A descriptive analysis of experienced nurses' clinical reasoning during a planning task

Area of Science:

• Nursing
• Healthcare Education
• Clinical Practice

Background:

• Current nursing education and practice often separate the identification of patient problems from the selection of interventions during care planning.
• Understanding the cognitive processes nurses use in care planning is crucial for improving educational strategies and clinical decision-making.

Purpose of the Study:

• To investigate the cognitive processes clinical nurses employ when formulating a plan of care.
• To analyze how nurses integrate patient problems and interventions during the care planning process.

Main Methods:

• Employed the Think Aloud (TA) method to gather verbal data from seven clinical nurses.
• Nurses reviewed a written case study and developed a plan of care.
• Utilized Protocol Analysis (PA) to visualize the care plans and identify used clinical data.

Main Results:

• The analysis revealed that patient problems and interventions were frequently considered together, rather than in separate sequential steps.
• A visual representation of each nurse's care plan highlighted the interconnectedness of problem identification and intervention selection.
• Identified the specific clinical data utilized by nurses during the planning process.

Conclusions:

• The findings suggest that clinical nurses often engage in a holistic, integrated approach to care planning, linking problems and interventions concurrently.
• This integrated approach contrasts with traditional educational and practice models that emphasize separate consideration of problems and interventions.
• Implications for nursing education and practice include a need to re-evaluate and potentially adapt current methods to reflect this integrated cognitive process.