Approaches to problem solving in nursing practice.

One of the requirements for high quality individualised nursing care is that nurses must recognise and attempt to solve patients' health problems. It is generally agreed that this needs a problem-solving approach.It was decided to investigate the perceptions and understanding of problem solving in nursing using a model derived from the general literature. This model, from an analysis of 55 studies, consists of 5 phases which happen to be similar to the 4 or 5 stages in discussions of the nursing process.Insight into nurses' perceptions of problem solving was obtained by presenting 120 nurses, in individual interviews, with 7 specially constructed and validated vignettes of clinical problem solving. Deliberately, only one of the vignettes was complete, containing all 5 elements of the derived model. The remaining vignettes had one or more of the elements missing. The nurses were encouraged to comment on each vignette and the protocols were analysed in detail.Analysis revealed that the phase model was generally understood by all types of informants, but a number failed to detect the missing phases in some vignettes, in particular, problem identification, planning and evaluation. On the other hand, problem assessment and implementation almost always attracted comment. There did not appear to be a relationship between informants' nursing experience and the recognition or non-recognition of phases. Another finding was that informants were not always systematic in their analysis of the vignettes; that is, some did not begin their analysis with problem identification and conclude with evaluation. Overall, the findings lend support to a stages model as a theoretical basis for problem solving in nursing.The theoretical basis of problem solving in nursing is also discussed in relation to problem solving in allied professional disciplines. Finally, the implications of the study for nursing education and practice are explained and recommendations made for further study.