Nursing Department, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia.
PLoS One. 2022 Jun 9;17(6):e0269624. doi: 10.1371/journal.pone.0269624. eCollection 2022.
Uncertainty and time pressure in emergency departments add a challenge to the rational decision-making process, specifically when encountering a critical patient who requires a prompt response. However, there has been little attempt to develop a mental structure model to understand the thought processes and identify cognitive weaknesses points in nurses' decision-making. A better understanding can inform changes in both practice learning strategies and decision-making in emergency department. This study aims to better understand how newly employed nurses process information and initiate actions in emergency situations characterized by time constraints and uncertainty.
Participants worked under time pressure and uncertainty to solve a simulated shock case by establishing an assumption of what type of shock the simulated patient might have and its cause. An 8-minute window was available to initiate action. Following the simulation, a retrospective think-aloud interview was conducted.
Participants' ability to identify the category of shock was better than their ability to identify the underlaying cause of the shock. This influenced their ability to intervene correctly. Participants' thinking process in an emergency situation can be organized using ABCDE acronym as follows: (1) awareness of the situation, followed by, an instant (2) generation of beliefs (presumption), (3) controlling the consequence (first-line management action), (4) involvement in deliberate thinking and, finally (5) execution, actions (second-line management action). The cognitive weakness was mainly noticed during the first-line management action when participants were involved in immediate lifesaving activities.
Classification of the steps involved in decision-making when encountering emergency situations may provide insight into the strengths and weaknesses of the thought process at different stages. Further studies are required.
急诊科的不确定性和时间压力给理性决策过程增加了挑战，尤其是在遇到需要快速反应的危急患者时。然而，目前很少有人试图开发一种心理结构模型来理解护士决策过程中的思维过程和认知弱点。更好地了解这一点可以为实践学习策略和急诊科决策的改变提供信息。本研究旨在更好地了解新入职护士在时间限制和不确定性的紧急情况下如何处理信息并采取行动。
参与者在时间压力和不确定性下通过建立对模拟患者可能患有哪种类型休克及其原因的假设来解决模拟休克病例。有 8 分钟的时间窗口可以采取行动。模拟结束后，进行回溯性出声思维访谈。
参与者识别休克类别的能力优于识别休克根本原因的能力。这影响了他们正确干预的能力。参与者在紧急情况下的思维过程可以使用 ABCDE 缩写组织如下：（1）对情况的意识，其次是瞬间（2）信念的产生（假设），（3）控制后果（一线管理行动），（4）参与深思熟虑，最后（5）执行，行动（二线管理行动）。认知弱点主要在一线管理行动中被注意到，此时参与者参与立即的救生活动。
对遇到紧急情况时决策所涉及步骤的分类可以深入了解不同阶段思维过程的优缺点。需要进一步研究。
