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Coronary care nurses' clinical decision making.

S A Corcoran-Perry1, S M Narayan, S Cochrane

  • 1School of Nursing, University of Minnesota, Minneapolis 55455, USA. corco001@tc.umn.edu

Nursing & Health Sciences
|July 14, 2000
PubMed
Summary

Experienced nurses showed lower quality reasoning than new nurses in cardiac care decisions. This highlights the need for decision support systems for all nursing levels and validates using simulations for training.

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Area of Science:

  • Nursing
  • Clinical Decision Making
  • Health Informatics

Background:

  • Hospitalized cardiac patients require complex decision-making from nurses.
  • Nursing knowledge systems development is hindered by a lack of understanding of nurses' decision-making processes.
  • Understanding how nurses utilize knowledge is crucial for improving clinical practice and system design.

Purpose of the Study:

  • To compare the lines of reasoning used by experienced and new coronary care nurses.
  • To determine if reasoning in hypothetical cases reflects clinical practice.
  • To inform the design of knowledge-based systems for nursing.

Main Methods:

  • Think-aloud protocol with 16 nurses (8 experienced, 8 new) in coronary care.
  • Analysis of decision-making processes across six hypothetical and comparable actual patient cases.

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  • Defined line of reasoning as embedded knowledge within decision-making arguments.

    • Main Results:

    • Nurses predominantly used one line of reasoning per case, demonstrating non-linear decision-making.
    • Experienced nurses used lower quality reasoning than new nurses in six identified areas.
    • Reasoning in hypothetical cases showed modest similarity to actual clinical practice.

    Conclusions:

    • Clinical decision-making is complex and non-linear, utilizing multiple reasoning pathways.
    • Nurses at all expertise levels can benefit from decision support due to inherent fallibility.
    • Hypothetical cases and simulations are valid tools for studying and teaching clinical decision-making in nursing.