HOW DO COMMUNITY NURSES USE COGNITION AND INTUITION TO MAKE DECISIONS? A QUALITATIVE STUDY
Method(s): Subjects were nurses in a hospital based transitional care program. Interviews were face-to-face to address limitations of focus group interviews where individual participants may not disclose sensitive information in a social setting. Pre-defined question probes and active interviewer facilitation enable description and exploration of cognitive skills that respondents may be unable to describe relying on self-reflection and report alone. Data included process flow diagrams, and audiotaped and text transcripts. Using the ACTA protocol one graduate MD student and MPH research assistant studied patient home assessment and patient monitoring processes in a nurse led transitional care program based at a public hospital in Singapore.
Result(s): Nineteen community nurses were interviewed over thirty days with each interview lasting approximately 2 hours. The nurses differed in seniority and educational backgrounds. Preliminary examination of the process diagrams drawn by nurse’s illustrate differences and similarities between nurses in work priorities and difficult tasks. Difficult tasks containing planning or decision points suggest where introduction of decision aids may be useful to support clinical work in the field and enhance program quality. Data will be presented and full results will be discussed when analysis is complete.
Conclusion(s): ACTA is a practical qualitative protocol that enables researchers with only a basic understanding of nursing practice to effectively study work processes, environmental context and human behaviors for complex community health systems interventions.