title: Differences in clinical reasoning among nurses working in highly specialised paediatric care.
abstract: OBJECTIVE
  The aim of the study was to examine differences in clinical reasoning among novice, experienced and specialist paediatric nurses.
  
  
  BACKGROUND
  Highly specialised paediatric care requires specific knowledge and ongoing skill performance of the nurses employed. There is a lack of research in how paediatric nurses manage the daily care problems they encounter and how they acquire the skills required to give patients the best possible care. More knowledge is needed about how paediatric nurses with different experience and education reason and communicate about paediatric patient situations.
  
  
  METHODS
  The study was based on six recorded group discussions of a fictitious, but realistic paediatric case. Three categories of nurses: novices (n = 7), experienced (n = 7) and specialists (n = 7) from a paediatric hospital participated. A qualitative content analysis approach was chosen to examine differences in clinical reasoning.
  
  
  RESULTS
  Several themes were uncovered: child's social situation, child abuse and the child's illness, qualitative differences emerged in how the nurses discussed the case. Three approaches were identified: a task-oriented approach (novices and experienced), an action-oriented approach (novices and experienced) and hypothesis-oriented approach (specialists) while discussing the case.
  
  
  CONCLUSIONS
  When comparing nurses in three competence groups, it was established that the groups with extensive experience and specialist education reasoned differently than the other groups. Between the novice and experienced groups, no obvious differences were found. Thus, the importance of experience alone for the development of competence is still an open question. Experience combined with further education appears important for developing professional competence in paediatric care.
  
  
  CONCLUSIONS
  Nurses' reasoning in clinical paediatric care is related to experience and training.
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. nina.andersson@ki.se
authors.forename: Nina
authors.initials: N
authors.lastname: Andersson
authors.forename: Birgitta
authors.initials: B
authors.lastname: Klang
authors.forename: Gunilla
authors.initials: G
authors.lastname: Petersson
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D003657:Decision Making; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D008875:Middle Aged; D009720:Nurse Clinicians / Q000193:education / Q000592:standards*; D009736:Nursing Process; D009741:Nursing Staff, Hospital / Q000193:education / Q000592:standards*; D010371:Pediatric Nursing / Q000193:education / Q000592:standards*; D011340:Problem Solving; D011787:Quality of Health Care; D013548:Sweden; D055815:Young Adult