The treatment of pressure sores: a comparison of novice and expert nurses’ knowledge, information use and decision accuracy

Abstract

The knowledge experts have and the way it is organized is thought to affect their decision accuracy and the information they use to make decisions. This exploratory study examines the information used by experts, the way they organize their knowledge and their decision accuracy when considering treatments for pressure sores. A convenience sample of 14 subjects (seven experts and seven novices) were given a card sorting task and a decision task. The cards for the sort contained photographs of pressure sores and various dressings, which the subjects had to place into meaningful categories. In the decision task they were given a photograph of a pressure sore, together with various items of information which could be used to make a decision about the appropriate treatment for the pressure sore. The accuracy of the subjects' decisions were compared to a 'gold standard' decision formulated by an expert panel. Results indicated that experts were more accurate in their choice of treatments in the decision task, and also focused on specific items of information to make their decisions. The accuracy of their decisions was not linked to the categorization strategy used in the card sorts. The findings from this study indicate that more research into the way in which such treatment decisions are undertaken needs to be carried out. Specifically, the way in which education into wound care treatments affects decision accuracy needs to be identified, and ways of aiding individuals to focus on relevant information explored.

Clinical Reasoning in Experienced Nurses

“…In addition, nurses often interpreted assessment findings while simultaneously planning interventions. Narayan and Corcoran-Perry (1997), Grobe et al (1991), andCorcoran (1986b) concluded that experienced and expert nurses used knowledge, domain experience, and multiple cognitive processes to reason about a patient's readiness to wean from a ventilator, treatment for a pressure ulcer, a drug administration plan for pain control, and a plan of care for a child with pharyngitis (Corcoran, 1986a;Grobe et al, 1991;Lamond & Farnell, 1998;Lee & Ryan-Wenger, 1997;Narayan & Corcoran-Perry, 1997). Lack of knowledge and oversimplification of the reasoning task were the difficulties noted in novices (Corcoran, 1986b).…”

A comparison of the management of venous leg ulceration by specialist and generalist community nurses: A judgement analysis

“…Generalist nurses (which included nurses working in general/ family practice and district/home care nurses) were classified as -tissue viability nurses were classified as . In addition, data considered relevant to nurse decision making (Thompson 1999) and expertise (Lamond and Farnell 1998;Lauri and Salantera 2002;Hoffman, Donoghue and Duffield 2004;Ashton and Price 2006) were collected from all participants. These data included length of experience, level of education, knowledge, seniority, degree of clinical autonomy, and peer nomination as experts.…”

Surveillance as an Intervention in the Care of Stroke Patients

“…Furthermore, because knowledge of individual patients, in addition to knowledge about the typical patient with a particular disease, diagnosis, or problem, is a consistent theme in the studies of nurse's decision making, the use of simulators and innovative teaching strategies may allow educators to teach and support the use of individual patient information in decision making. Prior research (Lamond & Farnell, 1998;Taylor, 1997) has shown that less-experienced nurses have greater difficulty extracting salient cues from change-of-shift report or other sources. Simulation and clinical experiences that emphasize these abilities may improve nurses' ability to develop an accurate mental picture of the patient and ultimately improve patient outcomes by allowing the nurse to have an accurate baseline for surveillance and the ability to focus care.…”