes used by clinicians.

Main Methods:

• A comprehensive literature review of research on problem-solving strategies.
• Analysis of studies from a cognitive perspective, focusing on decision-theory and information processing-theory.
• Examination of research approaches from the past three decades.

Main Results:

• No universal problem-solving model consistent across all tasks and disciplines has been identified.
• Cognitive approaches, particularly decision-theory and information processing-theory, dominate the research landscape.
• A consistent pattern observed in clinicians across disciplines involves initial hypothesis activation followed by testing.

Conclusions:

• The nursing process's deductive reasoning differs from the actual problem-solving employed in clinical care.
• Further research is needed to fully understand the cognitive processes underlying clinical problem-solving.
• Hypothesis activation and testing represent a potentially generalizable strategy in clinical problem-solving.