Hamers J P, van den Hout M A, Halfens R J, Abu-Saad H H, Heijltjes A E
Department of Nursing Science, Universiteit Maastricht, The Netherlands.
Int J Nurs Stud. 1997 Oct;34(5):325-34. doi: 10.1016/s0020-7489(97)00024-2.
This article describes a study examining the influence of expertise on nurses' pain assessments and decisions regarding pharmacological interventions in children. In an experimental design, novices (n = 271), intermediates (n = 222), and experts (n = 202) in pediatric nursing, various cases were presented. Each case consisted of a combination of a vignette and a video. Subjects were asked (1) to assess the child's pain intensity, (2) to specify their confidence in the assessment, and (3) to state whether or not they would administer a non-narcotic analgesic. The results indicated that expertise did not influence assessments of pain intensity. However, expertise did have a distinct impact on both the subjects' confidence in their decisions, and the decision to administer analgesics. Experienced nurses were most confident and were most inclined to administer analgesics. The findings of this study are placed in the context of a general theory on the development of expertise, which assumes that experts' decision-making is based on cognitive structures that describe features of prototypical or even actual patients, so called "illness scripts". From this theory it can be deduced that mainly practical experience is responsible for the (lack of) differences in decision-making between novices, intermediates and experts.
本文描述了一项研究，该研究考察了专业知识对护士疼痛评估以及关于儿童药物干预决策的影响。在一项实验设计中，向儿科护理新手（n = 271）、中级护士（n = 222）和专家（n = 202）呈现了各种病例。每个病例都由一个案例 vignette 和一段视频组成。受试者被要求：（1）评估儿童的疼痛强度；（2）明确他们对评估的信心；（3）说明他们是否会给予非麻醉性镇痛药。结果表明，专业知识并未影响疼痛强度评估。然而，专业知识确实对受试者对其决策的信心以及给予镇痛药的决策产生了显著影响。经验丰富的护士最有信心，也最倾向于给予镇痛药。本研究结果置于专业知识发展的一般理论背景下，该理论假定专家的决策基于描述典型甚至实际患者特征的认知结构，即所谓的“疾病脚本”。从该理论可以推断，新手、中级护士和专家在决策上（缺乏）差异主要是由实践经验造成的。
