Browsing by Author "Pirret, Alison Margaret"

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    Nurse practitioner diagnostic reasoning : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, New Zealand
    (Massey University, 2013) Pirret, Alison Margaret
    Introduction: Nurse practitioners were introduced to increase patients’ access to healthcare, improve patient outcomes, and provide a sustainable solution to ongoing workforce shortages. They provide a diagnostic role previously delivered by doctors, however, their ability to perform this role has been challenged. Methodology: The study used a post-positivist mixed methods convergent parallel design to explore nurse practitioner diagnostic reasoning and compare it to that of registrars. Methods included a complex case scenario using think aloud protocol to determine diagnostic abilities, including identifying correct diagnoses, problems and actions; a previously validated intuitive/analytic reasoning instrument to identify diagnostic reasoning style; a maxims questionnaire to identify maxims used to guide diagnostic reasoning; and a demographic data sheet to identify variables influencing the results of the former. The study included 30 nurse practitioners and 16 registrars. An expert panel determined the correct diagnoses/problems and actions for the case scenario using a Delphi technique. Registrar data provided normative data and norm-referenced testing compared the nurse practitioner data to the normative data. Results: Nurse practitioners identified a mean of 10.30 (range=4-17, Mdn=10, mode=9, SD=3.09) correct diagnoses, problem and action items as identified by the expert panel whereas registrars identified a mean of 10.88 (range=6-21, Mdn=10, SD=3.88); there was no statistically significant difference between the two groups (U=238.5, z=-.04, p=.97). Nurse practitioners’ diagnostic reasoning reflected an analytic-intuitive style whereas registrars reflected an analytic style, however, this difference was not statistically significant, t(44)=1.91, p=.06. Diagnostic reasoning style was not related to diagnostic reasoning abilities in either the nurse practitioner (rs=-.14, n=30, p=.46) or registrar (rs=.03, n=16, p=.90) groups. There was no difference in how nurse practitioners and registrars employ maxims to guide their diagnostic reasoning, t(44)=-.89, p=.38. Maxims used to guide diagnostic reasoning were not related to diagnostic reasoning abilities in either the nurse practitioner (r=-.17, n=30, p=.37) or registrar (rs=-.08, n=16, p=.77) groups. Conclusion: Nurse practitioners’ diagnostic reasoning, although incorporating more System I processes than registrars, does not differ from that of registrars. This supports the nurse practitioner role as a sustainable solution firstly, to effectively meet the health needs of the New Zealand population and secondly, to address workforce shortages.
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    The use of knowledge of respiratory physiology in critical care nurses' clinical decision-making : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University
    (Massey University, 2005) Pirret, Alison Margaret
    The knowledge and experience of expert nurses has long been recognised as contributing to early identification of patient problems, early intervention and an improved patient outcome. The present study sought to answer the research question, following completion of a critical care specialty practice programme, do nurses use knowledge of respiratory physiology in their clinical decision-making? An evaluation methodology using a managerial perspective was used to compare the use of knowledge of respiratory physiology in critical care nurses' clinical decision-making with the respiratory physiology recommended in the New Zealand Standards for Critical Care Nursing Education (Critical Care Nurses' Section, 2000). Using intensity sampling, 27 nurses who had completed a critical care specialty practice programme and who were currently working in the critical care units of two tertiary hospitals in a large metropolitan city within New Zealand were selected. Quantitative and qualitative methods were used to collect data. Data analysis was completed using descriptive statistics, correlations and identification of common terms and themes. The results showed that following completion of a critical care programme, critical care nurses demonstrated a low to medium level of knowledge of respiratory physiology in their clinical decision-making. In the total group, no statistically significant associations were found between the use of knowledge of respiratory physiology in clinical decision-making and age, experience, academic level, use of guidelines and protocols, standards and integrated care pathways, conference attendance, reading of journals and accessing the World Wide Web for literature. Qualitative analysis identified factors contributing to the low to medium use of knowledge as being nurses' high reliance on intuitive knowledge, lack of in-depth discussion of respiratory concepts in critical care programmes, lack of opportunity in the clinical practice environment to discuss respiratory physiology and lack of collaborative practice. The study identified the need for more collaborative practice and for clinical nurse educators firstly, to have a closer relationship with the critical care programme providers to ensure adequate theoretical content and secondly, to work with nurses in the clinical setting.