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Registered nurses' thinking strategies on malnutrition and pressure ulcers in nursing homes: a scenario-based think-aloud study
Örebro University, School of Health and Medical Sciences.
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2011 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 17-18, p. 2425-2435Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this study was to explore the thinking strategies and clinical reasoning processes registered nurses use during simulated care planning for malnutrition and pressure ulcers in nursing home care.

Background: Clinical reasoning is an essential component of nursing practice. Registered nurses’ thinking strategies and clinical reasoning have received limited attention in nursing science. Further research is needed to understand registered nurses’ clinical reasoning, especially for prevention of malnutrition and pressure ulcers as they are important quality indicators of resident care in nursing homes.

Design: A qualitative explorative design was used with a think-aloud interview technique.

Methods: The transcribed verbalisations were analysed with qualitative deductive content analysis. Data were collected during six months in 2007-2008 from 30 registered nurses at nine nursing homes in Norway.

Results: The registered nurses used a variety of thinking strategies, but there were differences in the frequency of use of the different strategies. The three most commonly used thinking strategies were ‘making choices’, ‘forming relationships’ and ‘drawing conclusions’. None of the nurses performed a structured risk assessment of malnutrition or pressure ulcers. Registered nurses started with assessing data from the scenarios, but after a short and elementary assessment they moved directly to planning.

Conclusion: Many different thinking strategies were used in registered nurses’ clinical reasoning for prevention of malnutrition and pressure ulcers. The thinking strategy ‘making choices’ was most commonly used and registered nurses’ main focus in their reasoning was on planning nursing interventions. Relevance to clinical practice. This study showed that most of the registered nurses go directly to planning when reasoning clinically about residents in nursing homes. A lack of systematic risk assessments was identified. The insight gained from this study can be used to recommend improvements in tools designed for nursing homes to support the registered nurses.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2011. Vol. 20, no 17-18, p. 2425-2435
Keywords [en]
clinical reasoning, content analysis, pressure ulcers, registered nurses, think-aloud method, thinking strategies
National Category
Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:oru:diva-17022DOI: 10.1111/j.1365-2702.2010.03578.xISI: 000293748900005PubMedID: 21689181Scopus ID: 2-s2.0-80051573153OAI: oai:DiVA.org:oru-17022DiVA, id: diva2:439374
Available from: 2011-09-07 Created: 2011-09-02 Last updated: 2020-01-28Bibliographically approved
In thesis
1. Computerized decision support system in nursing homes
Open this publication in new window or tab >>Computerized decision support system in nursing homes
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to study the thinking strategies and clinical reasoning processes of registered nurses (RNs) and to implement and test a computerized decision support system (CDSS) integrated into the electronic health care record (EHR) to improve patient outcomes, i.e. to prevent pressure ulcers (PUs) and malnutrition among residents in nursing homes. 

A think-aloud (TA) study with a purposeful sample of RNs (n=30) was conducted to explore their thinking strategies and clinical reasoning (Paper I). A quasi-experimental study with a convenience sample of residents (at baseline, n=491 and at follow-up, n=480) from nursing homes (n=15) allocated into two intervention groups and one control group was carried out in 2007 and 2009 (Paper II). In Paper III residents’ records were reviewed with three instruments. Nursing personnel (n=25) from four nursing homes that had used the CDSS for eight months were interviewed and the CDSS was tested by nursing personnel (n=5) in two usability evaluations (Paper IV).

The results showed that the RNs used a variety of thinking strategies and a lack of systematic risk assessment was identified (Paper I). The proportion of malnourished residents decreased significantly in one of the intervention groups after implementing the CDSS, however there were no differences between the groups (Paper II). The CDSS resulted in more complete and comprehensive documentation of PUs and malnutrition (Paper III). The nursing personnel considered ease of use, usefulness and a supportive work environment as the main facilitators of CDSS use in nursing homes. Barriers were lack of training, resistance to using computers and limited integration of the CDSS within the EHR system (Paper IV). In conclusion, the findings support integrating CDSSs into the EHR in nursing homes to support the nursing personnel.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2012. p. 95
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 36
Keywords
Computerized decision support, intervention study, malnutrition, nursing documentation, pressure ulcer, qualitative content analysis, think-aloud interviews, usability evaluation
National Category
Medical and Health Sciences Nursing Information Systems
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-21673 (URN)978-91-7668-857-1 (ISBN)
Public defence
2012-04-20, Hörsal P2, Prismahuset, Örebro universitet, Fakultetsgatan 1, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2012-02-16 Created: 2012-02-16 Last updated: 2018-01-12Bibliographically approved

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Fossum, MariannGöransson, Katarina E.Ehnfors, MargaretaEhrenberg, Anna

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