Critical care cardiovascular nurse expert and novice diagnostic cue utilization


Rosalyn R. Reischman, College of Nursing, University of Florida, 2102 College Street, Jacksonville, FL 32204, USA. E-mail:


Aim.  Critical care cardiovascular (CCCV) nursing diagnostic expertise was the focus of this research. The purpose of the study was to compare diagnostic cue utilization between expert and novice CCCV nurses.

Background.  Knowledge related to objective measures of clinical nursing diagnostic expertise would enhance effective and efficient recognition, utilization, and reward of clinical expertise.

Methods.  Five CCCV written simulations served as instruments in the study. Diagnostic content areas included left ventricular dysfunction, cardiac tamponade, sepsis, right ventricular failure, and hypovolemia related to internal abdominal haemorrhage. The sample was composed of 23 expert and 23 novice nurses. After reading each simulation, subjects were asked to verbally recall the simulation, give an impression of the predominant problem or diagnosis, and give a diagnostic explanation. Verbal recalls were audio-taped for protocol analysis. Diagnostic accuracy and cue utilization were determined through comparisons of subjects' recalled diagnoses and cues with results from an expert panel review consensus. The major variable was the mean recalled proportion of highly relevant cues to total cues (HRC/TC) on accurately diagnosed simulations. Chi-square analysis revealed that diagnostic accuracy was greater with experts than with novices. Differences between and among simulations, expertise, accuracy and the mean proportion of highly relevant cues to total cues were examined with a 4 × 2 × 2 factorial analysis of variance.

Results.  When considering all accurately diagnosed simulations, experts had a higher HRC/TC than novices. The major limitations were the use of low fidelity written simulations and virgin verbal protocol methods.

Conclusion.  The findings generally support the idea that the development of diagnostic expertise is associated with the ability to focus on highly relevant cues.