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Modelling novice clinical reasoning for a computerized decision support system.

Eileen S ONeill1, Nancy M Dluhy, Elizabeth Chin

  • 1College of Nursing, University of Massachusetts Dartmouth, 02747-2300, USA. eoneill1@verizon.net <eoneill1@verizon.net>

Journal of Advanced Nursing
|December 22, 2004
PubMed
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This project introduces a theoretical framework for a clinical decision support system to aid novice nurses. Grounding the system in a model of novice decision-making enhances its utility and acceptance.

Area of Science:

  • Nursing Informatics
  • Clinical Decision Support Systems
  • Cognitive Science in Healthcare

Background:

  • The Novice Computer Decision Support (N-CODES) Project aims to create a point-of-care system for novice acute care nurses.
  • Unlike previous systems, N-CODES is informed by a theoretical understanding of how nurses make clinical judgments and develop these skills.

Purpose of the Study:

  • To introduce the theoretical framework guiding the N-CODES project.
  • To present a novel perspective on novice nurse decision-making and skill development.

Main Methods:

  • The framework is based on information processing theory, incorporating a clinical decision-making model.
  • A second embedded model illustrates the clinical reasoning development of novice nurses.
  • A pluralistic perspective synthesizes existing theoretical and empirical knowledge.

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Main Results:

  • A visual representation of experienced nurse decision-making highlights the use of pre-encounter data and working knowledge.
  • A second model integrates empirical data on novice clinical reasoning development.
  • The intersection of these models offers a new view on how novices identify patterns and develop saliency.

Conclusions:

  • Previous clinical decision support systems have failed due to a lack of theoretical grounding.
  • A decision support system grounded in a theoretical model of novice decision-making will improve utility and acceptance.
  • This conceptualization of novice nurse development benefits educators, managers, and researchers.