Illness scripts in nursing: Directed content analysis

• Published in: Journal of advanced nursing Vol. 78; no. 1; pp. 201 - 210
• Main Authors: Vreugdenhil, Jettie, Döpp, Donna, Custers, Eugène J. F. M., Reinders, Marcel E., Dobber, Jos, Kusukar, Rashmi A.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-01-2022; John Wiley and Sons Inc
• Subjects: advanced practice; Clinical decision making; clinical judgement; Clinical nursing; clinical reasoning; Content analysis; Data; Data processing; directed content analysis; education; Experts; Humans; illness scripts; Illnesses; Medical History Taking; Nurses; Nursing; Original Research: Empirical Research–Quantitative; Patients; Qualitative Research; Research Papers; Script theory; Scripts; Students, Nursing; Thinking aloud; education; illness scripts; clinical reasoning; directed content analysis; clinical judgement; nursing; advanced practice; nurses
• DOI: 10.1111/jan.15011
• EISSN: 1365-2648
• ISSN: 0309-2402

Aims
To explore the possible extension of the illness script theory used in medicine to the nursing context.
Design
A qualitative interview study.
Methods
The study was conducted between September 2019 and March 2020. Expert nurses were asked to think aloud about 20 patient problems in nursing. A directed content analysis approach including quantitative data processing was used to analyse the transcribed data.
Results
Through the analysis of 3912 statements, scripts were identified and a nursing script model is proposed; the medical illness script, including enabling conditions, fault and consequences, is extended with management, boundary, impact, occurrence and explicative statements. Nurses often used explicative statements when pathophysiological causes are absent or unknown. To explore the applicability of Illness script theory we analysed scripts’ richness and maturity with descriptive statistics. Expert nurses, like medical experts, had rich knowledge of consequences, explicative statements and management of familiar patient problems.
Conclusion
The knowledge of expert nurses about patient problems can be described in scripts; the components of medical illness scripts are also relevant in nursing. We propose to extend the original illness script concept with management, explicative statements, boundary, impact and occurrence, to enlarge the applicability of illness scripts in the nursing domain.
Impact
Illness scripts guide clinical reasoning in patient care. Insights into illness scripts of nursing experts is a necessary first step to develop goals or guidelines for student nurses’ development of clinical reasoning. It might lay the groundwork for future educational strategies.