title: Registered nurses' clinical reasoning in home healthcare clinical practice: A think-aloud study with protocol analysis.
abstract: BACKGROUND
  The home healthcare context can be unpredictable and complex, and requires registered nurses with a high level of clinical reasoning skills and professional autonomy. Thus, additional knowledge about registered nurses' clinical reasoning performance during patient home care is required.
  
  
  OBJECTIVE
  The aim of this study is to describe the cognitive processes and thinking strategies used by recently graduated registered nurses while caring for patients in home healthcare clinical practice.
  
  
  METHODS
  An exploratory qualitative think-aloud design with protocol analysis was used.
  
  
  METHODS
  Home healthcare visits to patients with stroke, diabetes, and chronic obstructive pulmonary disease in seven healthcare districts in southern Norway.
  
  
  METHODS
  A purposeful sample of eight registered nurses with one year of experience.
  
  
  METHODS
  Each nurse was interviewed using the concurrent think-aloud technique in three different patient home healthcare clinical practice visits. A total of 24 home healthcare visits occurred. Follow-up interviews were conducted with each participant. The think-aloud sessions were transcribed and analysed using three-step protocol analysis.
  
  
  RESULTS
  Recently graduated registered nurses focused on both general nursing concepts and concepts specific to the domains required and tasks provided in home healthcare services as well as for different patient groups. Additionally, participants used several assertion types, cognitive processes, and thinking strategies.
  
  
  CONCLUSIONS
  Our results showed that recently graduated registered nurses used both simple and complex cognitive processes involving both inductive and deductive reasoning. However, their reasoning was more reactive than proactive. The results may contribute to nursing practice in terms of developing effective nursing education programmes.
authors.affiliation: Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway. Electronic address: hege.mari.johnsen@uia.no.
authors.forename: Hege Mari
authors.initials: HM
authors.lastname: Johnsen
authors.affiliation: Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway.
authors.forename: Åshild
authors.initials: Å
authors.lastname: Slettebø
authors.affiliation: Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway.
authors.forename: Mariann
authors.initials: M
authors.lastname: Fossum
mesh_terms: D002983:Clinical Competence; D003071:Cognition; D003657:Decision Making; D004508:Education, Nursing, Baccalaureate; D006699:Home Care Services; D006801:Humans; D024802:Nurse's Role / Q000523:psychology*; D009730:Nursing Assessment; D015404:Nursing Methodology Research; D009736:Nursing Process; D017009:Professional Autonomy; D013850:Thinking
keywords: Clinical skill; Decision-making; Norway; Nursing; Qualitative method; Verbal protocol analysis