Clinical decision making in nursing: theoretical perspectives and their relevance to practice

This paper is a response to Thompson's paper 'A conceptual treadmill: the need for a middle ground in clinical decision making theory' published in the Journal of Advanced Nursing in 1999.

This author agrees with his main recommendations, which are to seek a middle ground in the current polarized debate over clinical decision making in nursing, and to draw upon Hammond's Cognitive Continuum theory to do so. The theoretical background is sketched out, and the implications of these recommendations are analysed against this. It is argued that nurses now need to move the academic debate forward in such a way as to make serious impact on developing and improving practice. Cognitive continuum theory, in the way in which it focuses on practice, holds considerable potential to assist this move.

Drawing on cognitive continuum theory necessarily leads to consequences which are not addressed in Thompson's paper: namely a need to consider the quality of nursing decisions, and a willingness to consider approaches to decision making which have been neglected or criticised by nurses. These consequences are explored here, and the implications of adopting this approach for nurses are outlined.