An exploratory study of clinical decision-making in five countries.

Area of Science:

• Nursing Science
• Cognitive Psychology
• Healthcare Management

Background:

• Understanding nurses' cognitive processes is crucial for optimizing patient care.
• Decision-making in nursing is complex, influenced by various factors.
• Cross-cultural comparisons offer insights into universal and context-specific nursing practices.

Purpose of the Study:

• To identify cognitive decision-making processes used by nurses in long-term and short-term care.
• To explore demographic variables associated with nurses' decision-making.
• To compare nursing decision-making across five different countries.

Main Methods:

• A 56-item, reliable questionnaire was administered to registered nurses.
• Convenience samples included nurses from geriatric wards (n=236) and acute medical-surgical wards (n=223).
• Participants were from Canada, Finland, Sweden, Switzerland, and the United States.

Main Results:

• Five decision-making models emerged, reflecting analytical and intuitive cognitive processes.
• Analytical processes dominated information gathering and problem definition; intuitive processes were key in planning, implementation, and evaluation.
• Nurses in long-term care leaned towards analytical decision-making, while those in short-term care favored intuitive approaches.
• Professional education, experience, practice area, knowledge type, and country of residence significantly correlated with decision-making models.

Conclusions:

• Nursing decision-making varies significantly by country and care setting.
• Further research is needed to understand the reasons behind these variations.
• Investigating the link between nursing tasks, knowledge types, and decision-making strategies is recommended.