A comparison of novice and expert nurses' cue collection during clinical decision-making: Verbal protocol analysis

Background: The type of cues used during clinical decision-making contexts is not well understood. Further, there are conflicting findings in relation to how novice and expert nurses use cues. Objective: The aim of this study was to determine if there were differences between novice and expert nurses in the range and type of cues selected as well as how cues were clustered together when making clinical decisions while caring for post-operative patients in an Intensive Care Unit. Method: The sample consisted of four novice and four expert nurses caring for patients post Abdominal Aortic Aneurysm surgery in an Intensive Care Unit. Data were collected using a think aloud (TA) process while participants cared for patients, followed by retrospective interviewing, to generate verbal protocols. The verbal protocols were analysed using content analysis to examine various aspects of decision-making, including number and type of cues used and cue clustering. The decision tasks attended in the real world of practice were described in detail to illuminate the use of cues in context. Results: Expert nurses collected a wider range of cues than novice nurses, almost twice as many different cues. The expert nurses also clustered more cues together to identify patient status when making decisions. Expert nurses were more proactive in collecting relevant cues and anticipating problems that may help identify patient problems. Conclusions: In the real world of practice expert nurses collect a broader range of cues to assess patient status than novice nurses. This differs to expert nurses Cue collection in simulations where expert nurses may select only those Cues that are necessary for the identified problem. This difference, if identified in other studies, may have important implications for nursing research and education. (C) 2009 Elsevier Ltd. All rights reserved.