Strategy switching in the pediatric intensive care unit

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Ferguson, Ashley N.
Durso, Frank
Rogers, Wendy A.
Thomas, Rick P.
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The study was aimed at determining how operators select strategies and switch among these strategies as they acquire new pieces of information or cues from the environment. I first determined the cues that experienced Pediatric Intensive Care Unit (PICU) nurses used to select a given strategy. Participants were three experienced PICU nurse consultants. A modified Threat-Strategy Interview (TSI; Durso, Kazi, & Ferguson, 2015) was used to elicit cues from the consultants for a sample of previously elicited strategies. A subset of these elicited cues was used as stimuli in Study 2. Study 2 examined cue-strategy relationships by asking 21 PICU nurses to select strategies they would likely implement given a set of cues representing a current state of the environment. Each nurse was given multiple trials that began with the nurse receiving one cue and ended after the nurse had received five cues. For each trial, the nurses a) nominated all the strategies they would consider implementing, b) then selected the one strategy most likely to be implemented, and c) finally rated their confidence that this one selected strategy was the most appropriate strategy given the current cue(s). In general, nurses considered implementing the greatest number of strategies after acquiring a single cue but quickly narrowed the strategies they were considering after receiving one additional cue. The nurses maintained this level of nominations despite acquiring additional cues. Nurses’ confidence in the strategy selection was also highest when they only had access to a single cue. The failure of nominations to further reduce after two cues and the highest confidence after receiving only a single cue may mean nurses are using heuristics or more satisficing type decision making. By understanding the cues that experienced nurses use in strategy selection and strategy switching, models of experienced nurses can be examined.
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