Critical care nurses’ decision‐making activities in the natural clinical setting

Abstract

This article reports on observation of 18 nurses in urban and rural based critical care settings. The purpose of the study was to observe and describe the decision-making activities of critical care nurses within natural clinical settings. During the 2-hour observation, the researcher dictated a detailed commentary on to audio-tape of each nurse's actions. Tapes were transcribed and subjected to content analysis. Findings indicated three main categories of decisions. Decision frequencies were linked to nurses' critical care experience, appointment level, and location, as well as nursing shifts. The findings are discussed in relation to previous empirical evidence and the implications for practice. The author concludes that future research should be directed towards measuring the contextual influences on nurses' decision-making on the outcome of patient care.

Clinical Decision-Making among Critical Care Nurses: A Qualitative Study

“…The experience comes from recognizing patient's health situations and then developing action strategies to manage these situations [22]. The findings in this study concurred with those of [4] [27] in that experience is a factor influencing nurses' clinical decision making.…”

“…Patients in critical care units are seriously ill and frequently unstable and their health changed rapidly [14] [19] [20]. These changes require the nurses to make decisions in a limited period of time [4].…”

“…These advances in technology have led to an increase in the complexity of nurses' decision making particularly in critical care areas where nurses usually care for patients with multiple prob-lems [1] [2]. Indeed in critical care settings clinical decisions are frequently made in busy, stressful environment where there are competing demands and frequent distractions [3] [4]. Nurses need to make their decisions quickly and accurately to prevent the deterioration of patient condition to a life threatening situation.…”

Professional Autonomy, Collaboration With Physicians, and Moral Distress Among European Intensive Care Nurses

“…10,11 The ability to make discretionary and autonomous decisions based on comprehensive knowledge, clinical expertise, and evidence-based findings is a hallmark of professionalism. In general, ICU nurses make 1 care decision every 30 seconds 12 and approximately 9 important patient-care decisions per hour, 13 suggesting that exercising judgment is a core nursing activity and influences the quality of care provided. Previous studies 11,[14][15][16] in European ICUs indicated that the levels of nurse autonomy differ between countries and that the decision-making capacity of these clinicians needs to be developed and strengthened.…”

An exploratory mixed methods study of urban and rural registered nurses’ experience of clinical reasoning

“…Studies that investigate nurses' clinical reasoning fall into the following general categories: 1) ethical decision making; [12,13] 2) clinical reasoning for specific nursing procedures; [14,15] 3) decision-making and specific illnesses; [16,17] 4) decision-making within specific practice settings; [18,19] and 5) decision-making in nursing using simulation. [20,21] Contextual factors that influence clinical decision making that have been studied include: education, [5,22,23] experience, [3,24] level of appointment, [18] age, [25,26] and occupational orientation. [27] Thompson and Sutton [28] found that factors (listed in order of priority) that affected clinical reasoning in critical care nurses included knowledge and experience, role modelling and least important, values.…”