This paper considers the nature of decisions made in the context of community nursing practice, in the light of the stages of decision making distilled by Carroll & Johnson from the work of various theorists, and explores the relevance of each stage to community nurses' decision making. Illustrative examples of specific theoretical perspectives are included throughout the paper. The discussion forms part of the literature review for research currently being undertaken by the authors into patient assessment by community nurses. As decision making is a key element of community nurses' assessment practice, the paper argues that decision making theory forms a useful conceptual framework for investigating this aspect of community nursing.
This paper describes the development of an innovative research approach which used the complementary methods of simulation and post-simulation interview to examine the knowledge-base involved in community nursing assessment practice in the United Kingdom. The study commenced in 1994 and the main phase of data-gathering took place over a 3-week period in 1995. Having outlined the study's aim, context and theoretical background, this paper focuses on the two main methods of data-gathering used. Detailed description of the simulation method and the post-simulation interview and the rationales for their use are followed by critical discussion which identifies their particular strengths and weaknesses. Threats to validity are also considered. It is argued that the combined use of a simulated assessment and a post-simulation structured interview has great potential as a means of exploring the knowledge involved in community nursing assessment practice.
This paper describes how new insight into community nursing know-how or professional artistry was produced through qualitative analysis of 30 transcripts of audiorecorded simulation data. The data were generated by simulated patient assessments of two cases. These simulated assessments were undertaken by a heterogeneous sample of district nurses drawn from a large conurbation in central Scotland in 1995. The existence of multiple sets of rich, dynamic and interactive data about each case provided a sound basis for exploring important and poorly understood aspects of nursing knowledge which are generally regarded as implicit. These aspects of nursing knowledge are particularly challenging for empirical research. The findings described are believed to be of particular interest in their articulation of collaborative approaches to patient assessment. Illustrations from the data are provided, and it is argued that the validity of the findings is enhanced by the unusual nature of the database, as well as the analytical procedures described. The limitations and significance of the findings are also addressed. The empirical analysis is linked to a preliminary discussion of procedural knowledge in nursing practice. The findings are discussed with reference to certain aspects of Foucault's view of power.
The findings confirmed the utility of this unusual combination of methods, with their blend of control and naturalism, for articulating the knowledge and expertise which underpins assessment practice. Further research using a similar approach is recommended for the systematic examination of professional expertise in nursing and multi-disciplinary contexts.
Patient assessment is widely acknowledged as a core element of community nursing expertise (Griffiths and Luker, 1994). With the current drive towards evidence-based practice, it is becoming increasingly important to provide sound evidence about this key aspect of community nursing practice. This article describes how district nurses' assessments of a carefully constructed simulated patient have provided new insight into community nursing expertise. The innovative approach used in this study of district nursing assessment practice is outlined. One of the simulated patients developed for the study is then described. A case study of one nurse participant who assessed this simulated patient forms the main focus of the article. The case study (one of four) is based on a synthesis of simulation and interview findings relating to a particular study participant. It reveals some interesting associations between various elements of nursing knowledge and provides important insight into how the quality and effectiveness of patient assessment may be affected by a practitioner's approach and knowledge base. The usefulness of this approach and the relevance of the findings for nursing practice and education are also addressed.
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