The cognitive component of nursing assessment: an analysis

Abstract

This paper presents an analysis of the cognitive component of nursing assessment, complimenting the growth in knowledge of other important aspects of assessment. The purpose of the paper is to provide a framework for understanding how nurses structure assessment problems and the types of judgements they make. The thrust of the analysis is based on a comparison between nursing assessment and medical diagnosis, since the cognitive component and judgements formed in medical diagnosis have been more fully articulated. The results suggest that there may be similarities between the cognitive strategies used in nursing assessment and those used in medical diagnosis, particularly in relation to the gathering and organization of information. But the purpose of the information search appears to be different. In medical diagnosis the aim is to establish an explanation for the patient's presenting problem. In nursing assessment, on the other hand, the aim appears to be to provide an accurate picture of the patient's current condition or situation. The assessments formulated fit the definition of a judgement and, in common with medical diagnoses, include some form of prediction. Unlike the medical diagnoses, however, which usually remain stable throughout treatment, the assessments need to change as the patient's condition changes. The cognitive component of assessment has significant implications for nurse education and clinical practice. Further understanding of how nurses structure assessment problems and formulate judgements is therefore needed. The findings may also help to clarify the meaning of nursing diagnosis.

Clinical Reasoning in Experienced Nurses

“…Based on previous research, 2 years of experience was determined to be the minimum criterion for nurses who were between novice and expert (Benner, 1984;Crow et al, 1995;Grobe et al, 1991;Navin, 1991;Tanner, Padrick, Westfall, & Putzier, 1987). It is more difficult to define the expert nurse, and controversy exists as to whether the number of years in practice should be used to determine skill level.…”

“…Patient assessment has been described as the first of many steps of the nursing process that requires reasoning skills (Bittner & Tobin, 1998;dela Cruz, 1994;Narayan, 1990;Narayan & Corcoran-Perry, 1997;Nissila, 1992;Tanner et al, 1987;Thiele et al, 1991;Watkins, 1998;White et al, 1992). Assessment includes gathering and organizing patient data, cues, or information into categories that are linked together through inductive reasoning to determine patient status and need for action (Byrnes & West, 2000;Carnevali & Thomas, 1993;Crow et al, 1995;Jacavone & Dostal, 1992;Lyneham, 1998;Taylor, 2000;Thompson, 1999).…”

Decision Making in Clinical Practice

“…By doing this, nurses feel that they are shielded from responsibility. Crowe et al [1995] comment the purpose of assessment is to conduct an evaluation and to make a judgement, which does not include the practitioner -the nurse or midwifemaking the diagnosis, as this is seen to be the role of the doctor. Many experienced practitioners have become adept at forming a diagnosis the ultimate decision is made by our medical colleagues.…”

Strategies used by nurses for decision-making in the paediatric orthopaedic setting

“…An analysis of the cognitive strategies used by nurses in assessment has shown similarities with medical diagnostic reasoning, identifying how domain-specific knowledge structures improve our Ôway of thinkingÕ (Crow et al, 1995). This enables an experienced nurse in orthopaedic practice to make clinical judgements for an orthopaedic patient that will be different to a nurse who has skills and knowledge of another specialist area.…”