Krystyna M. Cholowski1, Robert H. Cantwell2
1 School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
2 School of Education, University of Newcastle, Callaghan, NSW, Australia
Background: Whilst it has been well established in research that qualitative difference in approaches to clinical problem-solving exist between more novice-like and more expert-like clinicians, only limited attention has been given in the past to ways of representing these in non-verbal forms. This paper reports on a methodology that allows for reliable and consistent graphical means of assessing clinical reasoning. Method: Sixty nurses were given a written case history of a “patient” and viewed a short video-tape of the (simulated) clinical interview. They were instructed to think about a primary nursing diagnosis for this patient. They were to verbalise their thoughts whilst reading the notes and watching the interview. Transcribed verbalisations were analysed for the presence of relevant clinical information and associated clinical concepts as well as for evidence of diagnostic hypotheses. Transcriptions were also analysed for evidence of strategic behaviours underlying the associations drawn between clinical information, concepts and diagnoses. Finally, the analysed protocols were mapped on to schematic diagrams to provide a visual representation of the diagnostic process. Results: The schematic diagrams revealed a greater use of conceptual knowledge as organising and interpretative schemes for clinical information amongst the more sophisticated expert and competent groups, and a greater focus on clinical information by the less sophisticated intermediate and novice groups. Groups were also shown to differ in both the timing of diagnostic hypothesising and in the accuracy and appropriateness of those diagnoses. Conclusions: The schematic data revealed patterns of responses amongst participants supporting the view that expertise may be associated with the use of more sophisticated diagnostic schemes than is the case with the more novice-like reasoning. Use of a graphically-based methodology enabled these different approaches to the complex task of clinical problem-solving to be demonstrated.