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

Abstract

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.

ICU Nurses' Perceived Barriers to Effective Enteral Nutrition Practices: A Multicenter Survey Study

“…Therefore, the availability of nutritional guidelines and protocols should be mandated since nutritional care is perceived as a low priority in critical care units. Promoting nurses' clinical decision making and autonomy with pre-set guidelines would promote their attitudes [ 32 ], and promote the provision of adequate enteral nutrition.…”

Improving ICU Nurses’ Practices of Physical Restraints in Jordan: Effect of an Educational Program

“…Finally, increasing ICU nurses' autonomy is also recommended that would have benefits for both nurses and patients [37].…”

Measuring Factors Affecting the Autonomy of Nurses Work

“…Autonomy of nurse work has been a subjectof interest for decades (Varjus et al, 2011). It was defined by many researches as the power to make choices (Gammelgaard et al, 2011;MacDonald, 2002;Maharmeh et al, 2016;Maylone et al, 2011;Rafferty, Ball, & Aiken, 2001;Varjus et al, 2011). Several studies in the literature discussed many factors that may affect the perception of autonomy among workers (Gagnon, Bakker, Montgomery, & Palkovits, 2010;Rafferty et al, 2001;Sigler & Pearson, 2000).…”

“…Nowadays, the science of nursing is more sophisticated; and the profession of nursing is more evident in the healthcare settings. Nurses are performingmore complex roles and multiple responsibilities (Mrayyan, 2004), thus, presenting of autonomy isa critical feature ofthe nursing profession (Maharmeh, Alasad, Salami, Saleh, & Darawad, 2016). Autonomy is defined as thework environment power that enables the employees doing their maximum efforts (Maylone, Ranieri, Griffin, Mcnulty, & Fitzpatrick, 2011).…”

“…Autonomy can be affected by many factors such as organizational culture and climate (Elliott, 2003), the relationship and cooperation (Gammelgaard, McDonald, Tüselmann, Dörrenbächer, & Stephan, 2011), facilities and adequate resources,compensation and rewards, and training and development (Gordon, 2017). The autonomy is recognized by front managers as the highest priority due to the increasing involvements of nurses in multi-disciplinary discussions and enhancing the nurses' patient care roles and responsibilities (Maharmeh et al, 2016).…”