Justifying clinical decisions: Nursing shift report as informal argument
After caring for people with life-threatening concerns, critical care nurses justify their clinical decisions and discuss their reasoning processes with other nurses during the change of shift report (CSR). Zarefsky's definition of argumentation as “the practice of justifying decisions under co...
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| Médium: | Dissertation |
| Jazyk: | angličtina |
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ProQuest Dissertations & Theses
01.01.2005
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| ISBN: | 054202134X, 9780542021343 |
| On-line přístup: | Získat plný text |
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| Shrnutí: | After caring for people with life-threatening concerns, critical care nurses justify their clinical decisions and discuss their reasoning processes with other nurses during the change of shift report (CSR). Zarefsky's definition of argumentation as “the practice of justifying decisions under conditions of uncertainty” is congruent with viewing CSR discourse as informal argumentative discourse. The CSR is an event of intense communication, social cognition, and expectation of accountability in a natural, high-stakes setting. Registered nurses (N = 40) working in four critical care units from three different medical centers volunteered to participate. Offgoing nurses were audiorecorded during CSR and interviewed at the end of a 12-hour shift. Oncoming nurses completed a brief written survey following CSR. Observation field notes, shift reports, interviews, and surveys were transcribed and qualitatively analyzed using Atlas TI for open coding via a line-by-line analysis, axial coding and hierarchical coding. Individual claims from each CSR were diagrammed using Inspiration 7.5 to explicate evidence and inferences. Data collection and analysis followed federal guidelines for the protection of human subjects and privacy of health records, including removal of identifying information from transcripts. Themes emerged regarding goals for the exchange, time perspective, information flow, communication techniques, recommended nursing interventions, and processes of achieving agreement. Identified themes and relationships were verified through member checks and interrater agreement. The results are consistent with recent argumentation research showing a substantial influence of pragmatic factors on the structures and outcomes of arguments. A purely structural approach defining argument in terms of strategic moves assembled into defined patterns is insufficient to explain a nurse's justification for decisions about patient care. Rather, the rapidly changing problem space of nursing care requires an interactive discussion organized by semantic content, with consideration to cognitive and social dynamics. |
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| Bibliografie: | SourceType-Dissertations & Theses-1 ObjectType-Dissertation/Thesis-1 content type line 12 |
| ISBN: | 054202134X 9780542021343 |