Zoekresultaten

Reasoning like a doctor or like a nurse? A systematic integrative review

When physicians and nurses are looking at the same patient, they may not see the same picture. If assuming that the clinical reasoning of both professions is alike and ignoring possible differences, aspects essential for care can be overlooked. Understanding the multifaceted concept of clinical reasoning of both professions may provide insight into the nature and purpose of their practices and benefit patient care, education and research. We aimed to identify, compare and contrast the documented features of clinical reasoning of physicians and nurses through the lens of layered analysis and to conduct a simultaneous concept analysis. The protocol of this systematic integrative review was published doi: 10.1136/bmjopen-2021-049862. A comprehensive search was performed in four databases (PubMed, CINAHL, Psychinfo, and Web of Science) from 30th March 2020 to 27th May 2020. A total of 69 Empirical and theoretical journal articles about clinical reasoning of practitioners were included: 27 nursing, 37 medical, and five combining both perspectives. Two reviewers screened the identified papers for eligibility and assessed the quality of the methodologically diverse articles. We used an onion model, based on three layers: Philosophy, Principles, and Techniques to extract and organize the data. Commonalities and differences were identified on professional paradigms, theories, intentions, content, antecedents, attributes, outcomes, and contextual factors. The detected philosophical differences were located on a care-cure and subjective-objective continuum. We observed four principle contrasts: a broad or narrow focus, consideration of the patient as such or of the patient and his relatives, hypotheses to explain or to understand, and argumentation based on causality or association. In the technical layer a difference in the professional concepts of diagnosis and the degree of patient involvement in the reasoning process were perceived. Clinical reasoning can be analysed by breaking it down into layers, and the onion model resulted in detailed features. Subsequently insight was obtained in the differences between nursing and medical reasoning. The origin of these differences is in the philosophical layer (professional paradigms, intentions). This review can be used as a first step toward gaining a better understanding and collaboration in patient care, education and research across the nursing and medical professions.

The Urban Belonging Photo App: A toolkit for studying place attachments with digital and participatory methods

This paper introduces the open-source Urban Belonging (UB) toolkit, designed to study place attachments through a combined digital, visual and participatory methodology that foregrounds lived experience. The core of the toolkit is the photovoice UB App, which prompts participants to document urban experiences as digital data by taking pictures of the city, annotating them, and reacting to others’ photos. The toolkit also includes an API interface and a set of scripts for converting data into visualizations and elicitation devices. The paper first describes how the app’s design specifications were co-created in a process that brought in voices from different research fields, planners from Gehl Architects, six marginalized communities, and citizen engagement professionals. Their inputs shaped decisions about what data collection the app makes possible, and how it mitigates issues of privacy and visual and spatial literacy to make the app as inclusive as possible. We document how design criteria were translated into app features, and we demonstrate how this opens new empirical opportunities for community engagement through examples of its use in the Urban Belonging project in Copenhagen. While the focus on photo capture animates participants to document experiences in a personal and situated way, metadata such as location and sentiment invites for quali-quantitative analysis of both macro trends and local contexts of people’s experiences. Further, the granularity of data makes both a demographic and post-demographic analysis possible, providing empirical ground for exploring what people have in common in what they photograph and where they walk. And, by inviting participants to react to others’ photos, the app offers a heterogeneous empirical ground, showing us how people see the city differently. We end the paper by discussing remaining challenges in the tool and provide a short guide for using it.

Do goal clarification and process feedback positively affect students’ need-based experiences?

Background: The importance of clarifying goals and providing process feedback for student learning has been widely acknowledged. From a Self-Determination Theory perspective, it is suggested that motivational and learning gains will be obtained because in well-structured learning environments, when goals and process feedback are provided, students will feel more effective (need for competence), more in charge over their own learning (need for autonomy) and experience a more positive classroom atmosphere (need for relatedness). Yet, in spite of the growing theoretical interest in goal clarification and process feedback in the context of physical education (PE), little experimental research is available about this topic. Purpose: The present study quasi-experimentally investigated whether the presence of goal clarification and process feedback positively affects students’ need satisfaction and frustration. Method: Twenty classes from five schools with 492 seventh grade PE students participated in this quasi-experimental study. Within each school, four classes were randomly assigned to one of the four experimental conditions (n = 121, n = 117, n = 126 and n = 128) in a 2 × 2 factorial design, in which goal clarification (absence vs. presence) and process feedback (absence vs. presence) were experimentally manipulated. The experimental lesson consisted of a PE lesson on handstand (a relatively new skill for seventh grade students), taught by one and the same teacher who went to the school of the students to teach the lesson. Depending on the experimental condition, the teacher either started the lesson explaining the goals, or refrained from explaining the goals. Throughout the lesson the teacher either provided process feedback, or refrained from providing process feedback. All other instructions were similar across conditions, with videos of exercises of differential levels of difficulty provided to the students. All experimental lessons were observed by a research-assistant to discern whether manipulations were provided according to a condition-specific script. One week prior to participating in the experimental lesson, data on students’ need-based experiences (i.e. quantitatively) were gathered. Directly after students’ participation in the experimental lesson, data on students’ perceptions of goal clarification and process feedback, need-based experiences (i.e. quantitatively) and experiences in general (i.e. qualitatively) were gathered. Results and discussion: The questionnaire data and observations revealed that manipulations were provided according to the lesson-scripts. Rejecting our hypothesis, quantitative analyses indicated no differences in need satisfaction across conditions, as students were equally satisfied in their need for competence, autonomy and relatedness regardless of whether the teacher provided goal clarification and process feedback, only goal clarification, only process feedback or none. Similar results were found for need frustration. Qualitative analyses indicated that, in all four conditions, aspects of the experimental lesson made students feel more effective, more in charge over their own learning and experience a more positive classroom atmosphere. Our results suggest that under certain conditions, lessons can be perceived as highly need-satisfying by students, even if the teacher does not verbally and explicitly clarify the goals and/ or provides process feedback. Perhaps, students were able to self-generate goals and feedback based on the instructional videos.

Script concordance test; a tool to assess cognitive integration?

Effects and Feasibility of the “Traffic Light Method for Somatic Screening and Lifestyle" in Patients with sever mental illness: a pilot study

PURPOSE: To study the preliminary effects and feasibility of the “Traffic Light Method for somatic screening and lifestyle” (TLM) in patients with severe mental illness. DESIGN AND METHODS: A pilot study using a quasi-experimental mixed method design with additional content analyses of lifestyle plans and logbooks. FINDINGS: Significant improvements were found in body weight and waist circumference. Positive trends were found in patients’ subjective evaluations of the TLM. The implementation of the TLM was considered feasible. PRACTICE IMPLICATIONS: The TLM may contribute to a higher quality of care regarding somatic screening and lifestyle training.

Illness scripts in nursing: Directed content analysis

AimsTo explore the possible extension of the illness script theory used in medicine to the nursing context.DesignA qualitative interview study.MethodsThe study was conducted between September 2019 and March 2020. Expert nurses were asked to think aloud about 20 patient problems in nursing. A directed content analysis approach including quantitative data processing was used to analyse the transcribed data.ResultsThrough the analysis of 3912 statements, scripts were identified and a nursing script model is proposed; the medical illness script, including enabling conditions, fault and consequences, is extended with management, boundary, impact, occurrence and explicative statements. Nurses often used explicative statements when pathophysiological causes are absent or unknown. To explore the applicability of Illness script theory we analysed scripts’ richness and maturity with descriptive statistics. Expert nurses, like medical experts, had rich knowledge of consequences, explicative statements and management of familiar patient problems.ConclusionThe knowledge of expert nurses about patient problems can be described in scripts; the components of medical illness scripts are also relevant in nursing. We propose to extend the original illness script concept with management, explicative statements, boundary, impact and occurrence, to enlarge the applicability of illness scripts in the nursing domain.ImpactIllness scripts guide clinical reasoning in patient care. Insights into illness scripts of nursing experts is a necessary first step to develop goals or guidelines for student nurses’ development of clinical reasoning. It might lay the groundwork for future educational strategies.