The purpose of this exploratory qualitative study was to determine the reasoning processes used by paramedics to solve clinical problems. Existing research documents concern over the accuracy of paramedics' clinical decision-making, but no research was found that examines the cognitive processes by which paramedics make either faulty or accurate clinical decisions. This study used verbal protocol analysis to examine data obtained by participants' thinking out loud as they concurrently solved and retrospectively reviewed two vignettes of clinical problems. Twenty concurrent verbal protocols and 20 retrospective debriefings were obtained from 10 paramedics purposively recruited for the study. Initial coding proceeded from a model of what was presumed to be true of paramedics' clinical reasoning processes, based on the information-processing theory of problem-solving, prescribed information in the Paramedic National Standard Curriculum, and literature on emergency medicine physicians' problem-solving processes. Codes were revised during data analysis to reflect themes that emerged from the data. Analysis revealed that participants' patient assessment and illness scripts related to the two vignettes were inadequately developed, disorganized, and, in some ways, faulty. Problem identification proceeded primarily by pattern recognition without adequate hypothesis testing. In the absence of adequate illness scripts for pattern recognition and the absence of adequate hypothesis testing, participants generated pseudo-information and used cognitive biases in problem solving. Participants had a low threshold for initiating treatment, often leading to inappropriate treatment being given.
|Advisor:||Chalofsky, Neal E.|
|Commitee:||Lindsey, Jeffrey, Weiss, Steven|
|School:||The George Washington University|
|Department:||Human Resource Development|
|School Location:||United States -- District of Columbia|
|Source:||DAI-A 71/01, Dissertation Abstracts International|
|Subjects:||Health education, Higher education|
|Keywords:||Clinical decision-making, Clinical problem-solving, Clinical reasoning, Emergency medical services, Paramedics|
Copyright in each Dissertation and Thesis is retained by the author. All Rights Reserved
The supplemental file or files you are about to download were provided to ProQuest by the author as part of a
dissertation or thesis. The supplemental files are provided "AS IS" without warranty. ProQuest is not responsible for the
content, format or impact on the supplemental file(s) on our system. in some cases, the file type may be unknown or
may be a .exe file. We recommend caution as you open such files.
Copyright of the original materials contained in the supplemental file is retained by the author and your access to the
supplemental files is subject to the ProQuest Terms and Conditions of use.
Depending on the size of the file(s) you are downloading, the system may take some time to download them. Please be