A conceptual treadmill: the need for 'middle ground' in clinical decision making theory in nursing.

This paper explores the two predominant theoretical approaches to the process of nurse decision making prevalent within the nursing research literature: systematic-positivistic approaches as exemplified by information processing theory, and the intuitive-humanistic approach of Patricia Benner. The two approaches' strengths and weaknesses are explored and as a result a third theoretical stance is proffered: the idea of a cognitive continuum. According to this approach the systematic and intuitive theoretical camps occupy polar positions at either end of a continuum as opposed to separate theoretical planes. The methodological and professional benefits of adopting such a stance are also briefly outlined.

[1]  Using intuitive knowledge in the neonatal intensive care nursery , 1987, Holistic nursing practice.

[2]  J. Jacavone,et al.  A descriptive study of nursing judgment in the assessment and management of cardiac pain. , 1992, ANS. Advances in nursing science.

[3]  S. Smith.  An analysis of the phenomenon of deterioration in the critically ill. , 1988, Image--the journal of nursing scholarship.

[4]  J K Itano.  A comparison of the clinical judgment process in experienced registered nurses and student nurses. , 1989, The Journal of nursing education.

[5]  P. S. Wise.  Applied Decision Making for Nurses , 1982 .

[6]  T L Panniers,et al.  A Decision‐Analytic Approach To Clinical Nursing , 1994, Nursing research.

[7]  P. Benner,et al.  Clinical judgment: how expert nurses use intuition. , 1987, The American journal of nursing.

[8]  C. Tanner,et al.  Diagnostic Reasoning Strategies Of Nurses and Nursing Students , 1987, Nursing research.

[9]  L. Rew,et al.  Intuition: A neglected hallmark of nursing knowledge , 1987, ANS. Advances in nursing science.

[10]  M. Aspinall,et al.  Use of a Decision Tree to Improve Accuracy of Diagnosis , 1979, Nursing research.

[11]  P. Kaiser,et al.  Applied decision making for nurses , 1979 .

[12]  P. Field,et al.  The impact of nursing theory on the clinical decision making process. , 1987, Journal of advanced nursing.

[13]  P. Benner.  From novice to expert. , 1984, The American journal of nursing.

[14]  Lynda Juall Carpenito‐Moyet,et al.  Nursing Diagnosis: Application to Clinical Practice 13/e , 1983 .

[15]  E S Berner,et al.  Paradigms and problem-solving: a literature review. , 1984, Journal of medical education.

[16]  Maryann Papanier Wells.  Diagnostic Reasoning in Nursing , 1985 .

[17]  Intuition and the nursing process. , 1992, Journal of continuing education in nursing.

[18]  Kenneth Louis. Cianfrani.  THE INFLUENCE OF AMOUNTS AND RELEVANCE OF DATA ON IDENTIFYING HEALTH PROBLEMS. , 1982 .

[19]  H. M. Jenkins.  A research tool for measuring perceptions of clinical decision making. , 1985, Journal of professional nursing : official journal of the American Association of Colleges of Nursing.

[20]  S. Corcoran,et al.  Task Complexity and Nursing Expertise as Factors In Decision Making , 1986, Nursing research.

[21]  K R Hammond,et al.  Clinical inference in nursing: revising judgments. , 1967, Nursing research.

[22]  D. Lamond,et al.  The cognitive component of nursing assessment: an analysis. , 1995, Journal of advanced nursing.

[23]  L. Rew,et al.  Nursing as a practice rather than an art or a science. , 1997, Nursing outlook.

[24]  K. Kelly.  AN APPROACH TO THE STUDY OF CLINICAL INFERENCE IN NURSING: Part III. Utilization of the “Lens Model” Method to Study the Inferential Process of the Nurse , 1964 .

[25]  M. Eraut.  Learning To Use Scientific Knowledge in Education and Practice Settings: An Evaluation of the Contribution of the Biological Behavioural and Social Sciences to Pre-Registration Nursing and Midwifery Programmes. Researching Professional Education. Research Reports Series Number 3. , 1995 .

[26]  R. Persaud.  Philosophy of science , 1992, The Lancet.

[27]  P. Gerrity.  Perception in nursing: The value of intuition , 1987, Holistic nursing practice.

[28]  L. Phillips,et al.  A decision-making model for diagnosing and intervening in elder abuse and neglect. , 1985, Nursing research.

[29]  S. Engberg,et al.  Content and process in clinical decision-making by nurse practitioners. , 1992, Image--the journal of nursing scholarship.

[30]  Hubert L. Dreyfus,et al.  Mind over Machine: The Power of Human Intuition and Expertise in the Era of the Computer , 1987, IEEE Expert.

[31]  K. Luker,et al.  An exploratory study of the sources of influence on the clinical decisions of community nurses. , 1992, Journal of advanced nursing.

[32]  S J Grobe,et al.  A descriptive analysis of experienced nurses' clinical reasoning during a planning task. , 1991, Research in nursing & health.

[33]  S. Salanterä,et al.  Decision-making models of Finnish nurses and public health nurses. , 1995, Journal of advanced nursing.

[34]  P. Klopovich.  NURSING DIAGNOSIS: PROCESS AND APPLICATION , 1982 .

[35]  J Dowie,et al.  Clinical intuition and clinical analysis: expertise and the cognitive continuum , 1988 .

[36]  C H McGuire,et al.  Medical problem-solving: a critique of the literature. , 1985, Journal of medical education.

[37]  B. Fischhoff,et al.  Hypothesis Evaluation from a Bayesian Perspective. , 1983 .

[38]  L. Radwin.  Research on diagnostic reasoning in nursing. , 1990, Nursing diagnosis : ND : the official journal of the North American Nursing Diagnosis Association.

[39]  J. Hamers,et al.  Diagnostic process and decision making in nursing: a literature review. , 1994, Journal of professional nursing : official journal of the American Association of Colleges of Nursing.