Use of search strategies in nursing clinical inference




Fields, Anita May

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The study examined the use of systematic search strategies and instantiation activities used by nurses in the formation of the minor premise in nursing clinical inference. Sarbin's Clinical Inference and Cognitive Theory (1960) served as the theoretical framework for the study. The following questions were formulated for investigation: (1) Do a majority of nurses make correct inferences on the Simulation Exercise? (2) Do nurses utilize structured search strategies in assessing client cues? (3) Do nurses who use structured search strategies also carry out instantiation activities? (4) Do nurses use search strategies and instantiation activities consistently?

Methodology. Thirty subjects were randomly selected from registered nurses with baccalaureate preparation who were employed full-time in an adult nursing setting in a 520-bed proprietary general hospital in a city in Northwest Louisiana. The factor-relating level II research used a relation-searching design. Data were collected on subject performance on the Simulation Exercise. The Simulation Exercise was a researcher designed tool which presented three clinical problems sequenced into vignettes presenting client cues to be perceived and acted upon by the nurses in one of the three or four available options. The nurse arrived at a clinical inference by working through the branching vignette sequences guided by a choice of nursing actions or verbalization.

The Kolmogorov-Smirnov One-Sample Test was used to determine the degree of agreement between observed and theoretical cumulative frequency distributions of correct inferences and search strategies. The level of confidence was set at the .05 level of significance. The calculated D (maximum deviation) values for correct inferences by nurses were not significant for any of the three problems when using researcher-identified response tracks. Subjects identified one additional response track on Problem I and two additional response tracks on Problem III. The calculated D was significant on Problem III using subject-identified response tracks indicating a correct inference was made by a majority of the nurses on Problem III using subject-identified tracks. The calculated D values on all three problems for use of search strategies were significant.

Summary of Findings. (1) A majority of nurses did not make correct inferences on the Simulation Exercise. (2) A majority of nurses use structured search strategies in assessing client cues. (3) Nurses who use search strategies do not consistently carry out instantiation activities. (4) Nurses do not use search strategies and instantiation activities consistently, that is, do not make correct inferences consistently.

Additional Findings. (1) Nurses with 0-2 years of experience made the greater number of correct inferences in the study. (2) Nurses with two and eight continued learning activities within the last two years made a higher number of correct inferences. (3) Nurses identifying the coronary care unit as their area of practice had a greater number of correct inferences.

Conclusions. (1) The Simulation Exercise tool requires further validation and/or modification. (2) Nurses have been taught to use the nursing process. (3) The nurses' knowledge bases may lack cue clusters. (4) No conclusion can be made on the basis of this study related to the lack of consistency in making correct inferences. (5) No conclusion can be made related to the years of experience, continued learning experience or area of practice since the sub-samples were too small to demonstrate tendencies.



Search strategies, Inferences, Simulation Exercise Tool