Holzemer W L
Nurs Res. 1986 Jul-Aug;35(4):231-6.
This study was a secondary analysis of an existing data set. The purpose was to explore the problem-solving cognitive structure that nurse practitioners (NPs) used in their assessment and management of a patient with acute pneumonia superimposed over chronic bronchitis, as measured by a patient management problem with 296 items. Results of a factor analysis suggested that the activity of patient education was different from assessment and medical management functions. A discriminant analysis was used to explore which variables correlated with high and low performance on the simulation. Laboratory proficiency scores were the first, patient education management the second best discriminating variables. Routes through the simulation were labeled typical, suggesting the usual sequence of history, physical, laboratory tests, and management, and atypical, suggesting variations on this route. The typical group performed significantly better than the atypical group. At the end of each section within the simulations, subjects were asked to list potential problems and possible medical diagnosis. Subjects were able, with a minimal amount of data, to list correct problems and diagnosis and appeared to proceed through the simulation attempting to confirm or deny those hunches. These findings support the concept that there appears to be a nursing focus within NPs' performance on a clinical simulation.
本研究是对现有数据集的二次分析。目的是通过一个包含296个项目的患者管理问题，探索执业护士（NP）在评估和管理慢性支气管炎合并急性肺炎患者时所使用的解决问题的认知结构。因子分析结果表明，患者教育活动与评估和医疗管理功能不同。采用判别分析来探索哪些变量与模拟中的高绩效和低绩效相关。实验室操作熟练度得分是最佳判别变量，患者教育管理是次佳判别变量。模拟过程中的路径被标记为典型路径，即病史、体格检查、实验室检查和管理的通常顺序，以及非典型路径，即该路径的变体。典型组的表现明显优于非典型组。在模拟的每个部分结束时，要求受试者列出潜在问题和可能的医学诊断。受试者能够凭借最少的数据列出正确的问题和诊断，并且在模拟过程中似乎是在尝试证实或否定这些直觉。这些发现支持了这样一种观念，即在临床模拟中，执业护士的表现似乎存在护理重点。
