Nursing students' decision-making regarding postpartum hemorrhage: An exploration using the recognition-primed...

Area of Science:

• Nursing Education
• Clinical Judgment
• Decision-Making Models

Background:

• Nurse's expectations are central to clinical decision-making, yet their relationship with knowledge remains under-researched.
• The Recognition-Primed Decision Model (RPDM) offers a framework to explore knowledge and expectations in high-stakes clinical scenarios.
• Testing the RPDM with nursing students in postpartum hemorrhage situations is crucial for validating its application and refining research methods.

Purpose of the Study:

• To investigate the knowledge content and structure of nursing students' decision-making during high-stakes postpartum hemorrhage scenarios.
• To apply the Recognition-Primed Decision Model (RPDM) to analyze nursing students' clinical judgment in a simulated critical event.

Main Methods:

• A descriptive qualitative and quantitative study analyzed data from 53 nursing students.
• Students responded to a postpartum hemorrhage vignette, and their decision-making processes were probed via recorded answers.
• Content analysis, based on the RPDM's four recognition components (cues, expectations, goals, actions), was performed on transcribed data.

Main Results:

• All students correctly identified postpartum hemorrhage, organizing knowledge around causes (tone, trauma, tissue, thrombin) and consequences (hemodynamic instability).
• Students effectively identified relevant cues and actions but demonstrated challenges in articulating long-term goals and expected patient outcomes.
• Knowledge structure revealed a focus on immediate cause-and-effect relationships rather than comprehensive patient trajectory planning.

Conclusions:

• The Recognition-Primed Decision Model effectively organized nursing students' decision-making knowledge in a critical postpartum hemorrhage scenario.
• Student knowledge disproportionately emphasizes immediate cue-action links, indicating a gap in anticipating future events and assessing patient responses.
• Nursing education should integrate a stronger focus on developing students' long-term goals and expectations for improved clinical judgment and patient care.