An investigation into, and an intervention designed, difficulties third level nursing students have when making clinical judgements

Abstract

In order to establish the specific difficulties experienced by students, the researcher tested their clinical judgement skills on a fixed task. Interviews were conducted using simulated clinical scenarios as problem statements and additional information was provided in the form of patient records. Protocol analysis was done by using Feuerstein's cognitive map as a frame of reference. (Feuerstein, 1980) The results indicated that students displayed some cognitive operations but that there was little evidence of structured thought. In order to streamline the students' approach and provide some measure of control, they were exposed to a "thinking procedure.” that resembled Landa's problem solving heuristic. (Landa, 1976) They were allowed to internalize the heuristic procedure through practise, using the peer-pair think-aloud method described by Whimbey and Lockhead (1982).

Once again individual interviews were conducted to evaluate, the effectiveness of the intervention. Perkins & Salomon (1989) stressed the importance of this type of evaluation in measuring the value of teaching a domain specific heuristic. The results of the study showed an improvement in the students' approach and management of clinical problems. The peer-pair sessions facilitated group interaction. Students also displayed a transferral of the judgement skills to real life situations. These findings were reflected by the positive response of participants to an evaluative questionnaire.