Home Medicine Using “Think Aloud” to Capture Clinical Reasoning during Patient Simulation
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Using “Think Aloud” to Capture Clinical Reasoning during Patient Simulation

  • Beth Burbach EMAIL logo , Susan Barnason and Sarah A Thompson
Published/Copyright: February 3, 2015

Abstract

Think Aloud (TA), a strategy in which subjects are instructed to verbalize thoughts as they occur while completing an assigned task, was integrated into a study of clinical reasoning during high fidelity patient simulation by baccalaureate nursing students. TA methods in nursing education research with patient simulation have not previously been reported. Concurrent TA (verbalization of thoughts in short-term memory) and retrospective TA (reflective thoughts verbalized during an immediate post-simulation interview) methods facilitated the collection of rich and meaningful data. Students demonstrated distinct patterns in verbalization during concurrent TA, including public and private thoughts, narration of care, and the use of the pause to facilitate clinical reasoning. Retrospective TA data provided rich descriptions of reflection-on-action. TA provides a rich source of data regarding clinical reasoning as experienced by the baccalaureate nursing student during high fidelity patient simulation.

Funding statement: Funding: Sigma Theta Tau International, Gamma Pi at-large Chapter.

References

Aitken, L., M., Marshall, A., Elliott, R., & McKinley, S. (2011). Comparison of ‘think aloud’ and observation as data collection methods in the study of decision making regarding sedation in intensive care patients. International Journal of Nursing Studies, 48, 318325.10.1016/j.ijnurstu.2010.07.014Search in Google Scholar PubMed

Benner, P., Sutphen, M., Leonard, V., & Day, L. (2009). Educating nurses: A call for radical transformation. San Francisco, CA: Jossey-Bass.Search in Google Scholar

Bremner, M., Adduddell, K., Bennett, D., & VanGeest, J. (2006). The use of human patient simulators: Best practices with novice nursing students. Nurse Educator, 31, 170174.10.1097/00006223-200607000-00011Search in Google Scholar PubMed

Charmaz, K., & McMullen, L. M. (2011). Five ways of doing qualitative analysis: Phenomenological psychology, grounded theory, discourse analysis, narrative research, and intuitive inquiry. New York, NY: Guilford PressSearch in Google Scholar

Connor, L. O. (2012). Critical care nurses’ judgment of pain status: A case study design. Intensive and Critical Care Nursing, 28, 215223.10.1016/j.iccn.2012.01.004Search in Google Scholar PubMed

Decker, S., Sportsman, S., Puetz, L., & Billings, L. (2008). The evolution of simulation and its contribution to competency. The Journal of Continuing Education in Nursing, 39, 74104.10.3928/00220124-20080201-06Search in Google Scholar PubMed

Dillard, N., Sideras, S., Ryan, M., Hodson Carlton, K., Lasater, K., & Siktberg, L. (2009). A collaborative project to apply and evaluate the clinical judgment model through simulation. Nursing Education Research, 30, 99104.Search in Google Scholar

Duncker, K. (1926). A qualitative (experimental and theoretical) study of productive thinking (solving of comprehensible problems. Pedagogical Seminary and Journal of Genetic Psychology, 33, 642708.10.1080/08856559.1926.10533052Search in Google Scholar

Durning, S., Artino, A. R., Pangaro, L., Cees, P. V., & Schuwirth, L. (2011). Context and clinical reasoning: Understanding the perspective of the expert’s voice. Medical Education, 45, 927938.10.1111/j.1365-2923.2011.04053.xSearch in Google Scholar PubMed

Durning, S. J., Graner, J., Artino, A., Pangaro, J., Beckman, L. N., Holmboe, T., & Schuwirth, L. (2012). Using functional neuroimaging combine with a think-aloud protocol to explore clinical reasoning expertise in internal medicine. Military Medicine, 177, 9, 7278.10.7205/MILMED-D-12-00242Search in Google Scholar PubMed

Ericsson, K., & Simon, H. (1980). Verbal reports as data. Psychological Review, 87, 215251.10.1037/0033-295X.87.3.215Search in Google Scholar

Ericsson, K., & Simon, H. (1998). How to study thinking in everyday life: Contrasting think-aloud protocols with descriptions and explanations of thinking. Mind, Culture, and Activity, 5, 178186.10.1207/s15327884mca0503_3Search in Google Scholar

Fonteyn, M. E., & Fisher, A. (1993). Use of think aloud method to study nurses’ reasoning and decision making in clinical practice settings. Journal of Neuroscience Nursing, 27(2), 124128.10.1097/01376517-199504000-00012Search in Google Scholar PubMed

Hertzum, M., Hansen, K. D., & Andersen, H. (2009). Scrutinising usability evaluation: Does thinking aloud affect behaviour and mental workload?Behaviour & Information Technology, 28, 165181.10.1080/01449290701773842Search in Google Scholar

Hoffman, K. A., Aitken, L. M., & Duffield, C. (2009). A comparison of novice and expert nurses’ cue collection during clinical decision-making: Verbal protocol analysis. International Journal of Nursing Studies, 46, 13351344.10.1016/j.ijnurstu.2009.04.001Search in Google Scholar PubMed

Laerdal Medical Corporation. (2010). NLN Simulation in Nursing Education Sim Man Scenarios. (Vol 1). New York, NY: Wappinger FallsSearch in Google Scholar

Lasater, K. (2007). High-fidelity patient simulation and the development of clinical judgment: Students’ experiences. Journal of Nursing Education, 46, 269276.10.3928/01484834-20070601-06Search in Google Scholar PubMed

Lundgrén-Laine, H., & Salanterä, S. (2010). Think-aloud technique and protocol analysis in clinical decision-making research. Qualitative Health Research, 20, 565575.10.1177/1049732309354278Search in Google Scholar PubMed

FossumM., Alexander, G. L., Göransson, K. E., Ehnfors, M., & Ehrenberg, A. (2011). Registered nurses’ thinking strategies on malnutrition and pressure ulcers in nursing homes: A scenario-based think-aloud study. Journal of Clinical Nursing, 20, 24252435.10.1111/j.1365-2702.2010.03578.xSearch in Google Scholar PubMed

Nørgaard, M., & Hornbæk, K. (2006, June 26–28). What do usability evaluators do in practice? an explorative study of think-aloud testing. In Proceedings of the 6th conference on Designing Interactive systems. Paper presented at DIS’06 Designing Interactive Systems Conference, University Park, PA (pp. 209–218). New York, NY: ACM.10.1145/1142405.1142439Search in Google Scholar

Pottier, P., Hardouin, J., Hodges, B. D., Pistorius, M., Connault, J., Durant, C., & Planchon, B. (2010). Exploring how students think: A new method combining think-aloud and concept mapping protocols. Medical Education, 44, 926935.10.1111/j.1365-2923.2010.03748.xSearch in Google Scholar PubMed

Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45, 204211.10.3928/01484834-20060601-04Search in Google Scholar PubMed

Weaver, A. (2011). High-fidelity patient simulation in nursing education: An integrative review. Nursing Education Perspectives, 32, 3740.10.5480/1536-5026-32.1.37Search in Google Scholar PubMed

Published Online: 2015-2-3
Published in Print: 2015-1-1

©2015 by De Gruyter

Articles in the same Issue

  1. Frontmatter
  2. Using “Think Aloud” to Capture Clinical Reasoning during Patient Simulation
  3. Translation and Evaluation of the Cultural Awareness Scale for Korean Nursing Students
  4. Making the Most of Simulated Learning: Understanding and Managing Perceptions
  5. Nursing Students’ Experiences with High-Fidelity Simulation
  6. An Integrative Review: Instructional Strategies to Improve Nurses’ Retention of Cardiopulmonary Resuscitation Priorities
  7. Effects of Team-Based Learning on Self-Regulated Online Learning
  8. Teaching Nursing Leadership: Comparison of Simulation versus Traditional Inpatient Clinical
  9. The Experience of Nursing Students Who Make Mistakes in Clinical
  10. Identification of the Learning Styles and “On-the-Job” Learning Methods Implemented by Nurses for Promoting Their Professional Knowledge and Skills
  11. Orientation, Evaluation, and Integration of Part-Time Nursing Faculty
  12. Perceptions of Clinical Stress in Baccalaureate Nursing Students
  13. The Flipped Classroom: Fertile Ground for Nursing Education Research
  14. Student Engagement: A Principle-Based Concept Analysis
  15. Assessment of High-Stakes Testing, Hopeful Thinking, and Goal Orientation among Baccalaureate Nursing Students
  16. Partners in Research: Developing a Model for Undergraduate Faculty-Student Collaboration
  17. Nursing Students Achieving Community Health Competencies through Undergraduate Clinical Experiences: A Gap Analysis
  18. Student Perceptions of Quality and Safety Competencies
  19. Integrating a Career Planning and Development Program into the Baccalaureate Nursing Curriculum: Part I. Impact on Students’ Career Resilience
  20. Integrating a Career Planning and Development Program into the Baccalaureate Nursing Curriculum. Part II. Outcomes for New Graduate Nurses 12 Months Post-Graduation
  21. Integrating a Career Planning and Development Program into the Baccalaureate Nursing Curriculum: Part III. Impact on Faculty’s Career Satisfaction and Confidence in Providing Student Career Coaching
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