Modelling novice clinical reasoning for a computerized decision support system
Article first published online: 20 DEC 2004
Journal of Advanced Nursing
Volume 49, Issue 1, pages 68–77, January 2005
How to Cite
O'Neill, E. S., Dluhy, N. M. and Chin, E. (2005), Modelling novice clinical reasoning for a computerized decision support system. Journal of Advanced Nursing, 49: 68–77. doi: 10.1111/j.1365-2648.2004.03265.x
- Issue published online: 20 DEC 2004
- Article first published online: 20 DEC 2004
- Submitted for publication 20 October 2003 Accepted for publication 27 May 2004
- theoretical framework;
- decision support system;
- clinical decision-making;
- Novice Computer Decision Support
Aim. The aim of this paper is to introduce the theoretical framework that directs the project.
Background. The Novice Computer Decision Support (N-CODES) Project is developing a point-of-care system to assist novice acute care nurses while making clinical judgements. Unlike prior approaches, N-CODES is guided by a theoretical understanding of nurses’ decision-making processes, including the manner by which novices develop this skill.
Framework. Assumptions within information processing theory guided the clinical decision-making framework. The framework is composed of a clinical decision-making model and a second embedded model depicting the clinical reasoning development of novice nurses.
Models. The model is developed within a pluralistic perspective synthesizing theoretical and empirical knowledge on clinical decision-making and the development of novice reasoning skills. A visual representation of experienced nurse decision-making is presented. A central element is the nurse's use of pre-encounter data and working knowledge. A second model integrates empirical data on the developing clinical reasoning of the novice. This knowledge is loosely scattered through 25 years of literature. The intersection of these models provides a novel perspective on the way novices begin to identify working knowledge patterns and develop a sense of saliency.
Conclusions. Previous attempts to build comprehensive clinical decision support systems have disregarded important theoretical considerations hindering the success of these projects. Grounding a Decision Support System in a theoretical model of novice nurse decision-making will strengthen the utility and acceptance of the Decision Support System. Additionally, a conceptualization of novice nurse development is an asset to nurse educators, managers and scientists interested in improving clinical decision-making.