The factors facilitating and inhibiting effective clinical decision-making in nursing: a qualitative study

Abstract

BackgroundNurses' practice takes place in a context of ongoing advances in research and technology. The dynamic and uncertain nature of health care environment requires nurses to be competent decision-makers in order to respond to clients' needs. Recently, the public and the government have criticized Iranian nurses because of poor quality of patient care. However nurses' views and experiences on factors that affect their clinical function and clinical decision-making have rarely been studied.MethodsGrounded theory methodology was used to analyze the participants' lived experiences and their viewpoints regarding the factors affecting their clinical function and clinical decision-making. Semi-structured interviews and participant observation methods were used to gather the data. Thirty-eight participants were interviewed and twelve sessions of observation were carried out. Constant comparative analysis method was used to analyze the data.ResultsFive main themes emerged from the data. From the participants' points of view, "feeling competent", "being self-confident", "organizational structure", "nursing education", and "being supported" were considered as important factors in effective clinical decision-making.ConclusionAs participants in this research implied, being competent and self-confident are the most important personal factors influencing nurses clinical decision-making. Also external factors such as organizational structure, access to supportive resources and nursing education have strengthening or inhibiting effects on the nurses' decisions. Individual nurses, professional associations, schools of nursing, nurse educators, organizations that employ nurses and government all have responsibility for developing and finding strategies that facilitate nurses' effective clinical decision-making. They are responsible for identifying barriers and enhancing factors within the organizational structure that facilitate nurses' clinical decision-making.

An Investigation of Factors Influencing Nurses’ Clinical Decision-Making Skills

“…The results of these qualitative studies indicate that clinical experience was one of the most critical influences on the overall decision-making process (Bakalis, 2006;Traynor, Boland, & Buus, 2010). Researchers from the United Kingdom, United States, and Iran found that education had a positive effect on nurses' CDM (Hagbaghery, Salsali, & Ahmadi, 2004;Prescott, Dennis, & Jacox, 1987;Rhodes, 1985). Bucknall (2003) concluded that three important environmental influences on nurses' real decisions in the critical care setting in Australia were patient situation, physical and personnel resource, and interpersonal relationships.…”

Importance of Building Confidence in Patient Communication and Clinical Skills Among Chiropractic Students

“…A health care provider possessing high confidence levels in the areas of communication and clinical (physical) skills is of paramount importance because of greater patient outcome expectancies seen by those who are assessed and treated by providers who possess higher levels of confidence. 27,28 Being confident is one of the most important personal factors influencing clinical decision making, 29 because if a clinician believes that he or she has the skills to assess a patient's concerns and that the outcome of this assessment will lead to an improved quality for the patient, it is more likely that the clinician will engage in a successful assessment. 30 This applies across all health care professions including chiropractic practice.…”

Reinforcing Sexual and Reproductive Health Education Prior to Graduation of Health School in Turkey

“…It is the real environment in which students find the opportunity to test their knowledge and skills [24]. The fact that the students use their knowledge about the SH/RH topics integrated into the curriculum in the clinical environment (Table 1; item 8) is evidence that knowledge has been translated into behavior [25] and that the project has proved successful. It might also be said that the successful results were attained because a new skills laboratory was set up and the support shown the project made it possible to use the school's own resources to complete the installation of tools and equipment.…”