AbstractCaring for patients in an acute medical ward occurs in a complex and dynamic environment. Prioritisation of goals and activities represents one element of effective planning and delivery of care. The importance of priority setting has been highlighted in the nursing literature for over twenty-five years; however, there would appear to be no systematic study of this key skill.
This thesis explores priority setting within a novice/expert framework, using a mixed methods approach. In addition to using simulation it investigates real-time priority setting within actual clinical practice.
Study one used simulation in four groups with a range of nursing experience. This included one group of non-nurses for comparison. Participants were asked to prioritise twelve care activities presented in a simulated case-load. Analysis demonstrated that the simulation evoked priority setting behaviour, and differences in priority setting were seen. Study two combined the simulated case-load with think-aloud method. Semistructured interview completed the data collection. Findings were consistent with Benner’s ovice/expert framework, suggesting that prioritisation is determined by two main characteristics, the views, values and perceptions of the nurse, and key skills, knowledge and experience. Study three used think-aloud method to examine priority setting in clinical practice, comparing junior student nurses with senior staff nurses. This was supplemented by observation and semi-structured interview. Findings from this study identified differences in cognitive processes, and priority setting strategies. Developing critical thinking skills, expert role modelling, and the use of an active apprenticeship model may facilitate skill acquisition.
This thesis highlights the complexity of priority setting in caring for patients in an acute medical ward. It explores the development of this skill in learner nurses, and demonstrated a range of methods for studying decision-making in both simulated and clinical settings.
|Date of Award||May 2001|