Nursing scripts and the organizational influences on critical thinking: report of a study of neonatal nurses’ clinical reasoning

Authors

  • Jennifer Greenwood RN RM DipN RNT DipEd MEd PhD FRCNA,

    1. Professor of Nursing, Western Sydney Area Health Service/University of Western Sydney, Nepean Professorial Nursing Unit, Westmead Hospital, Westmead, Australia,
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  • Jennifer Sullivan RN CM BA MAppSc(Nurs),

    1. Lecturer, Faculty of Health, University of Western Sydney, Campbelltown, Australia,
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  • Kaye Spence RN BEd(N) MN(UTS) MCN(NSW) MRCNA,

    1. Clinical Nurse Consultant — Neonatalogy, Royal Alexandra Hospital for Children, Sydney, Australia,
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  • Margaret McDonald RN RM NICC GradDipNEd MA

    1. Business Analyst, Business Information Management Unit, Territory Health Services, Darwin, Australia
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Jennifer Greenwood Professorial Nursing Unit, Level 2, Westmead Hospital, Westmead, NSW 2145, Australia. E-mail: jennieg@admin.wsahs.nsw.gov.au

Abstract

Nursing scripts and the organizational influences on critical thinking: report of a study of neonatal nurses’ clinical reasoning

During 1995–1997 a study was undertaken to explore the extent to which theoretical knowledge acquired through a distance education programme in neonatal nursing was brought to bear in the real-world clinical reasoning of course participants. The study utilized a think aloud technique and included both concurrent (on-the-job) and retrospective verbal reports at 0, 6 and 12 months into the programme. Participants (n=4) were also interviewed individually on completion of the study. Results indicated that important inconsistencies existed between participants’ theoretical knowledge and their practice; they also pointed to some organizational influences on these theory–practice inconsistencies. Script (or schema) theory provided a useful explanatory framework for these results. The paper includes a brief description of data collection and analysis techniques; its main emphasis, however, is on these theory–practice inconsistencies and their explanation in terms of the nature and acquisition of nursing practice scripts. The implications of nursing scripts for the promotion of critical thinking and evidence-based practice are discussed.

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