Expert nurses' clinical reasoning under uncertainty: representation, structure, and process

How do expert nurses reason when planning care and making clinical decisions for a patient who is at risk, and whose outcome is uncertain? In this study, a case study involving a critically ill elderly woman whose condition deteriorated over time, was presented in segments to ten expert critical care nurses. Think aloud method was used to elicit knowledge from these experts to provide conceptual information about their knowledge and to reveal their reasoning processes and problem-solving strategies. The verbatim transcripts were then analyzed using a systematic three-step method that makes analysis easier and adds creditability to study findings by providing a means of retracing and explaining analysis results. Findings revealed information about how patient problems were represented during reasoning, the manner in which experts subjects structured their plan of care, and the reasoning processes and heuristics they used to formulate solutions for resolving the patient's problems and preventing deterioration in the patient's condition.