Diagnostic reasoning strategies of nurses and nursing students

This study described and compared the cognitive strategies of diagnostic reasoning used by junior nursing students (n = 15), senior nursing students (n = 13), and practicing nurses (n = 15). Verbal responses to three videotaped vignettes provided the data. Findings suggested that diagnostic reasoning processes of both nurses and nursing students can be described by a general model developed from studies of physicians. Subjects activated diagnostic hypotheses early in the encounter and used systematic information gathering to rule in and rule out hypotheses. With increased levels of knowledge and experience, there was a trend toward more systematic data acquisition and greater accuracy in diagnosis. The number of hypotheses activated, the earliness with which they were activated, and their diagnostic accuracy were task-specific components of the process, but selection of data-acquisition strategies appeared to be more generalizable across cases.     

Learning from experience: differences in how novice vs. expert nurses diagnose why an infant is crying

Diagnosing client health problems is a well-recognized task for nurses. This study examined the effects of nursing education and experience on that problem-solving process by comparing the performance of four groups of nurses. Junior and senior nursing students, nursing students who were parents, and pediatric nurses solved two computer-presented problems. The task involved acquiring information in order to evaluate competing causal hypotheses. One problem concerned why an infant was crying and the other was a control problem. A number of group differences were identified. The experienced groups of pediatric nurses and parents differed from the student nurses by using less information and selecting different information units, such as information about the infant's age, earlier in the problems. Parents were the most accurate; they did not select any incorrect hypotheses. The dual roles of education and experience are discussed and it is proposed that computer-presented simulations can be an important tool for understanding problem-solving processes, as well as for promoting clinical skill development.     

Pediatric nursing practice: keeping pace with technological advances

Over the past 25 years, extensive technological and medical advances have had a major impact on the way pediatric nursing is practiced. Pediatric nurses have expanded their nursing roles, established professional organizations and certification standards to ensure clinical competence at the bedside, and tirelessly advocated for the health care needs of children and their families. In addition, pediatric nurses have collaborated with other health care providers to institute family-centered and developmentally appropriate philosophies of care. All of these changes will assist pediatric nurses to remain focused on the most important aspect of their work: Supporting the unique needs of children and their families.     

The casualisation of nursing jobs: a management response to having to do more with less

Restructuring of health care has raised a number of issues affecting nurses and nursing which have been documented over the last half decade. However, comparatively little attention has been given to staffing arrangements, particularly in relation to casualisation. This empirical South Australian study identifies three management responses to the current climate: working nurses harder, working smarter and casualising nursing jobs. The paper suggests that the identified trend to increasing casualisation, which is likely to point towards a national nursing labour market trend, needs to be considered in terms of cost and workload issues. It also suggests that the question of where responsibility for the professional development of casual nurses rests needs to be addressed.     

A programme for nursing ethics

This article defines nursing ethics and its place within the disciplines of ethics and nursing. The current endeavours of nursing ethics are identified as: revising codes, assisting nurses to reason ethically, and establishing the nurse's role in ethical decision-making regarding ethical issues, particular clients, and society's definition of health and illness. The authors then propose the further development of nursing ethics to examine critically the ethical dimensions of nursing practice with regards to its theories, diagnostic categories, diagnostic procedures, treatment goals and treatment procedures.     

Mental health issues within the general health care system: implications for the nursing profession.

AIM: The aim of this paper is to briefly describe the prevalence of mental illness within the general health care population and the implications for the nursing profession. PRIMARY ARGUMENT: The nursing profession espouses holism as its philosophy of care. This philosophy embraces the essential interaction between the biological, psychological and social aspects of each individual. The mainstreaming of mental health services within the general health care system has increased the level of contact nurses have with people experiencing mental health problems, yet the research evidence suggests they are not confident or competent in meeting the associated needs. CONCLUSION: There is an urgent need for education of the current and future nursing workforce if the challenges presented by mental health issues are to be addressed.     

Nurses' reasoning process during care planning taking pressure ulcer prevention as an example. A think-aloud study

BACKGROUND: Nurses' clinical reasoning is of great importance for the delivery of safe and efficient care. Pressure ulcer prevention allows a variety of aspects within nursing to be viewed. OBJECTIVE: The aim of this study was to describe both the process and the content of nurses' reasoning during care planning at different nursing homes, using pressure ulcer prevention as an example. DESIGN: A qualitative research design was chosen. SETTINGS: Seven different nursing homes within one community were included. PARTICIPANTS: Eleven registered nurses were interviewed. METHOD: The methods used were think-aloud technique, protocol analysis and qualitative content analysis. Client simulation illustrating transition was used. The case used for care planning was in three parts covering the transition from hospital until 3 weeks in the nursing home. RESULT: Most nurses in this study conducted direct and indirect reasoning in a wide range of areas in connection with pressure ulcer prevention. The reasoning focused different parts of the nursing process depending on part of the case. Complex assertations as well as strategies aiming to reduce cognitive strain were rare. Nurses involved in direct nursing care held a broader reasoning than consultant nurses. Both explanations and actions based on older ideas and traditions occurred. CONCLUSIONS: Reasoning concerning pressure ulcer prevention while care planning was dominated by routine thinking. Knowing the person over a period of time made a more complex reasoning possible. The nurses' experience, knowledge together with how close to the elderly the nurses work seem to be important factors that affect the content of reasoning.     

某地级市社区护士工作现状与居民护理需求的调查

目的调查某地级市社区护士工作现状与居民护理需求。方法采用自行设计的调查问卷对135名社区护士和338户社区居民进行调查。结果社区护士的工作重点在治疗护理方面,而预防、康复、保健、健康宣教和计划生育5项的工作力度明显不够;社区护理工作现状与居民需求存在差异,居民对社区护理服务的需求从疾病治疗向疾病预防和健康促进转变。结论社区护士应转变观念,加强疾病预防和健康促进的理念;社区护理应以居民需求为导向,尽快建立以社区人群健康为中心,融医疗、预防、保健、康复、健康教育、计划生育于一体的综合性社区护理服务模式。     

Contamination: Nursing Diagnoses with Outcome and Intervention Linkages

PURPOSE: To relate the collaborative processes involved in the evolution of environmental nursing diagnoses and the linkages between two new nursing diagnoses and their associated interventions and outcomes; to describe the environmental health implications of contamination. DATA SOURCES: Published research articles, official reports, textbooks, and collaborative discussion with experts in community and global health. DATA SYNTHESIS: Reflection following review of the literature and collaboration with experts led to the development of a new schema for environmental diagnoses and development of two new diagnoses, allowing for greater clarity and distinction between the contamination diagnoses and risk for poisoning diagnosis. CONCLUSIONS: An environmental nursing diagnosis schema, with its emphasis on contamination, infection, and violence, provides nurses with a holistic framework for making judgments about environmental influences related to individual, family, community, and global health. The diagnoses of Contamination and Risk for Contamination provide necessary language to describe human responses and risk states that may arise following exposure to environmental contaminants. PRACTICE IMPLICATIONS: Development of environmental diagnostic labels and delineation of the linkages to nursing outcomes and interventions will allow nurses to take active roles in identifying environmental components that affect health and planning care that responds to environmental health needs. Greater clarity in the use of language will allow nurses to incorporate environmental concepts appropriately in nursing assessments and improve the accuracy of the diagnostic process and selection of distinct interventions and outcomes. This will result in better outcomes for patients and communities and permit greater accountability of nursing's contribution to environmental health.     

母婴同室病区护理人力资源配置对患者满意度的影响

目的 探讨母婴同室病区护理人力资源配置对患者满意度的影响.方法 将2007年母婴同室病区全年住院患者对护理质量满意度调查结果、母婴同室病区护士人力资源配置情况进行分析.结果 住院患者对护理服务的满意度与护士的配置呈正相关;母婴同室病区护士人力资源配置相对不足导致护士疲溃感,出现服务质量退化,服务态度生硬,对患者冷漠,细节服务不到位,基础护理工作落实不够,健康教育简单.技术操作质量不能保证.结论 母婴同室病区护士人力资源配置应高于普通病房护士人力资源配置,重视母婴同室病区的护士安全配置,增加护士编制,合理利用人力资源,加强护士综合素质培养,提高质量意识、服务意识、安全意识,确保护理质量和母婴安全,提高患者满意度.     

A Model of Community-Focused Nursing

Theoretically, the focus of community health nursing is the community; however, the nature of the practice has not been well documented. The purpose of this study was to develop a community-focused model by identifying appropriate behaviors and activities for staff-level community health nurses. A list of suggested behaviors and activities was compiled by means of brainstorming sessions and sent to a sample of community health nursing administrators, educators, and staff nurses in Michigan. Responses were analyzed using nonmetric multidimensional scaling techniques to uncover and define the primary underlying dimensions of perceived community-focused practice of community health nursing. Three specific regions were identified and labeled: (1) client-oriented services; (2) aggregate needs identification; and (3) aggregate planning and intervention. These regions (concepts) have been illustrated graphically in a proposed model for community focused nursing entitled the S-C model. In addition, discrepancies among the three respondent groups were identified.     

Administrative Diagnosis—Implications for the Public''s Health

The nursing diagnosis of the health care needs of population groups has been deemed the responsibility of community nurse-administrators. Yet it was not known whether these nurses actually formulate nursing diagnoses pertaining to population groups. The purpose of this study was to describe the diagnostic reasoning of these nurses so as to enable the development of a factor-isolating theory of population group diagnosis using the grounded-theory method. Data were obtained from 31 community nurse-administrators regarding the health services they had created or discontinued within the last three years; it was assumed that these data could illuminate the diagnostic decisions that had preceded service change. The data revealed a first-stage diagnostic process in which the group's state of health was determined. Prior to service change, a second-stage diagnosis was made about the degree of match between the group's need and existing services; the nursing goal was to cultivate a need-service match that would positively affect the group's health status. Labels for the first- and second-stage diagnoses were developed based on the emergent theory and the relevant literature. The resultant factor-isolating theory of community nurse-administrator diagnosis was stated and the implications of the theory for the public's health were discussed.     

Public Health Nursing Research Priorities: A Collaborative Delphi Study

Abstract The purpose of this study was to identify research questions and priorities in public health nursing based on the perceived needs of practicing public health nurses, and to assess whether the respondents believed that the profession should provide leadership in the study of the identified questions. Using a modified Delphi survey. 76 research priorities were ranked and produced three factors or categories of questions during the two rounds: outcomes in maternal-child and family planning, outcomes in home health services, and public health nurse recruitment, retention, job satisfaction, and image. Forty-seven (62%) of the 76 priorities were deemed appropriate for nursing to assume leadership in seeking answers. Results reveal a consensus of research priorities generated by front-line nurses consistent with year 2000 health objectives for the nation.     

Do nursing diagnoses affect functional status?

1. Nurses in this study often made diagnoses pertaining to physiological or physical problems rather than psychosocial problems. One diagnostic category, "impaired home maintenance management," was consistently used incorrectly, suggesting a need for careful clinical training of nursing staff in diagnostic reasoning. 2. Patients who had a greater number of nursing diagnoses had greater improvements in function during the hospital stay. One explanation is that more nursing diagnoses may lead to more independent nursing actions, resulting in improvements in functional abilities. 3. Functional status on admission measured by the Katz ADL was the most powerful predictor of functional status at discharge. The scale can readily be used by nurses to document basic functioning and to quickly identify patients needing or coordinated discharge planning. 4. Institutionalized had a higher mean number of nursing diagnoses than those who were discharged to their own homes. The most powerful predictor of institutionalization was the Katz ADL score.     

Philippine population development: a nursing concern

In keeping with nurses' commitment to the preservation and care of human life, population development should be a major concern of the nursing profession in the Philippines. The profession should ensure that the health system is oriented toward people's needs and formulate manpower strategies on the basis of these needs and population distribution. Nurses are in an ideal position to advocate a family-centered approach to health care through their access to pregnant women and mothers. Nurses can promote child health by encouraging their patients to breastfeed and teach older youth the concept of responsible sexuality. To respond to the needs of their patients, nurses must be adequately trained about reproduction and sexuality, natural family planning, and laws affecting human rights. Although nurses are in the forefront of teaching family planning in the Philippines, surveys have indicated that less than a quarter of nurses believe they are adequately educated about natural family planning techniques--a deficiency that must be addressed. Moreover, while almost 100% of professional nurses in the Philippines reject abortion on any grounds, many are providing patients with the IUD and other abortifacient devices. The 1987 Constitution exempts nurses from assisting procedures that are contrary to their personal or religious beliefs, so nurses have protection in refusing to participate in IUD insertions. Nurses are committed to protect rather than destroy life, and the fetus represents an embodied spirit rather than just a mass of cells.     

Health policy and legislation: impact on cancer nursing and care

OBJECTIVES: To review policy and legislative initiatives in which nursing has played roles and to provide insight into trends and issues that characterize the policy and political agendas in which oncology nurses can play advocacy roles in the new millennium. DATA SOURCES: Professional journals, books, newspapers, news magazines, and internet web sites. CONCLUSIONS: Oncology nurses can offer solutions to the dilemmas posed by fiscal realities, unique American values and expectations, and the complexities of cancer care in the United State's market-based health care system. Oncology nurses must assume roles as health policy specialists. IMPLICATIONS FOR NURSING PRACTICE: For nurses to gain acceptance in health policy arenas, individual nurses and groups of nurses must become expert in assessing the environment, the interpretation of cues, and the development and implementation of realistic strategies targeting priority health policy and legislative issues.     

Critical care cardiovascular nurse expert and novice diagnostic cue utilization

AIM: Critical care cardiovascular (CCCV) nursing diagnostic expertise was the focus of this research. The purpose of the study was to compare diagnostic cue utilization between expert and novice CCCV nurses. BACKGROUND: Knowledge related to objective measures of clinical nursing diagnostic expertise would enhance effective and efficient recognition, utilization, and reward of clinical expertise. METHODS: Five CCCV written simulations served as instruments in the study. Diagnostic content areas included left ventricular dysfunction, cardiac tamponade, sepsis, right ventricular failure, and hypovolemia related to internal abdominal haemorrhage. The sample was composed of 23 expert and 23 novice nurses. After reading each simulation, subjects were asked to verbally recall the simulation, give an impression of the predominant problem or diagnosis, and give a diagnostic explanation. Verbal recalls were audio-taped for protocol analysis. Diagnostic accuracy and cue utilization were determined through comparisons of subjects' recalled diagnoses and cues with results from an expert panel review consensus. The major variable was the mean recalled proportion of highly relevant cues to total cues (HRC/TC) on accurately diagnosed simulations. Chi-square analysis revealed that diagnostic accuracy was greater with experts than with novices. Differences between and among simulations, expertise, accuracy and the mean proportion of highly relevant cues to total cues were examined with a 4 x 2 x 2 factorial analysis of variance. RESULTS: When considering all accurately diagnosed simulations, experts had a higher HRC/TC than novices. The major limitations were the use of low fidelity written simulations and virgin verbal protocol methods. CONCLUSION: The findings generally support the idea that the development of diagnostic expertise is associated with the ability to focus on highly relevant cues.     

Program development and maternal-child health consultation: a conceptual model for role enactment in developing countries

Increasingly, nurses are serving as consultants in designing programs to improve the health of individuals in developing countries. In order to be effective, such programs must reflect the socio-cultural context in which identified health problems occur. This can become problematic when nurses work as consultants in cultures with which they are unfamiliar. This paper proposes the use of the World Health Organization's risk strategy approach as a conceptual framework for developing culture specific programs in maternal-infant health. Suggested consultant role behaviors are articulated with this approach and the various phases of program development using an ongoing project in Juarez, Mexico to which the author has provided nursing consultation as a concrete example.