Relationships among the hypothesized components leading to complex reflective thinking in emergency nursing practice.
Bobay, Kathleen Lynn
2003
Abstract
Although expertise has been discussed extensively in the nursing literature, there exists no clear definition of what nursing expertise is or how to measure it. As a result, it is difficult to identify clinical nursing experts or to know how to promote the development of expertise in those nurses with the ability and desire to become experts. This study explored components of complex reflective thinking, which was hypothesized to be a proxy for clinical nursing expertise. It differs from the traditional nursing expertise model, in that subjects are not placed in predetermined categories based on experience. Key variables explored included progressive problem solving, domain-specific knowledge, experience, quest for excellence, reinvestment, and complex reflective thinking. Mail surveys were sent to 1000 nurses who had taken the Certification for Emergency Nursing (CEN) examination within the previous calendar year. A total of 338 (34%) of surveys were returned. Data analysis was conducted using structural equation modeling (SEM) and t-tests. Two separate models were considered, first using RCI-Recognition component (RCI-R) as the measure for complex reflective thinking, then using RCI-Discrimination component (RCI-D) as the measure for complex reflective thinking. Although the chi square (chi<super>2</super>) was not significant for either the RCI-R or RCI-D model, the results are unsatisfactory. There are clear indications that RCI-D is a mis-specified model and that unexpected results occurred in RCI-R suggesting that this model may also be mis-specified. Key findings showed that experience and progressive problem solving were poor predictors of complex reflective thinking (CRT), although these are the two most frequently used proxies of expertise used in previous studies. Reinvestment, which is continuous lifelong learning, was shown to have a significant effect on the development of CRT. The quest for excellence, an intrinsic motivation factor, also had a significant impact on the development of CRT. Limitations to this research study included a small sample size and lack of large effect sizes. Results are specific to the emergency nursing sample and cannot be generalized to other nursing populations. Recommendations for further research include determining if CRT is actually a proxy for clinical nursing expertise and exploring other instruments that may better measure the concepts. Triangulation may be needed to better represent the qualitative aspects of expertise. The concepts of reinvestment, complex reflective thinking, and quest for excellence have not been previously examined in the nursing literature and deserve more attention.Subjects
Clinical Expertise Complex Components Emergency Nursing Hypothesized Leading Practice Reflective Thinking Relationships
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