An exploratory study of the effects of general problem-solving aptitude, knowledge, and nursing practice experience on clinical problem-solving among nursing students.

The purpose of this study was to identify factors that contributed to differences in clinical problem solving among nursing students within and across three levels of university-based education. Formal education as well as scores on a knowledge test of basic Medical-Surgical Nursing, the Watson-Glaser Critical Thinking Appraisal (WGCTA), and nursing practice experience were used to predict performance on three written clinical simulations of Medical-Surgical Nursing. A cross-sectional, convenience sample of 59 currently enrolled nursing students completed all instruments. Subjects were asked to give their hypotheses regarding the likely physiological alterations exhibited by the simulation patients. They also indicated the information they used to formulate their hypotheses and data they would gather to confirm their initial hypothesis. Separate data analyses were conducted for each of the simulations. The results revealed that the most difficult simulation was Wound Dehiscence, followed by Congestive Heart Failure and Hypoglycemia Reaction. Within the total sample the best predictors of the Wound Dehiscence simulation performance were formal education and Nursing Assistant Experience. The best predictors of Hypoglycemia were Nursing Assistant Experience and nursing knowledge, and for the Congestive Heart Failure simulation, they were knowledge and problem solving. The within education group analyses revealed variations in performance on the simulations that were attributable to individual differences in knowledge, general problem solving and experience. A comparison of the best problem solvers with the others revealed that they excelled in identifying the information needed to generate the hypotheses. The results of the study are discussed in terms of their implications for further research and nursing education. Among the key questions raised by the results were: How does nursing experience enhance students' ability to identify key information in simulated clinical problems? Why is critical thinking a significant predictor of one's ability to specify data needed to confirm hypotheses? The findings also highlights the need to further refine instruments used in assessing nurses' clinical judgement. Foremost among the implications for education were: (1) to provide more opportunities for nursing students to apply knowledge and clinical problem solving skills; and (2) foster active reflection in and on their practice to facilitate the integration and synthesis of skills associated with critical thinking/problem solving.PhDAdult educationEducationHealth and Environmental SciencesNursingUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/129197/2/9409722.pd