Nurse clinical decision-making: A naturalistic inquiry

Nursing education has been inadequate in preparing nurses for clinical decision-making. The philosophical assumptions of researchers in decision-making are offered as an explanation for this education-practice gap. A Naturalistic inquiry grounded in new paradigm philosophy of science, was undertaken to describe the phenomenon of nurse clinical decision-making. The study design was emergent and based on active participation of participants. Methods of data collection included focus group discussion and participant observation. An emergent sample of 23 registered nurses practicing on general care units of an acute care hospital provided data for the description. Data were analyzed using an adaptation of the constant comparative technique. A comprehensive summary of the interpretative description was returned to participants for verification. A description of the context of nurse clinical decision-making provides for a fuller understanding of the phenomenon and facilitates reader judgment about transferability of findings. Nurse clinical decision-making has emerged as a situationally and context dependent phenomenon. It is a holistic phenomenon, not broken down into sequential steps. Implicit in nurses\u27 descriptions are evidence of problem-directed activities that vary depending on the patient situation. The diagnostic decision is the least valued of the problem-directed activities. Treatment and diagnostic decisions are highly interrelated and often inseparable entities. A second interrelated process is a keeping on top process completed in anticipation of need for clinical decision. Nurse clinical decision-making also emerged as a social phenomenon highly dependent upon nurses\u27 ability to establish trusting relationships with patients, other nursing staff, and physicians. Nurses also need time to establish relationships and to think and process information during decision-making, yet, they often perceive that their time is limited and not their own. Situational and years of work experience have the potential of influencing clinical decision-making ability. Nurse educators may need to examine their methods of teaching clinical decision-making and consider including strategies for facilitating a more holistic approach to clinical decision-making, for practice and skill development in interpersonal relationships, and for development of time management skills. Suggestions are made for additional descriptive research studies in clinical decision-making