Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
J Clin Nurs. 2012 Mar;21(5-6):870-9. doi: 10.1111/j.1365-2702.2011.03935.x. Epub 2012 Jan 13.
The aim of the study was to examine differences in clinical reasoning among novice, experienced and specialist paediatric nurses.
Highly specialised paediatric care requires specific knowledge and ongoing skill performance of the nurses employed. There is a lack of research in how paediatric nurses manage the daily care problems they encounter and how they acquire the skills required to give patients the best possible care. More knowledge is needed about how paediatric nurses with different experience and education reason and communicate about paediatric patient situations.
The study was based on six recorded group discussions of a fictitious, but realistic paediatric case. Three categories of nurses: novices (n = 7), experienced (n = 7) and specialists (n = 7) from a paediatric hospital participated. A qualitative content analysis approach was chosen to examine differences in clinical reasoning.
Several themes were uncovered: child's social situation, child abuse and the child's illness, qualitative differences emerged in how the nurses discussed the case. Three approaches were identified: a task-oriented approach (novices and experienced), an action-oriented approach (novices and experienced) and hypothesis-oriented approach (specialists) while discussing the case.
When comparing nurses in three competence groups, it was established that the groups with extensive experience and specialist education reasoned differently than the other groups. Between the novice and experienced groups, no obvious differences were found. Thus, the importance of experience alone for the development of competence is still an open question. Experience combined with further education appears important for developing professional competence in paediatric care.
Nurses' reasoning in clinical paediatric care is related to experience and training.
本研究旨在探讨新手、经验丰富和专科儿科护士在临床推理方面的差异。
高度专业化的儿科护理需要护士具备特定的知识和持续的技能表现。对于儿科护士如何管理他们遇到的日常护理问题以及如何获得为患者提供最佳护理所需的技能，研究还很缺乏。我们需要更多的知识来了解具有不同经验和教育背景的儿科护士如何推理和交流儿科患者的情况。
本研究基于对虚构但现实的儿科病例的六次记录的小组讨论。来自一家儿科医院的新手（n = 7）、经验丰富的护士（n = 7）和专科护士（n = 7）参与了研究。选择了定性内容分析方法来检查临床推理方面的差异。
揭示了几个主题：孩子的社会状况、儿童虐待和孩子的疾病，护士在讨论案例时出现了定性差异。确定了三种方法：任务导向方法（新手和经验丰富的护士）、行动导向方法（新手和经验丰富的护士）和假设导向方法（专科护士），在讨论案例时。
在比较三个能力组的护士时，发现经验丰富和专科教育的护士群体与其他群体的推理方式不同。新手和经验丰富的群体之间没有明显的差异。因此，仅经验对能力发展的重要性仍然是一个悬而未决的问题。经验与进一步教育相结合对于发展儿科护理的专业能力似乎很重要。
护士在临床儿科护理中的推理与经验和培训有关。
