Author

Kerry Risco

Defense Date

10-14-2009

Graduation Date

2009

Availability

Immediate Access

Submission Type

dissertation

Degree Name

PhD

Department

Nursing

School

School of Nursing

Committee Chair

Linda Goodellow

Committee Member

Joan Lockhart

Committee Member

Joyce Penrose

Committee Member

James Moore

Keywords

Diagnostic reasoning, Family Nurse Practitioner, Hypothesis generation, Hypotheticodeductive reasoning, Problem definition, single subject experimental design

Abstract

Little is known about the effect of problem definition on hypothesis-generation accuracy in recent family nurse practitioner (FNP) graduates. The hypotheticodeductive-reasoning model served as the theoretical framework for the study. An alternating-treatment single-subject experimental design was used to examine the effects of problem definition on 8 recent FNP graduates' ability to generate hypotheses to diagnose patient problems. Diagnostic-reasoning software provided web-delivered simulated-patient scenarios that described patient problems that were either ill defined or well defined. The independent variable was problem definition (ill-defined versus well-defined problems). The dependent variables were accuracy of the final diagnosis, the total number of diagnostic hypotheses generated, percent of the diagnostic hypotheses plausible, time from initial login to final diagnosis, and confidence in the final diagnosis. Analysis consisted of visual inspection of graphs and nonparametric tests for each of the dependent variables. Expected differences in accuracy between ill-defined and well-defined problems were not found. However, there were significant differences in time (p = .02) and confidence (p = .01) for diagnosing ill-defined and well-defined problems. One conclusion was that problem definition is a function of the individual problem solver's experience. Hypotheticodeductive reasoning was not used by most problem solvers; instead pattern matching was observed in recent FNPs' diagnosis of patient problems. Future studies should address individual perceptions of problem definition. Programs that educate FNPs should evaluate students' understanding of the hypotheticodeductive reasoning model and individualize learning experiences to promote clinical decision-making.

Format

PDF

Language

English

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