Clinical Decision-Making of Nurses Regarding Elder Abuse: Full Dissertation – ED Nurses, Assessment Cues, Intuition, Mandatory Training & Reporting Outcomes

This complete doctoral dissertation (Georgia State University, 2008) investigates the clinical decision-making processes of emergency department (ED) registered nurses regarding suspected elder abuse. Using a descriptive correlational design based on Donabedian's Structure-Process-Outcome Model and Benner's Novice to Expert Theory, the study examines relationships between: RNs' applied knowledge (assessment cues), years of experience, intuition use in nursing practice, clinical level of practice status (clinical ladder), and clinical decision outcomes (internal/external reporting interventions). Data collected from 84 ED RNs across three Magnet-designated hospitals in the southeastern US. Key findings: multiple regression revealed that applied knowledge (assessment cues) and years worked as a RN significantly predicted clinical decision outcomes (25.1% variance). No significant differences were found between nurses who received elder abuse education during orientation and those who did not. The study also identifies that clinical level of practice status was NOT a sensitive indicator of elder abuse recognition. Includes full instruments: Knowledge of Elder Abuse Survey, Intuition Use in Nursing Scale (Rew, 2000, Cronbach's alpha .81), Elder Abuse Vignette Instrument (4 validated scenarios with coding/scoring criteria), demographic form, IRB approvals, and complete methodology. Covers: neglect, self-neglect, financial abuse, physical abuse, psychosocial abuse, isolation, mandatory reporting barriers, nursing education deficits, Benner's five stages (novice to expert), Donabedian's quality framework, and recommendations for nursing practice, curriculum, and policy. Essential for PhD/DNP students, nursing researchers, gerontology specialists, forensic nurses, emergency nurses, nurse educators, and healthcare policy makers.