THE ORGANIZATION OF CLINICAL KNOWLEDGE IN NOVICE AND EXPERT NURSES (PROBLEM-SOLVING).

Description

This study explored the differences in the problem space of novice and expert nurses by examining categorization of problems, the organization of clinical knowledge at the beginning of the problem-solving process, and the reorganization of knowledge during the problem-solving process. Fifteen nursing students and 15 registered nurses were administered two activities: a freesort of 27 clinical situations and a "think-aloud" for three case studies presented in two parts. In Part A, a very general description of patient was provided. In Part B specific data about the patient were provided. In the categorization task, experts sorted the situations into fewer but larger-sized groups than novices. Experts tended to use acuity as their structure to group situations while novices used acuity, medical diagnoses, body systems and patient needs. At the beginning of the problem-solving process, experts and novices had a similar number of chunks in their "think-alouds" though experts had larger chunks. Experts identified a greater number of needs but when the needs were analyzed by types, both groups were similar. Experts requested more additional information, and more specific information than novices. Qualitative analysis indicated several differences between experts and novices. During the problem-solving process no difference in the number of problems identified was found. However, there were major differences in the problem labels and the data used to support the problem inference. Experts tended to use multiple cues to identify problems and used labels reflecting a more abstract level of categorizations. Experts identified a greater number and more complex inferences than novices. However, they both identified similar types of inferences. Qualitatively, experts were more confident and certain in their "think-alouds"; there was greater detail in their thinking; they more often identified nursing actions based on the data presented; and sometimes even questioned medical orders. Experts were more often "insiders", speaking as if they were right there caring for the patient, and were better able to "fill in the story", coming up with plausible explanations for what was happening with the patient.

Subjects