A BEHAVIORAL ANALYSIS OF CLINICAL PERFORMANCE DISCRIMINATING NOVICE FROM EXPERT NURSES.

Description

The purpose of this study was to use Skinner's operant theory to analyze the stimulus control factors that discriminate expert from novice nurses. It is this author's contention that the difference often expressed in the literature as intuition, efficiency, or experience is a function of building contingency systems whose stimulus events vary from artificial discriminative stimuli comprising the rule-governed behavior taught in school. The difference is not in the cognitive processes used by each group, or in the behavioral correlates of those processes. Behavioral analysis data were obtained from video tapes of five subjects representing various levels of nursing expertise as they performed pulse and blood pressure measurements on senior citizens. Data were analyzed in several phases to identify subject operants, the conditions under which the operants occurred, and the variations in performance of the operants. Six operants were identified as a result of data analysis. They were: (a) eye contact, (b) ver al interaction, (c) use of touch, (d) attending to the client, (e) obtaining the measurement, and (f) efficiency. Discriminative stimuli for all subjects included the client talking, the equipment the subjects used to take pulse and blood pressure measurements, and paper work. Discriminative stimuli that differentiated expert from novice performance included health-related information, client comfort, and casual conversation. Contingent events were the variations in operant performance seen in the subjects. Conclusions reached were that the expert subject remained focused on the client more than the task, even while completing the task. Less experienced subjects also focused on the client, but not while completing the task. Second, the congruence of stimulus conditions between the learning environment and the practice environment was shown to be of critical importance in behavior. If the conditions under which students learn are different from the conditions under which they must perform, their performance may be inappropriate. Third, results of the study support findings of other studies of novices and experts. However, explaining novice and expert behavior in operant terms provides more precise definitions and opens the possibility to teach elements of expertise.

Subjects