John FedoFollow

Date of Completion


Embargo Period



clinical decision making, pain management, cognitive continuum theory

Major Advisor

Deborah Dillon McDonald, PhD, RN

Associate Advisor

E. Carol Polifroni, EdD. RN

Associate Advisor

Barbara Bennett Jacobs, PhD, RN

Field of Study



Doctor of Philosophy

Open Access

Open Access


Nurses’ Decision-making Processes and Pain Management Outcomes

John M. Fedo, PhD.

University of Connecticut, 2014


The purpose of this study was to identify the cognitive processes used by nurses when making pain management decisions by testing how the structure of a task (well-structured or ill-structured) affects use of analytic cognitive processes. Identifying cognitive processes which nurses use to make clinical decisions in the practice setting may be used to gain understanding of which types of cognitive processes are more effective when managing decisions for planned pain management interventions. Two hypotheses were tested. H1: Nurses reading the well-structured patient vignette will use analytical cognitive processes more than nurses reading the ill-structured vignette, and H2: There is an association between the analytical cognitive processes identified on the continuum and the pain management interventions used.

The theoretical underpinning for the study was cognitive continuum theory. Cognitive continuum proposes cognitive processes occur on a continuum. One end of the continuum is anchored in analysis and the other anchored in intuition with varying degrees of analysis and intuition between.

Two hundred medical surgical nurses participated. Demographic data were collected and the nurses were randomly assigned to read either a well-structured pain vignette or an ill-structured pain vignette. The well-structured vignette was developed and pilot tested to induce analytical cognitive processes and the ill-structured vignette to induce intuitive cognitive processes. Nurses read the vignette and then responded out

John Fedo – University of Connecticut, 2014

loud describing what they would think and what actions they would take as the nurse caring for the patient. The well-structured vignette described a patient with a leg fracture. The ill-structured vignette included the addition of a family visit to manipulate the task

structure characteristics. Protocol analysis was used to gather the verbal data. Protocol analysis elicits the thoughts of a person in a given situation. Content analysis was used to analyze the transcripts for nurses’ use of analytic and intuitive cognitive processes, and planned pain management interventions.

Results did not support that the structure of the situation affected the type of cognitive processes used by nurses, that well-structured situations increase use of analytic cognitive processes and ill-structured increased intuitive cognitive processes. Increased use of analytic cognitive processes was positively correlated with planned use of a greater number of pain management interventions, however. The small positive correlation indicates that teaching nurses to use analytical cognitive processes when managing patients pain will increase the number of appropriate pain management actions used by the nurse.