The Department of Nursing, Faculty of Health and Welfare Sciences, University of Haifa, Israel.
The Department of Nursing, Faculty of Health and Welfare Sciences, University of Haifa, Israel.
Int J Nurs Stud. 2017 Sep;74:24-33. doi: 10.1016/j.ijnurstu.2017.05.009. Epub 2017 May 20.
Shared mental models are crucial for constructing mutual understanding of the patient's condition during a clinical handover. Yet, scant research, if any, has empirically explored mental models of the parties involved in a clinical handover.
This study aimed to examine the similarities among mental models of incoming and outgoing nurses, and to test their accuracy by comparing them with mental models of expert nurses.
A cross-sectional study, exploring nurses' mental models via the concept mapping technique.
40 clinical handovers.
Data were collected via concept mapping of the incoming, outgoing, and expert nurses' mental models (total of 120 concept maps). Similarity and accuracy for concepts and associations indexes were calculated to compare the different maps.
About one fifth of the concepts emerged in both outgoing and incoming nurses' concept maps (concept similarity=23%±10.6). Concept accuracy indexes were 35%±18.8 for incoming and 62%±19.6 for outgoing nurses' maps. Although incoming nurses absorbed fewer number of concepts and associations (23% and 12%, respectively), they partially closed the gap (35% and 22%, respectively) relative to expert nurses' maps. The correlations between concept similarities, and incoming as well as outgoing nurses' concept accuracy, were significant (r=0.43, p<0.01; r=0.68 p<0.01, respectively). Finally, in 90% of the maps, outgoing nurses added information concerning the processes enacted during the shift, beyond the expert nurses' gold standard.
Two seemingly contradicting processes in the handover were identified. "Information loss", captured by the low similarity indexes among the mental models of incoming and outgoing nurses; and "information restoration", based on accuracy measures indexes among the mental models of the incoming nurses. Based on mental model theory, we propose possible explanations for these processes and derive implications for how to improve a clinical handover.
共享心智模型对于构建临床交接过程中对患者病情的共同理解至关重要。然而，很少有研究（如果有的话）从实证角度探讨临床交接各方的心智模型。
本研究旨在检验新老护士心智模型的相似性，并通过与专家护士的心智模型进行比较来检验其准确性。
这是一项横断面研究，通过概念映射技术探索护士的心智模型。
40 次临床交接。
通过对新老护士以及专家护士的心智模型进行概念映射收集数据（共 120 个概念图）。计算概念和关联指标的相似性和准确性，以比较不同的地图。
约五分之一的概念出现在新老护士的概念图中（概念相似性=23%±10.6）。新老护士的概念准确性指数分别为 35%±18.8 和 62%±19.6。尽管新入职护士吸收的概念和关联较少（分别为 23%和 12%），但与专家护士的地图相比，他们部分缩小了差距（分别为 35%和 22%）。概念相似性与新入职和离职护士概念准确性之间的相关性均具有统计学意义（r=0.43，p<0.01；r=0.68，p<0.01）。最后，在 90%的地图中，离职护士除了专家护士的黄金标准外，还添加了与交接班过程中执行的流程相关的信息。
交接过程中发现了两个看似矛盾的过程。“信息丢失”，由新老护士心智模型之间的低相似性指数捕捉到；“信息恢复”，基于新入职护士心智模型的准确性指数。根据心智模型理论，我们对这些过程提出了可能的解释，并得出了如何改进临床交接的启示。
