Clinical diagnosis in nursing : an analysis of knowledge structures and decision making strategies

Abstract

The verbal protocol technique forms the basis of this research on clinical diagnosis in nursing. In this technique, a nurse subject, by asking specific questions about a patient, obtains the information required to diagnose patient problems. The knowledge area for the study was the assessment of pressure sore risk. Two sample groups were chosen for comparison. An 'Expert' group was made up of ward sisters while a 'Novice' group consisted of third year student nurses. Each subject undertook 3 verbal protocols. These progressed from, firstly, having no special instructions or interruptions given to, finally, being highly structured as the researcher questioned in depth about the problem solving strategy being used. On average, the 'Experts' (E group) gave longer protocols than the 'Novices' (N Group), mainly due to the difference in the number of COLLECT (ie. Data collecting) operations. The experts often failed to make use of the extra data they had collected and also tended to make more inferences from outside the data. Problem Behaviour Graphs were built up from the results. These demonstrated that experts tend to use a model of simultaneous data gathering and interpretation of data whereas novice subjects collect all the necessary data first. Vocabulary analysis showed approximately 50% of the language devoted to technical terms in both groups. The data gleaned from the expert group protocols was incorporated into a small knowledge based system which was then tested. It correlated well with the estimated risk of pressure sores given by subjects in clinical areas and was well received by the nurses using it. Recommendations were put forward for a professional education which encourages the techniques of clinical nursing diagnosis shown by the expert group in this research and for the nursing profession to take control of the introduction of computer technology into clinical practice

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