Procedure
A grounded theory approach was used to gather data through in-depth personal interviews. A series of eight open-ended questions was asked of all student partici-pants regarding direct patient care expe-riences with adult clients and the student's choices made concerning that care. The interview questions were developed using the results of clinical decision-making re-search from Benner and King's model of dynamic interaction between nurse and patient. See Table 1.
Interviews were conducted at the co-llege campus where the investigator was on faculty. A dialogical style between par-ticipant and investigator was used. Par-ticipants were given free range to share personal accounts of their decision-ma-king situations. The investigator prompted students for clarity of Information about the described situations. Students were questioned about their ways of thinking, their feelings during and after making their decisions, and the context of the situation described. The reflective process used in-cluding "thinking in action" and "thinking on action". Schon discussed the reflective technique as a teaching strategy among various disciplines to move the learner from apprentice to master levels of per-formance (29). His technique has been cited frequently in nursing literature and employed to teach student nurses how to analyze their reasoning processes during and after patient care, using reflection.
Students shared their thoughts and emotions about their decision-making ex-periences at a deeply personal level. It was evident to the investigator that both the patients and the experiences were ex-tremely meaningful to the students. Every minute detail was described in their reflec-
tions about the situations, as if they were revisiting the scenarios. This information helped the investigator to fully compre-hend what the student experienced in this process. Interviews were conducted until saturation was achieved; that is, until no new information was shared.
Analysis
Data were analyzed through content analysis. Taped interviews were trans-cribed verbatim. The investigator listened to the audiotapes and read the written transcripts several times to gain an un-derstanding of each student's responses and the context of the situations descri-bed. The researcher verified transcribed information with participants during the second meeting. After that, statements significant to the clinical decision-making process were extracted. Categories and sub-categories were identified and com-parisons made to determine connections between categories, including conditions that initiated or supported the categories. Meanings were formulated from coded statements and organized by themes. A detailed description of the themes was drawn up to explain the participant's ex-periences. A synthesis of themes to deve-lop a relational hypothesis was the final step in the analytical process.
The investigator developed the analy-sis manually so as to keep a close rela-tionship with the data. Throughout the analysis, the investigator consulted with two expert nurse researchers, both with prior research experience in descriptive qualitative methodology, regarding inter-pretation of the meaning of the data and the investigator's prior knowledge and po-tential biases regarding clinical decision-making. This process added to the validity and reliability of the findings.
This investigator chose to study the phenomenon of decision-making from a holistic viewpoint using qualitative methodology. The aim of the study was to gain a more clear understanding of the ways in which student nurses made clinical decisions rather than limit the investigation to the outcomes of clinical choices.