Coronary care nurses : developing an understanding of the decision making process in acute situations

Aim: The aim of this study was to explore the decision making of coronary care nurses in acute situations. More specifically, the study explored how coronary care nurses take their decisions and what are the factors that underpin those decisions.Background: Studies on clinical decision making have focused on the effect of nurses' experience on decision making, and on the decisions that are made. Until now there is very little data available that focuses on coronary care nurse's clinical decision making in acute situations, and what the factors are that underpin those decisions. Therefore there was an urgent need to investigate the decision making of coronary care nurses in acute situations.Method: This study involved eight nurses from three coronary care units from hospitals in the North West of England. An interpretive approach based on the principles ofethnography from an insider and outsider perspective was adopted. Data collection from coronary care nurses as they care for patients during an acute situation was used for this study. Both observation and interview were undertaken to ensure complete data collection of all aspects of decision making in real life settings.Results: What become apparent in the findings of this study was that contrary to much of the literature, the nurses on the coronary care units dealt with limited complex acutesituation that need complex decisions. The decision making about patient care during the acute situations was quite simple and considered as custom. It was also discoveredthat nurses tend to focus on the physiological aspects of care rather than a more holistic approach. The data revealed that the decision making process is continuous. Theassessment phase started using both analytical and intuitive models in order to observe the cues relating to the patient's situation. The nurses then moved towards theimplementation of action strategies to solve the patient's problem