Clinical judgement and information seeking by nurses and physicians working with cancer patients

This study examined and compared the processes of information collection and clinical judgement by nurses (n=107) and physicians (n=27) working with cancer patients. The data was collected in two university hospitals by means of a computer-simulated case description and the thinking-aloud method. Data interpretation was based on SPSS statistical software and the method of content analysis. Statistical differences between the two groups were tested with non-parametric Kruskal-Wallis Anova or the Mann-Whitney U-test. The Wilcoxon test was applied in pairwise comparisons. Independent questions were analysed by cross-tabulation and Pearson's chi(2). According to the results nurses and physicians apply different approaches to clinical judgement and problem-solving. On the basis of the status statement they received in the program both groups pointed to similar problems and sought a great deal of additional information. However the type of information required was different in the two groups. There were also significant differences in the knowledge base applied for purposes of clinical judgement: nurses tended to rely on personal knowledge, physicians on theory. Physicians were able to identify their patient's major clinical problems, but nurses had more difficulty doing this. On the other hand, nurses took a broader view on the general well-being of patients than physicians did.