Social-Cognitive Determinants of Clinical Inference in Mental Health: an Experimental Analysis (Decision-Making, Information Processing).

The problem of diagnostic discrepancy, the phenomenon of different clinicians making divergent diagnoses, has been ascribed to cognitive determinants of clinical inference and to contextual factors influencing such inference. A sample of seventy-two female senior nursing students was r and omly assigned to the cells of a 4 x 2 factorial experiment: (A) mode of client information presentation (client contact through videotape, audiotape, transcript, or no-contact), and (B) availability of pre-assessment information (information versus no-information). Dependent measures assessed subjects' evaluations of the client's maladjustment, stress, depressive status, psychiatric emergency, and overall psychological functioning. Subjects were also requested to evaluate the causes for the condition, to rate the applicability of nursing diagnoses and selected psychiatric diagnoses, and to report their confidence in their clinical inferences. Main effects were noted for Factor A on all the dependent measures (except the causal analysis scale) suggesting that much of clinical inference is determined by the condition under which the diagnostic process takes place. However, post hoc comparisons revealed that these overall statistical significances were due to differences between no-contact subjects and videotape, audiotape and transcript subjects taken as a group. Main effects for Factor B were noted only for the perceived client stress instrument. No interaction effects were determined. Finally, confidence ratings were high for data-acquisition tasks, low for integrative inferential and psychiatric diagnostic tasks, and moderately high for nursing diagnostic tasks. These findings are indicative of a trend, at least among novice clinicians, to scan client-related information for sets of discriminant and prototypical information representative of specific clinical patterns. This information is hypothesized to be verbal-semantic, as suggested by an analysis of the data subjects used in their inferences. The lack of variance in causal inferences is ascribed to the action of general cognitions about causality. The implications for clinical practice and the education of nurses are discussed.Ph.D.NursingUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/160085/1/8422187.pd