Price Amanda, Zulkosky Kristen, White Krista, Pretz Jean
Department of Psychology, Pennsylvania College of Health Sciences, Lancaster, Pennsylvania, USA.
Department of Nursing, Pennsylvania College of Health Sciences, Lancaster, Pennsylvania, USA.
J Adv Nurs. 2017 May;73(5):1147-1157. doi: 10.1111/jan.13202. Epub 2016 Nov 30.
To assess the reliance on intuitive and analytical approaches during clinical decision-making among novice clinicians and whether that reliance is associated with accurate decision-making.
Nurse educators and managers tend to emphasize analysis over intuition during clinical decision-making though nurses typically report some reliance on intuition in their practice. We hypothesized that under certain conditions, reliance on intuition would support accurate decision-making, even among novices.
This study utilized an experimental design with clinical complication (familiar vs. novel) and decision phase (cue acquisition, diagnosis and action) as within-subjects' factors, and simulation role (observer, family, auxiliary nurse and primary nurse) as between-subjects' factor.
We examined clinical decision-making accuracy among final semester pre-licensure nursing students in a simulation experience. Students recorded their reasoning about emerging clinical complications with their patient during two distinct points in the simulation; one point involved a familiar complication and the other a relatively novel complication. All data were collected during Spring 2015.
Although most participants relied more heavily on analysis than on intuition, use of intuition during the familiar complication was associated with more accurate decision-making, particularly in guiding attention to relevant cues. With the novel complication, use of intuition appeared to hamper decision-making, particularly for those in an observer role.
Novice clinicians should be supported by educators and nurse managers to note when their intuitions are likely to be valid. Our findings emphasize the integrated nature of intuition and analysis in clinical decision-making.
评估新手临床医生在临床决策过程中对直觉和分析方法的依赖程度，以及这种依赖是否与准确决策相关。
护士教育工作者和管理人员在临床决策过程中往往更强调分析而非直觉，尽管护士通常表示在实践中会依赖一些直觉。我们假设在某些情况下，即使是新手，依赖直觉也有助于做出准确决策。
本研究采用实验设计，将临床并发症（熟悉与新颖）和决策阶段（线索获取、诊断和行动）作为受试者内因素，将模拟角色（观察者、家属、辅助护士和责任护士）作为受试者间因素。
我们在模拟体验中考察了预执业护理专业最后一学期学生的临床决策准确性。学生们在模拟过程中的两个不同时间点记录了他们对患者出现的临床并发症的推理；一个时间点涉及熟悉的并发症，另一个涉及相对新颖的并发症。所有数据均在2015年春季收集。
尽管大多数参与者更依赖分析而非直觉，但在处理熟悉的并发症时使用直觉与更准确的决策相关，尤其是在引导关注相关线索方面。对于新颖的并发症，使用直觉似乎会妨碍决策，尤其是对于那些处于观察者角色的人。
教育工作者和护士长应支持新手临床医生注意他们的直觉何时可能有效。我们的研究结果强调了直觉和分析在临床决策中的综合性质。
