title: Thinking in clinical nursing practice: a study of critical care nurses' thinking applying the think-aloud, protocol analysis method.
abstract: OBJECTIVE
  The purpose of the paper is to discover the patterns and processes of decision-making in clinical nursing practice.
  
  
  METHODS
  A set of think-aloud data from five critical care nurses during 40 to 50 minutes of caregiving in intensive care units were obtained and analyzed by applying the procedures recommended by Ericsson and Simon for protocol analysis.
  
  
  RESULTS
  Four thinking processes before acting were identified to constitute various sorts of thoughts in which the nurses were engaged during patient care: reviewing, validation, consideration, rationalization, and action. In addition, three patterns of sequential streaming of thinking (short, intermediate, long) were identified to reveal various ways the nurses dealt with clinical situations involving nursing tasks and responsibilities.
  
  
  CONCLUSIONS
  This study specifies the initial categories of thoughts for each of the processes and various patterns with which these processes are sequentially combined, providing insights into the ways nurses think about problems and address their concerns. The findings suggest that the thinking in clinical practice involves more than focused decision-making and reasoning, and needs to be examined from a broader perspective.
authors.affiliation: Professor, College of Nursing, Seoul National University, Seoul, Korea.
authors.forename: Kyung-Ja
authors.initials: KJ
authors.lastname: Han
authors.affiliation: Professor, College of Nursing, University of Rhode Island, Kingston, RI, USA.
authors.forename: Hesook Suzie
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Professor, College of Nursing, Seoul National University, Seoul, Korea.
authors.forename: Mae-Ja
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Professor, College of Nursing, Seoul National University, Seoul, Korea.
authors.forename: Kyung-Ja
authors.initials: KJ
authors.lastname: Hong
authors.affiliation: Professor, College of Nursing, Seoul National University, Seoul, Korea.
authors.forename: Sungae
authors.initials: S
authors.lastname: Park
authors.affiliation: Professor, College of Nursing, Seoul National University, Seoul, Korea.
authors.forename: Soon-Nyoung
authors.initials: SN
authors.lastname: Yun
authors.affiliation: Professor, College of Nursing, Seoul National University, Seoul, Korea.
authors.forename: Misoon
authors.initials: M
authors.lastname: Song
authors.affiliation: Department of Nursing, Samsung Medical Center, Seoul, Korea.
authors.forename: Yoenyi
authors.initials: Y
authors.lastname: Jung
authors.affiliation: Professor, Department of Nursing, College of Medicine, Kwandong University, Gangreung, Gangwon do, Korea.
authors.forename: Haewon
authors.initials: H
authors.lastname: Kim
authors.affiliation: Associate Professor, Department of Nursing, College of Oriental Medicine, Daejeon University, Daejeon, Korea.
authors.forename: Dong-Oak Debbie
authors.initials: DO
authors.lastname: Kim
authors.affiliation: Associate Professor, Department of Nursing, College of Medicine, Konkuk University, Chungju, Chungbuk, Korea.
authors.forename: Heejung
authors.initials: H
authors.lastname: Choi
authors.affiliation: Professor, College of Nursing, Seoul National University, Seoul, Korea.
authors.forename: Kyungae
authors.initials: K
authors.lastname: Kim