Cognitive factors in student nurses' clinical problem solving

The assumption that the acquisition and mastery of the nursing process alone is sufficient to explain problem-solving performance has been challenged in recent literature. Researchers have argued that the quality of prior knowledge is a key component in explaining performance. In addition, motivational orientation and the quality of reasoning have been found to have different effects on performance in cognitive tasks. The aim of this study is to explore student nurses' clinical problem solving based on a model consisting of their motivational orientation, prior knowledge, diagnostic reasoning and diagnostic solutions.

One hundred and thirty-five second-year nursing students completed the Study Process Questionnaire and the Causal Attribution Questionnaire prior to receiving five lectures on mental illness. A knowledge test and a clinical problem-solving task provided measures of prior knowledge, quality of diagnostic reasoning, and the quality and comprehensiveness of nursing diagnosis. A correlational design using pairwise correlations, hierarchical regression and path analysis examined the relationships among these data.

The results indicated an important role for a belief in personal control, for the accessibility and structuring of prior knowledge, and the quality of diagnostic reasoning, in generating high quality and comprehensive nursing diagnoses. The findings suggest that all contributing components of clinical problem solving need to be addressed in nursing education.