Decision making from the perspective of nursing students

Abstract

Objective: To analyze the decision making of students from a nursing higher school and understand how they make decisions in the care process. Method: A qualitative study with an exploratory and descriptive approach was carried out with the case study method. Results: Six types of decision making were categorized by the students as follows: Decision about communication (15 record units [RU]); Decision about understanding (14 RU); Decision about intervention (9 RU); Decision about timing (5 RU); Decision about targeting (4 RU); and Decision about management (0 RU), with a total of 47 RU. Final considerations: Analysis of the learning diaries showed that students make more decisions regarding communication with patients and understanding of the care situation, than with the acting decision.

Perceptions of senior nursing students regarding clinical decision-making

“…The current healthcare context, together with rapid evolution of the nursing profession, demands implementation of pedagogical strategies that promote the development of the scientific mindset, reflective critical thinking, problem-solving, and decision-making in teaching and learning processes (4,(34)(35) . With these strategies, it is possible for students to develop and mobilize skills that will allow them to grasp the healthcare reality, which is dynamic and complex.…”

“…With these strategies, it is possible for students to develop and mobilize skills that will allow them to grasp the healthcare reality, which is dynamic and complex. This scenario implies a need for students to reason about changes that occur in clinical situations and conditions existing in the context and make decisions, keeping clients (a person or a group, whether it is a family or a community) as the central focus of the care process (18) , so they can provide safe and individualized care that translates into health gains (4,36) .…”

“…In the responding dimension, students emphasized prioritization, which they put into practice by applying clinical reasoning (36) , a tool that allows the selection of appropriate interventions when it is necessary to deliver care and the best time to act to prevent complications (4) . Care individualization is achieved by designing and implementing interventions adapted to the client's specific clinical situation (6) (customization), that is, nurses define and implement interventions tailored to that specific client, which is followed by monitoring the patient's progress, resulting in adjustments in the intervention according to the observed response (39) .…”

“…Consequently, decision-making has been gaining more and more prominence as a cornerstone of high-quality nursing care (3) . The cognitive process and clinical reasoning that nurses use in clinical decision-making have sparked growing concern about the teaching of this skill (4) . In search of explanations for the concept, most authors agree that clinical decision-making is a process that nurses use to evaluate and select the best actions to meet the desired results in a clinical context (5)(6) .…”

“…Because this is a recent inclusion in the nursing curriculum that has to be evaluated, and because perceptions of nursing students regarding clinical decision-making (and the skills inherent to it) is a subject that is little explored in Portugal (4) , the following research question emerged for the teaching staff: What are the perceptions of senior nursing students at ESEL regarding the skills learned in the initial training promoted by the curricular unit PTDE?…”