Faculty of Nursing, Université de Montréal, 2375 Chemin De la Côte-Sainte-Catherine, Montreal, Quebec H3C 3J7, Canada; Montreal Heart Institute Research Center, 5000 rue Bélanger, Montreal, Quebec H1T 1C8, Canada.
Faculty of Nursing, Université de Montréal, 2375 Chemin De la Côte-Sainte-Catherine, Montreal, Quebec H3C 3J7, Canada.
Nurse Educ Pract. 2022 Oct;64:103448. doi: 10.1016/j.nepr.2022.103448. Epub 2022 Sep 8.
To explore the knowledge content and structure of nursing students' decision-making in a high-stake clinical situation of postpartum hemorrhage using the Recognition-Primed Decision Model.
According to research on clinical judgment, a nurse's expectations for a patient situation are central to the clinical decision-making process. However, little research has addressed the expectation concept and its relationship with the nurse's knowledge. Grounded in the naturalistic decision-making paradigm, the Recognition-Primed Decision Model provides a potential framework to describe the content and structure of nurses' knowledge and expectations as they unfold in high-stake clinical situations, such as postpartum hemorrhage. As it is typically used in studies of expert decision-making, it is crucial to test the adequacy of the Model with a student population and refine the research methods for using this framework.
Descriptive design where qualitative data were analyzed using qualitative and quantitative methods.
A convenience sample of 53 students enrolled in a maternal and child health course in the Fall of 2021 was formed. As part of an online exercise to prepare for a simulation, they read a vignette presenting the story of a woman experiencing postpartum hemorrhage and recorded their answers to questions designed to probe their decision-making. Recordings were transcribed and subjected to content analysis based on the four components of recognition according to the Recognition-Primed Decision Model (i.e., cues, expectations, goals and actions).
All participants recognized the postpartum hemorrhage. Their knowledge was organized into clusters representing the potential causes (i.e., tone, trauma, tissue and thrombin) and consequences (i.e., hemodynamic instability) of postpartum hemorrhage, as well as other potential issues (e.g., pain and comfort, baby and partner, infection). Although students could identify relevant cues and actions, they had difficulties articulating their longer-term goals and expectations for the mother and care outcomes.
This study showed the potential of the Recognition-Primed Decision Model to organize the content and structure of the knowledge that supported nursing students' decision-making in a high-stake situation. The findings suggest that their knowledge disproportionately focuses on the cause-and-effect relations between cues and actions. They invite further consideration of longer-term goals and expectations in nursing education to prepare students to anticipate events and assess patient responses appropriately.
运用识别-启动决策模型，探讨高风险产后出血临床情境下护理学生决策的知识内容和结构。
根据临床判断研究，护士对患者情况的预期是临床决策过程的核心。然而，很少有研究涉及预期概念及其与护士知识的关系。基于自然决策范式，识别-启动决策模型为描述护士在高风险临床情境（如产后出血）中知识和预期的内容和结构提供了一个潜在框架。由于该模型通常用于专家决策研究，因此必须用学生群体来检验模型的充分性，并改进使用该框架的研究方法。
描述性设计，使用定性和定量方法对定性数据进行分析。
2021 年秋季，组成了一个由 53 名参加母婴保健课程的学生组成的方便样本。作为在线模拟准备练习的一部分，他们阅读了一个介绍一名经历产后出血的女性故事的小插曲，并记录了他们对旨在探查其决策的问题的回答。记录被转录，并根据识别-启动决策模型的四个组成部分（即线索、预期、目标和行动）进行内容分析。
所有参与者都识别出了产后出血。他们的知识组织成了代表产后出血潜在原因（即音调、创伤、组织和凝血酶）和后果（即血流动力学不稳定）以及其他潜在问题（如疼痛和舒适度、婴儿和伴侣、感染）的集群。尽管学生能够识别相关线索和行动，但他们难以表达对母亲和护理结果的长期目标和预期。
这项研究表明，识别-启动决策模型有可能组织支持护理学生在高风险情境下决策的知识内容和结构。研究结果表明，他们的知识过分侧重于线索和行动之间的因果关系。它们进一步考虑了护理教育中的长期目标和预期，以准备学生适当预测事件和评估患者反应。
