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Aladefe

Aladefe

OCTUBRE 2017 N° 4 Volumen 7

Analyses of models and skills for clinical decision-making in nursing graduates

Section: Originals

How to quote

Quezada Ramírez Y, Morán Peña L, González Ramírez P. Análisis de modelos y habilidades para la toma de decisiones clínicas en egresados de enfermería. Rev. iberoam. Educ. investi. Enferm. 2017; 7(4):18-26.

Authors

1 Yarisbeth Quezada Ramírez, 2 Laura Morán Peña, 3 Patricia González Ramírez

Position

1 Mtra. en Enf. Profesora de carrera de tiempo completo. Escuela Nacional de Enfermería y Obstetricia. Universidad Nacional Autónoma de México (ENEO-UNAM). México.2 Dra. en Ciencias de la Educación. Profesora Titular C de tiempo completo. ENEO-UNAM. México. 3 Secretaria general. ENEO-UNAM. México.

Contact email: yarisquezada@gmail.com

Abstract

Introduction/purpose: clinical decision-making (CDM) is a complex process used by nurses to select interventions aimed at offering quality care. Models and cognitive skills underlie decision-making and infiltrate the process from analytical to intuitive levels.
Purpose: to identify cognitive model and skills used in prevailing clinical decision-making in nursing graduates working in social services.
Methods: a descriptive quantitative cross-sectional study in 119 nursing graduates involved in social services in healthcare institutions at the three different levels. The tool “Decision-making in nursing” (Lauri and Salanterä, 2002) with 56 items in a Likert-type scale was                      used to identify the prevailing cognitive model and skills for CDM step by step.
Results: overall, a prevailing analytic-intuitive model was observed (67%). In step by step results, "data management" showed an analytic-intuitive model in 97% (slow, non-integral, non-simultaneous), whereas "implementation and assessment of patient condition" showed a predominant intuitive-analytical model (69%). The perception of skills development for CDM was only 60% (mean = 166 ± 4.765 in 280).
Conclusions: analytical-intuitive model was the prevailing one, and represents the beginner step in Benner's model; when CDM skills are incompletely developed, clinical problems are partly identified, and an impact on healthcare quality results. This is an interest focus for educational and healthcare institutions, and educational strategies to promote them are essential.

Keywords:

clinical decision-making; cognitive models; cognitive skills; new nursing graduates and nursing graduates

Versión en Español

Título:

Análisis de modelos y habilidades para la toma de decisiones clínicas en egresados de enfermería

Artículo completo no disponible en este idioma / Full article is not available in this language

Bibliography

  1. Bibliografía
    1.    Latapí P. Conferencia magistral al recibir el doctorado Honoris Causa de la Universidad Autónoma Metropolitana. Instituto de Investigaciones sobre la Universidad y la Educación. Perfiles Educativos. 2007; 29(115):113-22.
    2.    World Health Organization. Global strategic directions for strengthening nursing and midwifery 2016-2020. Geneva, Switzerland: WHO; 2016.
    3.    Castrillón-Agudelo MC. Orientaciones para la Educación Inicial de Enfermería en las Américas: hacia el 2020. Organización Panamericana de la Salud. Documento en Proceso de Elaboración; 2007.
    4.    Frenk J, Chen L, Bhutta ZA, Cohen J, Evans T, Fineberg H, et al. Health Professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010; 376(9756):1923-58.
    5.    Institute of Medicine. The Future of Nursing Leading Change, Advancing Health. Washington: National Academy of Sciences; 2010.
    6.    Lauri S, Salanterä S. Developing an Instrument to Measure and Describe Clinical Decision Making in Different Nursing Fields. Journal of Professional Nursing. 2002; 18(2):93-100.
    7.    Tiffen J, Corbridgen SJ, Slimer L. Enhancing Clinical Decision Making: Development of a Contiguous Definition and Conceptual Framework. Journal Professional Nursing 2014.
    8.    Standing M. Clinical decision making skill on the developmental journey from student to Registered Nurse: a longitudinal inquiry. Journal of Advanced Nursing. 2007; 60(3):257-69.
    9.    Hammond K. Judgment and decision making. An interdisciplinary reader. Coherence and Correspondence. Theories in Judgment and decision making. 2nd ed. UK: Cambrige University Press; 1986. p. 53-66.
    10.    Hammond K. Coping with uncertainty. The Rivalry Between Intuition and Analysis. In: Hammond KR. Human Judgment and Social Policy. Irreducible Uncertainty, Inevitable Error, Unavoidable injustice. New York: Oxford University Press; 1996. p. 60-93.
    11.    Hammond K. The Cognitive Continuum. Theory of judgment judgment under stress. New York: Oxford University Press; 2000.
    12.    Cader R, Campbell S, Watson D. Cognitive Continuum Theory in nursing decision-making. Journal of Advanced Nursing. 2005; 49(4): 397-405.
    13.    Dreyfus H, Dreyfus S. Mind over machine: the power of human intuition and the expertise in the era of the computer; 1986.
    14.    Benner P. From Novice to Expert. American Journal of Nursing. 1982; 82(3):402-7.
    15.    Benner P. Práctica progresiva en enfermería. Manual de comportamiento profesional. Grijalbo; 1987.
    16.    Benner P, Tanner C. Clinical judgment: how expert nurses use intuition. American Journal of Nursing. 1987; 87(1):23-31.
    17.    Higgs J, Jones MA, Loftus S, Christensen N. Clinical reasoning and clinical decision making nature and context. In: Higgs J, Jones MA, Loftus S, Christensen N. Clinical reasoning in the health professions. 3rd ed. Elsevier Health Science; 2008. p. 3-18.
    18.    Molina P, Jara P. El saber práctico en enfermería. Rev Cubana Enfermer. 2010; 26(2).
    19.    Valenzuela S, Vera R. Formando docentes. La toma de decisiones clínicas. Universidad de La Sabana. Aquichan. 2008; 8(2):144-5.
    20.    Wieland DM, Altmiller GM, Dorr MT, Wolf ZR. Situational transitions: education. clinical transition of baccalaureate nursing students during preceptored, pregraduation practicums. In: Meleis AI. Transitions theory middle range and situation specific theories in nursing research and practice. New York, NY: Springer Publishing Company; 2010. p. 293-300.
    21.    Juárez F, Villatoro J, López EK. Apuntes de estadística inferencial. Ciudad de México: Instituto Nacional de Psiquiatría Ramón de la Fuente; 2002.
    22.    National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. Belmont Report: ethical principles and guidelines for the protection of human subjects of research. Washington, DC: Government Printing. Office; 1983.
    23.    Benner P. From Novice to Expert. Excellence and Power in Clinical Nursing Practice. Publishing Company; 1984.
    24.    Torunn-Bjørk I, Hamilton GA. Clinical decision making of Nurses Working in Hospital Settings. Nursing Research and Practice; 2011.
    25.    Alfaro-Lefrevre R. Aplicación del proceso enfermero. Fomentar el cuidado en colaboración. Barcelona: Elsevier; 2003.