Factors influencing decision making among ambulance nurses in emergency care situations

Gunnarsson, Bjorn; Stomberg, Margareta Warrén

doi:10.1016/j.ienj.2008.10.004

Cited by 80 publications

(88 citation statements)

References 13 publications

(16 reference statements)

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“…These cues are learnt from previous knowledge and experience [9]. 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.…”

Section: Discussionsupporting

confidence: 77%

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

Maharmeh¹,

Alasad²,

Salami³

et al. 2016

Health

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The purposes of this study were to describe the decision making process and decision activities of critical care nurses in natural clinical settings. An exploratory descriptive approach utilizing both interview and observation methods, was used for data collection. The study involved twenty four critical care nurses from three hospitals in Jordan. Participant observation was performed to understand the routine clinical decisions made by Intensive Care nurses. About 150 hours of observations were spent in the involved Intensive Care Units. Nurses were interviewed to elicit information about how they made decisions about patient's care. The study revealed that the most common model nurses tend to use was intuitive model in order to observe the cues relating to the patient's situation. Data revealed that the decision making process is continuous and that experience is one of the main factors that determine nurses' ability to take decisions. Five themes were generated from the data: on-going process, autonomy, experience/power, joint/ethical decisions, and advocacy. Critical care nurses were seen to be sensitive to the patient's verbal and non-verbal cues; they were able to respond to these evidences to ensure that the patient's condition did not deteriorate. Critical care nurses are likely to be more confident and effective when dealing with patient's changing situations with more experience.

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Section: Discussionsupporting

confidence: 77%

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

Maharmeh¹,

Alasad²,

Salami³

et al. 2016

Health

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“…including lack of time, poor support and leadership, left on one's own with radical decision-making, not being informed about important decisions, and general high demands, surprisingly few had not been on sick leave caused by too high a workload. This stands in stark contrast to many other studies on high psychological demands, emotional exhaustion, and cumulative exposure to stress sometimes leading to PTSD (27,(29)(30)(31)(32). It could be that few responders had experienced a particularly disturbing incident in the previous six months, which is said to be predictive for severe consequences at emergency work.…”

Section: Discussioncontrasting

confidence: 86%

Psychosocial Workload of Swedish Ambulance and Emergency Room Personnel with High Prevalence of Dying, Death and Grieving Relatives. A Descriptive and Comparison Study

Johansson¹,

Johansson²,

Grimby

2014

AJNS

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Frequent caretaking of severely ill, dying, and dead people as well as bereaved close relatives could involve too much stress for emergency personnel to be satisfied with the job situation. Screening for critical aspects for work satisfaction and endurance at ambulance and emergency rooms would provide useful information to the workers themselves, their management, and for pre-hospital acute routines/programs. Two hundred and forty 40-item job-related, postal enquieries on demographical, as psychological, social, economical, and existential work aspects were sent to 26 clinical directors to be assessed by personnel at the ambulance and emergency rooms in Sweden. The response rate was 64%, the majority being nurses and nurse assistants, experiencing a very high, high, or rather high prevalence of severely ill or dead patients at their work place. The hospitals' frequency of severely ill or dead patients predicted a higher mental workload experience in both ambulance and emergency room personnel. More personnel at the emergency rooms compared with ambulance workers expressed time pressure and were less satisfied with their caretaking, two of three reporting their job to be mentally straining as compared with one of three among the ambulance personnel. Change of work due to heavy workload was reported by one in three. The majority thought they could get used to a job with death and grieving, wellbeing however negatively affected. Still, the majority reported good health and little sick leave due to excessive workload. Several critical factors seemed important for job satisfaction among Swedish ambulance workers and personnel at the emergency rooms. Complaints about psychological stress, physically high workload, physical damage, many working hours, low salary, much shift-and night work, better vacation leave, more resources, too little time for recovery, crisis support and guidance, better routines, more explicit care programs including improved bereavement support for relatives, better possibilities for job control, self-efficacy, unit efficiency, and clearer work duties, and a family-non-conflicting job situation could favour work performance in both groups.

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“…While the process by expert nurses involved both rational and intuitive thinking [2] , the process in stressful situations is believed to involve oscillations between analytic and intuitive reasoning [3] . Under the pressure to produce students who are prepared for effective clinical practice, there is an increasing demand to develop students' ability to engage in the kind of decision making process similar to that employed by qualified nurses at the point of their qualifying as registered nurses [4,5] . The development of decision making based on critical thinking skills has become important in pre-registration nursing education [6] ; also known as pre-licensure or pre-qualifying nursing education.…”

Section: Introductionmentioning

confidence: 99%

High fidelity full sized human patient simulation manikins: Effects on decision making skills of nursing students

Loke

Lee

Noor

et al. 2014

JNEP

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Background: The continued use of high fidelity full sized human patient simulation manikins (HF-HPSMs) for developing decision making skills of nursing students has led to growing research focusing its value on student learning and decision making skills. Methods:In October 2012, a cross-sectional survey using the 24-item Nurse Decision-Making Instrument was used to explore the decision making process of 232 pre-registration nursing students (age 22.0 ± 5.4; 83.2% female) in Singapore. Results:The independent samples t-tests demonstrated three significant predictive indicators. These indicators include: prior experience in high fidelity simulation based on pre-enrolled nursing course (t = 70.6, p = .001), actual hands-on practice (t = 69.66, p < .005) and active participation in debrief (t = 70.11, p < .005). A complete experience based on role-playing followed by active discussion in debrief was a significant contributor to the decision making process (t = 73.6667, p < .005). However, the regression model indicated active participation in debrief as a significant variable which explained its development (t = 12.633, p < .005). Conclusions:This study demonstrated the usefulness of active participation in simulation learning for an analyticintuitive approach to decision making, however active participation in debrief was a more important influencing element than role-playing. In situations where resources are limited for students to experience hands-on role-playing, peer reviewing and feedback on others' experiences could benefit students, just as much. However, further study is warranted to determine the development of HF-HPSMs as a pedagogic tool for enhancing the decision making process of nursing students.

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Factors influencing decision making among ambulance nurses in emergency care situations

Cited by 80 publications

References 13 publications

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

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

Psychosocial Workload of Swedish Ambulance and Emergency Room Personnel with High Prevalence of Dying, Death and Grieving Relatives. A Descriptive and Comparison Study

High fidelity full sized human patient simulation manikins: Effects on decision making skills of nursing students

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