Studies to date have employed a variety of methods to elucidate the cognitive processes that underlie nursing actions in clinical situations. Most studies relied on clinical case scenarios rather than actual patient care situations, and did not supplement cognitive measures with quantitative measures of performance or physiologic outcomes of care. The present study employed a quasi-experimental design to describe and compare the verbal report data of baccalaureate nursing students who were assigned to high and low performing groups based on their ability to alter the physiological trajectory of the patient in a simulated task environment. Low performing participants observed many irrelevant cues and failed to perform vital actions in lieu of extraneous actions that were not directly related to the patient's condition. Higher performing students were better able to recognize salient symptoms suggestive of deterioration in the patient's condition and were more expeditious intervening to improve the patient's physiological status.

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There are a dearth of studies that quantitatively measure nurses' appreciation of stimuli and the subsequent generation of options in practice environments. The purpose of this paper was to provide an examination of nurses' ability to solve problems while quantifying the stimuli upon which they focus during patient care activities. The study used a quantitative descriptive method that gathered performance data from a simulated task environment using multi-angle video and audio. These videos were coded and transcripts of all of the actions that occurred in the scenario and the verbal reports of the participants were compiled. The results revealed a pattern of superiority of the experienced exemplar group. Novice actions were characterized by difficulty in following common protocols, inconsistencies in their evaluative approaches, and a pattern of omissions of key actions. The study provides support for the deliberate practice-based programs designed to facilitate higher-level performance in novices.