Student nurses' clinical decision-making, key to professional practice

grantor: University of TorontoExpertise in clinical decision-making is a hallmark of professional nursing. Changing demographics, technology, and health care have increased the complexity and importance of nurses' clinical decision-making (DM). Developing students' clinical DM ability is a prime goal of nursing educators, but understanding of this complex phenomenon is fragmentary. The literature related to clinical DM reveals many disagreements, while alternative cognitive processing theories (Information Processing, Skill Acquisition) have led to several DM models. Nursing research in this area has used simulations and focused on RNs and university nursing students. Research into college students' DM, and into the effects of context is lacking. The purpose of this research project was to learn about university and college nursing students' clinical DM while giving patient care. The research questions were: What are the DM patterns of student nurses engaged in patient care and how appropriate are they? Are there observable differences in DM patterns and appropriateness based on program type or age/life experience? How does the context affect students' clinical DM? Does clinical DM change during a clinical rotation? This was a focused ethnography with a volunteer sample of 7 college and 8 university nursing students. The researcher observed participants giving care on medical/surgical in-patient units. Data were analyzed within the context of Information Processing Theory (IPT) which postulates short-term and long-term memory constraints. The study indicated cognitive processing limitations similar to those postulated by IPT. The sample's nature precludes generalization, and the study's results are limited to a description of student nurses' clinical DM in a particular semester and location. The major finding was the powerful influence of context on participants' DM. The context was strong enough to nullify differences based on program type and age/life experience. Participants made five types of decisions in short, irregular sequences. Participants' DM improved during the rotation. The study identifies the importance of increasing clinical teachers' awareness of the clinical environment's complexity from the students' standpoint. Students need a supportive atmosphere and freedom to practice decision-making within the limits of patient safety if they are to develop the clinical DM abilities needed in professional practice.Ed.D