Abstract

The aim of this study is to describe the development of nursing students' decision-making as a part of their professional skills during their nursing education. The population consisted of 32 college nursing students who had started their education in January 1987 or 1988 and 23 polytechnic nursing students who had started their education in 1996. The college students' process of learning decision - making was studied during 1988-1991 by taping clinical lessons about planning patient care (terms IV-VI) and by collecting essays prodeced by the students during the clinical periods (terms III, V and VII). Essays produced by the polytechnic students (terms III and IV) during 1997-1998 were also collected. The data were analyzed by using both quantitatively and qualitatively content analysis (deductive and inductive analysis).

The results show that rational decision-making was emphasized both in college and in polytechnic. The care plans made by the students were consistent with the phases of the nursing process. Of the different phases of the nursing process the implementation and the evaluation of nursing care were most important. At the beginning of their practical training college students emphazised nursing methods, while polytechnic students focused on medical methods. In all data sets, most uttrances pertained to the physical aspects in the implementation of nursing, in the definition of nursing problems and in the evaluation of nursing. As learning proceeded from one term to the next no changes were seen. The only exception were the clinical lessons at the beginning of the education and the essays and clinical lessons during the last phases of education in which psychic support and the need to evaluate the patient's psychic condition were emphazised. At the beginning of practical training polytechnic students gave more attention to physic support of the patient than college students. Plenty of knowledge was collected about a patient for purposes of decision-making, but it was only partly utilized as the planning of care proceeded. All data sets clearly reflected the mechanical decision-making model. At the beginning of practical training the next largest category in the college students' data was the patient-centered model which was only rarely seen in the polytechnic data. In all data sets the objectives of nursing were defined in a patient-centered manner. The college data included a small number of features of the model-oriented and creative decision-making model which were not found in the polytechnic data at the beginning of practical training at all. The following features of the creative decision-making model were found setting priorities, giving reasons for choosing the nursing model, nursing problems and methods and producing alternative nursing solutions. In both data sets the students' learning level appeared to be quite low. The findings reflected superficial mechanical learning without reflection and critical thinking.