The integration of patient cues, nursing knowledge and clinical judgements by Intensive Care Unit nurses in simulated situations of urgency.

Abstract

Nurses who work in critical care areas must learn how to make effective clinical judgements about patients under a variety of conditions. The process of making clinical judgements includes attending to cues from the patient and integrating prior nursing knowledge. The study examined this process within the context of simulated patient instability, in which there is minimal time for the nurse to reflect upon the judgements made. Registered Nurses from four Intensive Care Units (ICU) within the Regional Municipality of Ottawa-Carleton were randomly selected and invited to participate in the study and twenty-four nurses participated. The study employed a 'think aloud' method and verbal protocol analysis to examine the number and types of patient cues from six case studies, that were attended to by the nurses. The relationship between cue recognition, domain-specific knowledge and clinical judgements was examined. Nurses verbalized a low percentage of the available patient cues, knowledge, and clinical judgements. A significant and moderately positive correlation was found between cue recognition and knowledge verbalized, knowledge verbalized and clinical judgements made and cue recognition and clinical judgements made. The number of knowledge items verbalized were positively correlated with the level of ICU (tertiary or secondary), with higher levels of knowledge items verbalized found in the nurses working in the two tertiary level ICUs. The results of this study have implications for all nurses as well as those in advanced practice roles. Case reviews, as part of ongoing education, can encourage the nurses to examine and improve their clinical judgements. Teaching nurses to become reflective practitioners would provide them with tools to examine and improve their own process of making clinical judgements. Ensuring that nurses have current nursing knowledge can provide a stronger basis for their clinical judgements. Areas for further research are described.