Comparison of 'think aloud' and observation as data collection methods in the study of decision making regarding sedation in intensive care patients

Background: There is recognition that different data collection methods gather different aspects of decision making data. Although the selection of a method to explore nurses' decision making is partially determined by the theoretical perspective that informs each study, some flexibility remains. Description of the relative benefits of each method will enable future researchers to selectively identify which method is most suited to answering their specific research question. Objectives: To describe the decisions identified using observation and think aloud in the study of decision making related to sedation assessment and management within intensive care, as well as to examine the strengths and weaknesses of each method in the context of this study. Design: Secondary analysis of data collected during an observational study. Settings: This study was conducted in one intensive care unit in a tertiary teaching hospital in Australia. Participants: Seven self-identified expert critical care nurses. Methods: Nurses providing sedation management for a critically ill patient were observed and asked to think aloud during 2 h of care, with follow-up interviews conducted up to 4 days later to clarify information collected. Data were analysed independently by an investigator not involved in data collection. Analysis involved identification of decision tasks with comparison of number and type of tasks identified with each of the two data collection techniques. Results: Assessment and management were the most common types of sedation decisions made by nurses in this study. A total of 130 decisions were identified using observation and 209 decisions were identified using think aloud. More management decisions were identified through observation, while more assessment decisions were identified through think aloud. Conclusions: The two data collection methods of think aloud and observation resulted in identification of different decision tasks. These results suggest an essential consideration in design of decision making studies is the method of data collection and the type of decision data that is likely to be identified. It may be appropriate to use a combination of data collection methods to optimise the completeness of data capture. (C) 2010 Elsevier Ltd. All rights reserved.