System 2 thinking approach is generated by collecting, searching for additional information. Participants ability to identify the category of shock was better than their ability to identify the underlaying cause of the shock. \pB5QUTa,E}ay#>[LKb/IQ# h?,7uVS;4^254*6T)~b4zFeA_b7~}lBye8KD{xl-y{jLX!/.nel'Zm/xCN@.} 3O(=o~J fQ,[n The experts, then agreed that the case designed was reasonable and reflect the realities of the clinical practice. More studies are recommended in this area of investigation. % TCy_s)k&]s
m*fs~8e&>mL @_TqNY[d@S"xy7a It is also important in assisting experienced nurses in their practice by enhancing self-awareness of their own mental processes and limitations. Mental shortcuts offer rapid assessment and permit immediate action to safe patients life. SU provides low and high-fidelity manikins and standardized patients. Further studies are required. The cognitive weakness was mainly noticed during the first-line management action when participants were involved in immediate lifesaving activities. Although the underlying causes of these categories of shock syndrome are different, they have some similarities and differences in clinical presentations. This method of thinking helps nurses to prove their thinking outcomes and reach a conclusion about the specific situation [10], particularly when the nurses fail to match the patients clinical cues with a specific disease classification script [11]. Yes Studies involving different nurses from different geographic populations is recommended. An Explanatory Statement relating to the study design and purpose were given to the participants. here. Reviewing the performance sheets of the 12 participants revealed that nine participants (75%) correctly identified the shock category and out of these 9 participants, five (56%) determined the correct etiology. For example, the participant could circle hypovolemic, cardiogenic, or septic for the shock category.
System-1 thinking approach was the influencing factor in how decisions were made. She could not do this scientific work without their invaluable contributions. Once participants finished their simulated scenario task, they were invited to review the recorded video of their performance and to reflect on their actions. An inherent issue in emergency setting work is its chaotic nature [17]. Methodology, The simulation session was offered to all newly graduated nurses (n = 25) recently employed at one of the regional hospitals. When participants met the simulated patient, they instantaneously began to perceive the context. As the participant entered the room, there is, adult male who is wearing a hospital gown, sitting at a 45-degree angle and showing facial expression of pain. This is in line with what was reported in the literature [17]. For nurses, working in emergency settings in hospitals is always "stressful, time sensitive, life-critical, and information poor and loaded" [6]. Initial clinical information were: At the bedside, a registered nurse taking the role of an emergency department (ED) nurse, hands an ED Note to the participant. stream A 1520min interview was conducted. e0269624. Although this study adds valuable information to the body of knowledge, there are several limitations. Such an assumption is a typical System 1 Thinking approach and is generated almost immediately upon encountering the patient [5]. broad scope, and wide readership a perfect fit for your research every time. he is vomiting, not to say that intake might be decreased I should immediately put him on a fluid balance if I want to save his life", so like you might go by the BP (blood pressure), If he is a bit dry, hes blood pressure might be low. No, PLOS is a nonprofit 501(c)(3) corporation, #C2354500, based in San Francisco, California, US, Corrections, Expressions of Concern, and Retractions, https://doi.org/10.1371/journal.pone.0269624, Mental status: lethargic; oriented to time, place, and person; cognition intact; answers questions appropriately. Participants in this stage tend to arrange, analyse and relate clinical information, form some queries that attempt to test the assumption by looking for information that confirm or, alternatively, reject it. For more information about PLOS Subject Areas, click The data are then processed carefully, and consciously [7]. I thought well, Id better check his temperature because if he got a rupture appendix a bit of a temperature that might be going up.but the temperature was normal, I thought, well if the urine is dark thats give me clue that he (patient) is dehydrated . In particular, the theoretical frameworks constructed by Al-Azri [17], Al Moteri [18] have guided the presentation of themes and codes and their interrelationships (Table 1). B/LL#(>. you can see me too busy keeping my eyes on him". In this phase participants attended a session in which the objectives of the study were explained. %PDF-1.3 This is done through shortening the thinking process rather than a detailed evaluation.
This step does not oppose the action initiated earlier to safe the patients life (C), nevertheless it helps emergency nurse to have holistic view to manage the case. The proposed conceptual mental model addresses this issue by organizing emergency nurses activities (A, B), prompt acts (C) which represent the first-line management actions and involve a triaging process in order to identify the most appropriate management-action to initiate an immediate lifesaving action; then finally responses (D, E) and this includes the second-line management actions and involves analyzing and planning for further care for the patient if required. The journal is focused on research and theory in all the topics associated with occupational/organizational behavior. He was instructed to depict the case consistently for every trainee. The participant was again shown a recorded video of his performance and was asked to explain his actions. In spite of the abundance of literature addressing the characteristics of emergency settings [4, 8, 9, 10], there has not been a mental structure model proposed to understand the thought processes of clinicians and to identify particular cognitive weaknesses [6]. option. The (C) step however, represents a connection point between System 1 Thinking approachstep (B), and System 2 Thinking approach in the next step (D) which involves a deliberate thinking. The 25 newly employed nurses were divided into two groups: those who agreed to participate (n = 12) and those who had no interest to participate (n = 13). The implications of this proposed mental model for emergency nursing practice are: decision-making structure guidance; better cognitive performance in emergency settings in relation to decision-making; and encouragement in the implementation of formal follow up, thus supporting continued improvement in practice to better thought process outcomes. It illustrates the process of decision-making when encountering an emergency situation with limited information. The investigator always kept in mind the aim of the analysisto investigate the underlying cognitive process of cue recognition. How health providers use their cognitive and attention resources in emergency situations is sometimes overlooked area of study [17]. This study aims to better understand how newly employed nurses process information and initiate actions in emergency situations characterized by time constraints and uncertainty. Nurses practice in emergency settings is characterized by being action-driven rather than analytic-driven [9]. Each participant had eight minutes to rapidly assess the patient, record key clinical findings in a chart, and attempt at least one nursing action before moving to the next briefing phase. In the current study and during the inductive phase, the researcher read and reread the transcripts to generate a general understanding. Information processing refers to the ability to perceive, interpret and connect relevant information whilst filtering out unnecessary information to generate a decision and initiate actions [6]. https://doi.org/10.1371/journal.pone.0269624.s001, https://doi.org/10.1371/journal.pone.0269624.s002, https://doi.org/10.1371/journal.pone.0269624.s003, https://doi.org/10.1371/journal.pone.0269624.s004, https://doi.org/10.1371/journal.pone.0269624.s005, https://doi.org/10.1371/journal.pone.0269624.s006. Making an optimal decision under such conditions is difficult and sometimes challenging [5]. This retrospective think-aloud interview was conducted by the researcher to promote reflection of participants on their performance with respect to the scenario and to identify the underlying cognitive process they used (S1 Appendix). The study provides new insights into decision-making and thinking processes under conditions of time pressure and uncertainty. Study findings bear several implications. This is a descriptive exploratory qualitative study design in which retrospective think-aloud interviews were conducted [12] that investigated the underlying thought processes and actions of newly graduated nurses while identifying a type of shock and initiating appropriate actions. [4], Al Moteri et al. These conditions add a challenge to rational thought process, specifically when encountering a critical patient who requires a prompt response [1]. All the 25 participants were invited to voluntarily join the study. This would contribute to learning opportunities by identifying areas for improvement and gaps in clinical decision making. https://doi.org/10.1371/journal.pone.0269624.g001. However, the suggested approach requires further studies. To maintain privacy, interviews were conducted with the participation of only the interviewer and the interviewee. No, Is the Subject Area "Decision making" applicable to this article? In the current study participants visually observed the patients facial expression and the position of the patient on the bed and heard the voice the patient produced. Questions such as Help me understand why you do that and this and tell me more about was used to reveal the participants own thought processes used to interpret the clinical situation. The goal of this quick scan is to identify and manage any potential life-threatening conditions. Click through the PLOS taxonomy to find articles in your field. No, Is the Subject Area "Cognition" applicable to this article? They were also asked "What was the main take-home message?". PLOS ONE promises fair, rigorous peer review, Time pressure and uncertainty are widely recognised experienced phenomena that may have substantial negative effect on patient safety [3, 4]. The proposed mental model steps were arranged in an alphabetical order from A to E for easy use and recall: (A) awareness of the situation by sensory processing of the contextual information present in the patient and environment. It is generated almost instantly without much thinking effort by matching patterns with existing knowledge obtained form similar past situations; this is also known as the gut feeling.
During the scenario, the ED nurse provides further scripted information that cannot be portrayed by the simulated patient while staying in role. Awareness can be achieved through many sensory channels (visual, auditory and touch) [21, 22]. A second round of a deductive analysis was initiated to enable an in-depth exploration of data in line with the existing literature. In addition, the practical classification of the thought processes of nurses during emergency decision-making provided additional insight into the cognitive weaknesses in the process in which lapses and errors may occur [6]. The identified codes were then reviewed, reorganized and similar codes were grouped [16]. Themes were then organized using ABCDE acronym for easy use. Several strategies were used to maintain credibility, transferability, dependability, and conformability of the data [19]. This is followed by close observation and a search for critical signs that may indicate the presence of threats on the patients life in an attempt to (C) control the consequence by initiating immediate lifesaving actions. A better understanding can inform changes in both practice learning strategies and decision-making in emergency department. It should provide a concise and precise description of the experimental results, their interpretation, as well as the experimental conclusions that can be drawn. The simulation activity was standardized at 1215 minutes long and was run 12 to 13 times a day (from 9:00am to 01:00pm) for two consequent days.
They were all male graduated from the same educational institution and their GPAs ranged from 2.6 to 3.4 out of 4, with the mean score of GPA being 2.85 points and the standard deviation being 0.27. dolls) and a standardized patient. Yes In this step, the brain immediately began to process the sensory information obtained from multiple sensory modalities to form general understanding. An 8-minute window was available to initiate action. Firstly, the homogeneity of the sample interferes with the generalizability of the results. In the deductive analysis phase, the emerged codes were aligned with the findings of the previous studies presented in Al Moteri et al. Founded in 1807, John Wiley & Sons, Inc. has been a valued source of information and understanding for more than 200 years, helping people around the world meet their needs and fulfill their aspirations. Uncertainty and time pressure in emergency departments add a challenge to the rational decision-making process, specifically when encountering a critical patient who requires a prompt response. Check out using a credit card or bank account with. Data from the ten interviews contributed to describe several main mental activities reflecting new graduate nursing students actions triggered by uncertainty, namely, (1) awareness of the situation, followed by, a prompt (2) generation of beliefs (presumption), (3) controlling the consequence (first-line management action), (4) involvement in in deliberate thinking and, finally (5) execution of actions (second-line management action). Our online platform, Wiley Online Library (wileyonlinelibrary.com) is one of the worlds most extensive multidisciplinary collections of online resources, covering life, health, social and physical sciences, and humanities. However, there has been little attempt to develop a mental structure model to understand the thought processes and identify cognitive weaknesses points in nurses decision-making. Uncertainty and time pressure are common and unavoidable in emergency nurses practice [1, 2]. The inductive analysis phase mainly allows themes to directly develop from the qualitative data. In the current study, the standardized patient was a male trained to portray patient scenarios for the purposes of teaching, training, and evaluation of trainees performance. Their perception at this early stage was mainly based on highly visible and easily notable information presented by the patient or in the surrounding environment. He is making moaning sounds expressing physical suffering, cough, and takes labored breaths. Written informed consent was obtained from the willing participants. Nursing Department, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia. The simulated session followed three traditional phases of healthcare simulation: "pre-briefing, simulation, and debriefing". a little bit increase of O2 (Oxygen) would do no harm but it may save his life.. you see me too busy giving him O2 maskIm thinking he might need a defibrillator.. Indeed, in the current study inappropriate actions to prevent further deterioration of the patient, were noticed. See the comments below: so you go by dehydration . Based on the outcomes of the deliberate thinking, an overall plan that includes actions to manage the patient problem is produced. 2020 [6], Al-Azri [17], Al Moteri [18]. The SU consisted of three forms of simulation: high fidelity simulators (e.g., SimMan), low fidelity of simulators (e.g. Conceptualization, Meanwhile, nurses in emergency settings are required to act immediately in the absence of or having limited information that can be obtained from patient history, physical examination and medical investigations [9]. Shock syndrome is defined as the inadequate means of arterial blood pressure to meet the needs of the tissues and body organs [13]. The simulation session was part of the training and orientation program introduced by the hospital. Ensuring dependability was made by careful development and preparation of all the steps of the study, including data collection and analysis. No, Is the Subject Area "Pain" applicable to this article? The ED nurse provides participant the diagnostic studies, if requested by participants. This is extremely important for the newly employed nurses who initially require extra support as they obtain their practical experience and combine it with their existing theoretical knowledge. It is, indeed, slower than System 1 Thinking approach and a cognitively demanding process but is more likely to generate better decisions [9]. The proposed conceptual mental model may contribute to the development of certain clinical reasoning skills useful to develop in emergency practice, particularly, those used in emergency settings. Finally, the focus of the current study was only to better understand how new graduate nurses process information and initiate actions in an emergency situation characterized by time constraint and uncertainty; more studies are required to investigate the contributing factors underlying errors in initiating actions. << /Length 7 0 R /Filter /FlateDecode >> Classification of the steps involved in decision-making when encountering emergency situations may provide insight into the strengths and weaknesses of the thought process at different stages. Failure to identify patients who have a serious and potentially life-threatening problem is well documented in literature [5]. A better understanding may inform changes in both practice and decision-making in the emergency department setting. Participants were informed that their participation was entirely voluntary and that their contribution would enhance the development of clinical practice and training. This study explored the thought processes of 10 newly graduated nurses while they managed patients with unknown shock syndromes using retrospective think-aloud interviews. Meanwhile, time constraint is a kind of psychological pressure that add stress on nurses when they have less time available than is necessary to complete a task or obtain an intended care result [3]. The model may also be used to develop clinical decision-making tools tailored to the needs of the emergency practice. Emergency nurses expectations, skills and knowledge all may contribute to the initial perception of the emergency situation. Since this simulation case could be any of the three shock categories: (1) hypovolemic, (2) cardiogenic, and (3) septic, the equipment necessary to manage each shock syndrome was available and visible on a cart. Ethical approval was granted from the Ministry of Health Ethical Committee. In addition to newly employed nurses, this model could also have implications for anyone practicing emergency care such as paramedics and general nurse practitioners in rural clinics. Step (D) involves analyzing and investigating clinical information for optimal decision-making. No, Is the Subject Area "Allied health care professionals" applicable to this article? However, this fast thinking does not always lead to correct actions and outcomes. Journal of Organizational Behavior aims to report and review the growing research in the industrial/organizational psychology and organizational behavior fields throughout the world.
Of those 12 participants, 10 completed the interview.
Formal analysis, This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. This section may be divided by subheadings. In the current study, the nurses assume that the patient has pain from interpreting the patients facial expression and behavior. Highlighting the importance of the theoretical mental model to nurses in emergency situations to support their thinking process may encourage the field to implement formal follow up processes enabling nurses to review their thinking process outcomes. Mental shortcuts are considered useful and even necessary in emergency situations under time constraint and uncertainty. Worthy, Texas A&M University, UNITED STATES, Received: January 4, 2022; Accepted: May 24, 2022; Published: June 9, 2022. Finally, in (E) execution, actions are initiated to start intervention or to continue observing and monitoring the patient. Following the simulation, a retrospective think-aloud interview was conducted. Journal of Organizational Behavior is currently published 8 times a year. For more information about PLOS Subject Areas, click These include motivation, work performance, equal opportunities at work, job design, career processes, occupational stress, quality of work life, job satisfaction, personnel selection, training, organizational change, research methodology in occupational/organizational behavior, employment, job analysis, behavioral aspects of industrial relations, managerial behavior, organizational structure and climate, leadership and power. Roles Yes Investigation, Since this simulated scenario is introduced by a regional hospital for training and orientation purposes, all newly employed nurses (n = 25) are mandated to take part in this program, however, only those (n = 12) who agreed to take part in the current study, were videorecorded (Fig 1). Newly employed nurses have relied on the easily accessible contextual information to form an initial impression. The vital signs monitor is turned on. These factors should be considered in future research. Experience is seen to be a critical factor to enhance an individuals own thought process and decision-making. Data Availability: All relevant data are within the article and its Supporting Information files. Request Permissions, Nancy H. Leonard, Richard W. Scholl and Kellyann Berube Kowalski, Access everything in the JPASS collection, Download up to 10 article PDFs to save and keep, Download up to 120 article PDFs to save and keep. This study aims to better understand how new graduate nurses process information and initiate actions in emergency situations characterized by time constraints and uncertainty. The sensory processing of the contextual information in the previous step is interpreted in a matter of seconds to generate a preliminary clinical assumption (impression). Indeed, knowing nurses thinking process not only helps to improve patients outcomes, it also supports the improvement of the emergency nurses at all levels. Immediately following the retrospective think-aloud interviews, participants were debriefed to allow them to reflect on the experience, analyse and revealed their emotional states. Participants were informed that study results would have no bearing on the formal evaluation of their training program. Participants worked under time pressure and uncertainty to solve a simulated shock case by establishing an assumption of what type of shock the simulated patient might have and its cause. Is the Subject Area "Nurses" applicable to this article? The assumption is formed unconsciously and on the basis of little evidence. This may create a degree of uncertainty for a nursing clinician and might be mistakenly interpreted [14]. Yes Transcripts were examined and checked by an external reviewer to ensure credibility. Finally, conformability was maintained through using virtual presentation of the data. It is typical in emergency situations to think about potential threats and intervene promptly. Peripheral IV access is established. However, System 2 to System 1 thinking approaches may be used interchangeably to solve problems [7, 9]. This is because nurses in other clinical settings generally use an analytical method (System 2 Thinking approach) which is an information-seeking method and involves history-taking, physical assessment, and investigations. From the 12 participants who showed interest in participating in the study, 10 were interviewed and two refused (Fig 1). The approach combined two philosophical reasoning techniques: deductive (a top-down reasoning), and inductive (a bottom-up reasoning) [15]. Nevertheless, step (C) may not be correct under uncertainty and time pressure. Although it was not the focus of the current study to investigate why it was more likely for participants to make errors in (C) step under time pressure, researchers reported that time pressure tends to increase the perception of the difficulty of the task [24, 25]. Hence, to devise practical training to strengthen the weak areas of thinking may be helpful. The author wishes also to express her gratitude to the participants for their significant contribution. Participants noted key observation findings, clicked or circled the suspected shock category and the etiology and the chosen medical and nursing management. She also wishes to express her thanks for all the simulation unit team members for their significant contribution and help. Yes Wiley has published the works of more than 450 Nobel laureates in all categories: Literature, Economics, Physiology or Medicine, Physics, Chemistry, and Peace. Information-processing in clinical decision-making is based mainly on two systems of thinking processes, called System 1 and System 2 thinking approaches [7]. This study tested the interrelationship among four measures of this construct: the Myers-Briggs Type Indicator, the Group Embedded Figures Test, the Learning Styles Inventory, and the Decision Style Inventory. The study was conducted with the hospital clinical instructors involvement following a unit coordinator agreement. https://doi.org/10.1371/journal.pone.0269624, Editor: Darrell A. To prevent participants revealing knowledge of the task from their colleagues and peers, the 12 participants who agreed to participate in the study were assigned to be the first to commence the simulated activity. https://doi.org/10.1371/journal.pone.0269624.t001. No, Is the Subject Area "Sensory perception" applicable to this article? The significance of this instant sensory processing is not reflected adequately in the emergency decision-making process [17]. Teaching the mental model to newly employed nurses working in emergency departments and critical care units will contribute to their understanding of their own mental processes and limitations. https://doi.org/10.1371/journal.pone.0269624.g002. you can see me giving him antiemetic and monitoring fluid balance". Information processing style, often termed cognitive style, has gained prominence in the organizational behavior literature as researchers use it as a basis for studying decision making behavior, conflict, strategy development, and group processes. Select the purchase This study dissects the mental activities of nurses in emergency care into five steps. Saturation was reached after approximately seven interviews. Ten interviews were transcribed and analysed. H*+RF*|-Z[gmWbV7auWlPC. A mental model (Fig 2) was proposed as a summary of the research findings. Wiley is a global provider of content and content-enabled workflow solutions in areas of scientific, technical, medical, and scholarly research; professional development; and education. Wiley has partnerships with many of the worlds leading societies and publishes over 1,500 peer-reviewed journals and 1,500+ new books annually in print and online, as well as databases, major reference works and laboratory protocols in STMS subjects. here. With a growing open access offering, Wiley is committed to the widest possible dissemination of and access to the content we publish and supports all sustainable models of access.
For the sake of maintaining transferability, participants were invited to judge the end results of data analysis. so the quicker you get cannulas into him, the better end outcome is", " . Evidences have suggested that being aware of the situation increases the likelihood of a good decision [20], specifically in urgent situations that demand rapid decision-making [21]. Participants failure to identify the etiology has influenced their ability to intervene correctly. Uncertainty is a "mental state" experienced by nurses when trying to decide between two or more actions [2]. Read your article online and download the PDF from your email or your account. The instant sensory processing of the contextual information is very important in guiding decision-making when encountering an emergency situation. They are more likely to make errors as they decide upon the actions required to perform life-saving measures. For the researcher to understand the cognitive processes underlying the information seeking behaviour in the context of shock syndrome, a hybrid thematic analysis approach was conducted [15]. Immediately after assessing the patient, each participant completed the performance sheet for the simulated patient. The program is introduced to the newly employed healthcare providers and included some theoretical lectures, simulation sessions and field training. The problem may be explained in part by poor information processing, causing a delay in responding. xYYs~XeBHDe%C,] ,38b8=GOI>)QUGS*;{:LCJXB^#1$$T^GWR+wR_$OJJ;8/m;u]5n5omYq~[-Fjb44U,PaH%1I$#F^10p7 =fC6$[bPCRTkCYW*J6@_G,KYzK4ueYb/P&RiA.}6euL5t^PRd/$^ y0UYw{"H43z*/R1{; ! 2ct4yb<3Z/z8hf'K{I3>H*12qm:^ '37lKF[c`[jG.1sh!mv_Yg0k3Kc-w]]aa3~48B3^ #6f7HOM@v'[o}~{{5b[q ~ Pf:,}1bIe!*V[g, I should be ready too..", . He was selected based on the case requirements which include gender, age, physical appearance, attributes and acting ability and experience.
System-1 thinking approach was the influencing factor in how decisions were made. She could not do this scientific work without their invaluable contributions. Once participants finished their simulated scenario task, they were invited to review the recorded video of their performance and to reflect on their actions. An inherent issue in emergency setting work is its chaotic nature [17]. Methodology, The simulation session was offered to all newly graduated nurses (n = 25) recently employed at one of the regional hospitals. When participants met the simulated patient, they instantaneously began to perceive the context. As the participant entered the room, there is, adult male who is wearing a hospital gown, sitting at a 45-degree angle and showing facial expression of pain. This is in line with what was reported in the literature [17]. For nurses, working in emergency settings in hospitals is always "stressful, time sensitive, life-critical, and information poor and loaded" [6]. Initial clinical information were: At the bedside, a registered nurse taking the role of an emergency department (ED) nurse, hands an ED Note to the participant. stream A 1520min interview was conducted. e0269624. Although this study adds valuable information to the body of knowledge, there are several limitations. Such an assumption is a typical System 1 Thinking approach and is generated almost immediately upon encountering the patient [5]. broad scope, and wide readership a perfect fit for your research every time. he is vomiting, not to say that intake might be decreased I should immediately put him on a fluid balance if I want to save his life", so like you might go by the BP (blood pressure), If he is a bit dry, hes blood pressure might be low. No, PLOS is a nonprofit 501(c)(3) corporation, #C2354500, based in San Francisco, California, US, Corrections, Expressions of Concern, and Retractions, https://doi.org/10.1371/journal.pone.0269624, Mental status: lethargic; oriented to time, place, and person; cognition intact; answers questions appropriately. Participants in this stage tend to arrange, analyse and relate clinical information, form some queries that attempt to test the assumption by looking for information that confirm or, alternatively, reject it. For more information about PLOS Subject Areas, click The data are then processed carefully, and consciously [7]. I thought well, Id better check his temperature because if he got a rupture appendix a bit of a temperature that might be going up.but the temperature was normal, I thought, well if the urine is dark thats give me clue that he (patient) is dehydrated . In particular, the theoretical frameworks constructed by Al-Azri [17], Al Moteri [18] have guided the presentation of themes and codes and their interrelationships (Table 1). B/LL#(>. you can see me too busy keeping my eyes on him". In this phase participants attended a session in which the objectives of the study were explained. %PDF-1.3 This is done through shortening the thinking process rather than a detailed evaluation.
This step does not oppose the action initiated earlier to safe the patients life (C), nevertheless it helps emergency nurse to have holistic view to manage the case. The proposed conceptual mental model addresses this issue by organizing emergency nurses activities (A, B), prompt acts (C) which represent the first-line management actions and involve a triaging process in order to identify the most appropriate management-action to initiate an immediate lifesaving action; then finally responses (D, E) and this includes the second-line management actions and involves analyzing and planning for further care for the patient if required. The journal is focused on research and theory in all the topics associated with occupational/organizational behavior. He was instructed to depict the case consistently for every trainee. The participant was again shown a recorded video of his performance and was asked to explain his actions. In spite of the abundance of literature addressing the characteristics of emergency settings [4, 8, 9, 10], there has not been a mental structure model proposed to understand the thought processes of clinicians and to identify particular cognitive weaknesses [6]. option. The (C) step however, represents a connection point between System 1 Thinking approachstep (B), and System 2 Thinking approach in the next step (D) which involves a deliberate thinking. The 25 newly employed nurses were divided into two groups: those who agreed to participate (n = 12) and those who had no interest to participate (n = 13). The implications of this proposed mental model for emergency nursing practice are: decision-making structure guidance; better cognitive performance in emergency settings in relation to decision-making; and encouragement in the implementation of formal follow up, thus supporting continued improvement in practice to better thought process outcomes. It illustrates the process of decision-making when encountering an emergency situation with limited information. The investigator always kept in mind the aim of the analysisto investigate the underlying cognitive process of cue recognition. How health providers use their cognitive and attention resources in emergency situations is sometimes overlooked area of study [17]. This study aims to better understand how newly employed nurses process information and initiate actions in emergency situations characterized by time constraints and uncertainty. Nurses practice in emergency settings is characterized by being action-driven rather than analytic-driven [9]. Each participant had eight minutes to rapidly assess the patient, record key clinical findings in a chart, and attempt at least one nursing action before moving to the next briefing phase. In the current study and during the inductive phase, the researcher read and reread the transcripts to generate a general understanding. Information processing refers to the ability to perceive, interpret and connect relevant information whilst filtering out unnecessary information to generate a decision and initiate actions [6]. https://doi.org/10.1371/journal.pone.0269624.s001, https://doi.org/10.1371/journal.pone.0269624.s002, https://doi.org/10.1371/journal.pone.0269624.s003, https://doi.org/10.1371/journal.pone.0269624.s004, https://doi.org/10.1371/journal.pone.0269624.s005, https://doi.org/10.1371/journal.pone.0269624.s006. Making an optimal decision under such conditions is difficult and sometimes challenging [5]. This retrospective think-aloud interview was conducted by the researcher to promote reflection of participants on their performance with respect to the scenario and to identify the underlying cognitive process they used (S1 Appendix). The study provides new insights into decision-making and thinking processes under conditions of time pressure and uncertainty. Study findings bear several implications. This is a descriptive exploratory qualitative study design in which retrospective think-aloud interviews were conducted [12] that investigated the underlying thought processes and actions of newly graduated nurses while identifying a type of shock and initiating appropriate actions. [4], Al Moteri et al. These conditions add a challenge to rational thought process, specifically when encountering a critical patient who requires a prompt response [1]. All the 25 participants were invited to voluntarily join the study. This would contribute to learning opportunities by identifying areas for improvement and gaps in clinical decision making. https://doi.org/10.1371/journal.pone.0269624.g001. However, the suggested approach requires further studies. To maintain privacy, interviews were conducted with the participation of only the interviewer and the interviewee. No, Is the Subject Area "Decision making" applicable to this article? In the current study participants visually observed the patients facial expression and the position of the patient on the bed and heard the voice the patient produced. Questions such as Help me understand why you do that and this and tell me more about was used to reveal the participants own thought processes used to interpret the clinical situation. The goal of this quick scan is to identify and manage any potential life-threatening conditions. Click through the PLOS taxonomy to find articles in your field. No, Is the Subject Area "Cognition" applicable to this article? They were also asked "What was the main take-home message?". PLOS ONE promises fair, rigorous peer review, Time pressure and uncertainty are widely recognised experienced phenomena that may have substantial negative effect on patient safety [3, 4]. The proposed mental model steps were arranged in an alphabetical order from A to E for easy use and recall: (A) awareness of the situation by sensory processing of the contextual information present in the patient and environment. It is generated almost instantly without much thinking effort by matching patterns with existing knowledge obtained form similar past situations; this is also known as the gut feeling.
During the scenario, the ED nurse provides further scripted information that cannot be portrayed by the simulated patient while staying in role. Awareness can be achieved through many sensory channels (visual, auditory and touch) [21, 22]. A second round of a deductive analysis was initiated to enable an in-depth exploration of data in line with the existing literature. In addition, the practical classification of the thought processes of nurses during emergency decision-making provided additional insight into the cognitive weaknesses in the process in which lapses and errors may occur [6]. The identified codes were then reviewed, reorganized and similar codes were grouped [16]. Themes were then organized using ABCDE acronym for easy use. Several strategies were used to maintain credibility, transferability, dependability, and conformability of the data [19]. This is followed by close observation and a search for critical signs that may indicate the presence of threats on the patients life in an attempt to (C) control the consequence by initiating immediate lifesaving actions. A better understanding can inform changes in both practice learning strategies and decision-making in emergency department. It should provide a concise and precise description of the experimental results, their interpretation, as well as the experimental conclusions that can be drawn. The simulation activity was standardized at 1215 minutes long and was run 12 to 13 times a day (from 9:00am to 01:00pm) for two consequent days.
They were all male graduated from the same educational institution and their GPAs ranged from 2.6 to 3.4 out of 4, with the mean score of GPA being 2.85 points and the standard deviation being 0.27. dolls) and a standardized patient. Yes In this step, the brain immediately began to process the sensory information obtained from multiple sensory modalities to form general understanding. An 8-minute window was available to initiate action. Firstly, the homogeneity of the sample interferes with the generalizability of the results. In the deductive analysis phase, the emerged codes were aligned with the findings of the previous studies presented in Al Moteri et al. Founded in 1807, John Wiley & Sons, Inc. has been a valued source of information and understanding for more than 200 years, helping people around the world meet their needs and fulfill their aspirations. Uncertainty and time pressure in emergency departments add a challenge to the rational decision-making process, specifically when encountering a critical patient who requires a prompt response. Check out using a credit card or bank account with. Data from the ten interviews contributed to describe several main mental activities reflecting new graduate nursing students actions triggered by uncertainty, namely, (1) awareness of the situation, followed by, a prompt (2) generation of beliefs (presumption), (3) controlling the consequence (first-line management action), (4) involvement in in deliberate thinking and, finally (5) execution of actions (second-line management action). Our online platform, Wiley Online Library (wileyonlinelibrary.com) is one of the worlds most extensive multidisciplinary collections of online resources, covering life, health, social and physical sciences, and humanities. However, there has been little attempt to develop a mental structure model to understand the thought processes and identify cognitive weaknesses points in nurses decision-making. Uncertainty and time pressure are common and unavoidable in emergency nurses practice [1, 2]. The inductive analysis phase mainly allows themes to directly develop from the qualitative data. In the current study, the standardized patient was a male trained to portray patient scenarios for the purposes of teaching, training, and evaluation of trainees performance. Their perception at this early stage was mainly based on highly visible and easily notable information presented by the patient or in the surrounding environment. He is making moaning sounds expressing physical suffering, cough, and takes labored breaths. Written informed consent was obtained from the willing participants. Nursing Department, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia. The simulated session followed three traditional phases of healthcare simulation: "pre-briefing, simulation, and debriefing". a little bit increase of O2 (Oxygen) would do no harm but it may save his life.. you see me too busy giving him O2 maskIm thinking he might need a defibrillator.. Indeed, in the current study inappropriate actions to prevent further deterioration of the patient, were noticed. See the comments below: so you go by dehydration . Based on the outcomes of the deliberate thinking, an overall plan that includes actions to manage the patient problem is produced. 2020 [6], Al-Azri [17], Al Moteri [18]. The SU consisted of three forms of simulation: high fidelity simulators (e.g., SimMan), low fidelity of simulators (e.g. Conceptualization, Meanwhile, nurses in emergency settings are required to act immediately in the absence of or having limited information that can be obtained from patient history, physical examination and medical investigations [9]. Shock syndrome is defined as the inadequate means of arterial blood pressure to meet the needs of the tissues and body organs [13]. The simulation session was part of the training and orientation program introduced by the hospital. Ensuring dependability was made by careful development and preparation of all the steps of the study, including data collection and analysis. No, Is the Subject Area "Pain" applicable to this article? The ED nurse provides participant the diagnostic studies, if requested by participants. This is extremely important for the newly employed nurses who initially require extra support as they obtain their practical experience and combine it with their existing theoretical knowledge. It is, indeed, slower than System 1 Thinking approach and a cognitively demanding process but is more likely to generate better decisions [9]. The proposed conceptual mental model may contribute to the development of certain clinical reasoning skills useful to develop in emergency practice, particularly, those used in emergency settings. Finally, the focus of the current study was only to better understand how new graduate nurses process information and initiate actions in an emergency situation characterized by time constraint and uncertainty; more studies are required to investigate the contributing factors underlying errors in initiating actions. << /Length 7 0 R /Filter /FlateDecode >> Classification of the steps involved in decision-making when encountering emergency situations may provide insight into the strengths and weaknesses of the thought process at different stages. Failure to identify patients who have a serious and potentially life-threatening problem is well documented in literature [5]. A better understanding may inform changes in both practice and decision-making in the emergency department setting. Participants were informed that their participation was entirely voluntary and that their contribution would enhance the development of clinical practice and training. This study explored the thought processes of 10 newly graduated nurses while they managed patients with unknown shock syndromes using retrospective think-aloud interviews. Meanwhile, time constraint is a kind of psychological pressure that add stress on nurses when they have less time available than is necessary to complete a task or obtain an intended care result [3]. The model may also be used to develop clinical decision-making tools tailored to the needs of the emergency practice. Emergency nurses expectations, skills and knowledge all may contribute to the initial perception of the emergency situation. Since this simulation case could be any of the three shock categories: (1) hypovolemic, (2) cardiogenic, and (3) septic, the equipment necessary to manage each shock syndrome was available and visible on a cart. Ethical approval was granted from the Ministry of Health Ethical Committee. In addition to newly employed nurses, this model could also have implications for anyone practicing emergency care such as paramedics and general nurse practitioners in rural clinics. Step (D) involves analyzing and investigating clinical information for optimal decision-making. No, Is the Subject Area "Allied health care professionals" applicable to this article? However, this fast thinking does not always lead to correct actions and outcomes. Journal of Organizational Behavior aims to report and review the growing research in the industrial/organizational psychology and organizational behavior fields throughout the world.
Of those 12 participants, 10 completed the interview.
Formal analysis, This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. This section may be divided by subheadings. In the current study, the nurses assume that the patient has pain from interpreting the patients facial expression and behavior. Highlighting the importance of the theoretical mental model to nurses in emergency situations to support their thinking process may encourage the field to implement formal follow up processes enabling nurses to review their thinking process outcomes. Mental shortcuts are considered useful and even necessary in emergency situations under time constraint and uncertainty. Worthy, Texas A&M University, UNITED STATES, Received: January 4, 2022; Accepted: May 24, 2022; Published: June 9, 2022. Finally, in (E) execution, actions are initiated to start intervention or to continue observing and monitoring the patient. Following the simulation, a retrospective think-aloud interview was conducted. Journal of Organizational Behavior is currently published 8 times a year. For more information about PLOS Subject Areas, click These include motivation, work performance, equal opportunities at work, job design, career processes, occupational stress, quality of work life, job satisfaction, personnel selection, training, organizational change, research methodology in occupational/organizational behavior, employment, job analysis, behavioral aspects of industrial relations, managerial behavior, organizational structure and climate, leadership and power. Roles Yes Investigation, Since this simulated scenario is introduced by a regional hospital for training and orientation purposes, all newly employed nurses (n = 25) are mandated to take part in this program, however, only those (n = 12) who agreed to take part in the current study, were videorecorded (Fig 1). Newly employed nurses have relied on the easily accessible contextual information to form an initial impression. The vital signs monitor is turned on. These factors should be considered in future research. Experience is seen to be a critical factor to enhance an individuals own thought process and decision-making. Data Availability: All relevant data are within the article and its Supporting Information files. Request Permissions, Nancy H. Leonard, Richard W. Scholl and Kellyann Berube Kowalski, Access everything in the JPASS collection, Download up to 10 article PDFs to save and keep, Download up to 120 article PDFs to save and keep. This study aims to better understand how new graduate nurses process information and initiate actions in emergency situations characterized by time constraints and uncertainty. The sensory processing of the contextual information in the previous step is interpreted in a matter of seconds to generate a preliminary clinical assumption (impression). Indeed, knowing nurses thinking process not only helps to improve patients outcomes, it also supports the improvement of the emergency nurses at all levels. Immediately following the retrospective think-aloud interviews, participants were debriefed to allow them to reflect on the experience, analyse and revealed their emotional states. Participants were informed that study results would have no bearing on the formal evaluation of their training program. Participants worked under time pressure and uncertainty to solve a simulated shock case by establishing an assumption of what type of shock the simulated patient might have and its cause. Is the Subject Area "Nurses" applicable to this article? The assumption is formed unconsciously and on the basis of little evidence. This may create a degree of uncertainty for a nursing clinician and might be mistakenly interpreted [14]. Yes Transcripts were examined and checked by an external reviewer to ensure credibility. Finally, conformability was maintained through using virtual presentation of the data. It is typical in emergency situations to think about potential threats and intervene promptly. Peripheral IV access is established. However, System 2 to System 1 thinking approaches may be used interchangeably to solve problems [7, 9]. This is because nurses in other clinical settings generally use an analytical method (System 2 Thinking approach) which is an information-seeking method and involves history-taking, physical assessment, and investigations. From the 12 participants who showed interest in participating in the study, 10 were interviewed and two refused (Fig 1). The approach combined two philosophical reasoning techniques: deductive (a top-down reasoning), and inductive (a bottom-up reasoning) [15]. Nevertheless, step (C) may not be correct under uncertainty and time pressure. Although it was not the focus of the current study to investigate why it was more likely for participants to make errors in (C) step under time pressure, researchers reported that time pressure tends to increase the perception of the difficulty of the task [24, 25]. Hence, to devise practical training to strengthen the weak areas of thinking may be helpful. The author wishes also to express her gratitude to the participants for their significant contribution. Participants noted key observation findings, clicked or circled the suspected shock category and the etiology and the chosen medical and nursing management. She also wishes to express her thanks for all the simulation unit team members for their significant contribution and help. Yes Wiley has published the works of more than 450 Nobel laureates in all categories: Literature, Economics, Physiology or Medicine, Physics, Chemistry, and Peace. Information-processing in clinical decision-making is based mainly on two systems of thinking processes, called System 1 and System 2 thinking approaches [7]. This study tested the interrelationship among four measures of this construct: the Myers-Briggs Type Indicator, the Group Embedded Figures Test, the Learning Styles Inventory, and the Decision Style Inventory. The study was conducted with the hospital clinical instructors involvement following a unit coordinator agreement. https://doi.org/10.1371/journal.pone.0269624, Editor: Darrell A. To prevent participants revealing knowledge of the task from their colleagues and peers, the 12 participants who agreed to participate in the study were assigned to be the first to commence the simulated activity. https://doi.org/10.1371/journal.pone.0269624.t001. No, Is the Subject Area "Sensory perception" applicable to this article? The significance of this instant sensory processing is not reflected adequately in the emergency decision-making process [17]. Teaching the mental model to newly employed nurses working in emergency departments and critical care units will contribute to their understanding of their own mental processes and limitations. https://doi.org/10.1371/journal.pone.0269624.g002. you can see me giving him antiemetic and monitoring fluid balance". Information processing style, often termed cognitive style, has gained prominence in the organizational behavior literature as researchers use it as a basis for studying decision making behavior, conflict, strategy development, and group processes. Select the purchase This study dissects the mental activities of nurses in emergency care into five steps. Saturation was reached after approximately seven interviews. Ten interviews were transcribed and analysed. H*+RF*|-Z[gmWbV7auWlPC. A mental model (Fig 2) was proposed as a summary of the research findings. Wiley is a global provider of content and content-enabled workflow solutions in areas of scientific, technical, medical, and scholarly research; professional development; and education. Wiley has partnerships with many of the worlds leading societies and publishes over 1,500 peer-reviewed journals and 1,500+ new books annually in print and online, as well as databases, major reference works and laboratory protocols in STMS subjects. here. With a growing open access offering, Wiley is committed to the widest possible dissemination of and access to the content we publish and supports all sustainable models of access.
For the sake of maintaining transferability, participants were invited to judge the end results of data analysis. so the quicker you get cannulas into him, the better end outcome is", " . Evidences have suggested that being aware of the situation increases the likelihood of a good decision [20], specifically in urgent situations that demand rapid decision-making [21]. Participants failure to identify the etiology has influenced their ability to intervene correctly. Uncertainty is a "mental state" experienced by nurses when trying to decide between two or more actions [2]. Read your article online and download the PDF from your email or your account. The instant sensory processing of the contextual information is very important in guiding decision-making when encountering an emergency situation. They are more likely to make errors as they decide upon the actions required to perform life-saving measures. For the researcher to understand the cognitive processes underlying the information seeking behaviour in the context of shock syndrome, a hybrid thematic analysis approach was conducted [15]. Immediately after assessing the patient, each participant completed the performance sheet for the simulated patient. The program is introduced to the newly employed healthcare providers and included some theoretical lectures, simulation sessions and field training. The problem may be explained in part by poor information processing, causing a delay in responding. xYYs~XeBHDe%C,] ,38b8=GOI>)QUGS*;{:LCJXB^#1$$T^GWR+wR_$OJJ;8/m;u]5n5omYq~[-Fjb44U,PaH%1I$#F^10p7 =fC6$[bPCRTkCYW*J6@_G,KYzK4ueYb/P&RiA.}6euL5t^PRd/$^ y0UYw{"H43z*/R1{; ! 2ct4yb<3Z/z8hf'K{I3>H*12qm:^ '37lKF[c`[jG.1sh!mv_Yg0k3Kc-w]]aa3~48B3^ #6f7HOM@v'[o}~{{5b[q ~ Pf:,}1bIe!*V[g, I should be ready too..", . He was selected based on the case requirements which include gender, age, physical appearance, attributes and acting ability and experience.