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Clinical decision making by nurses when faced with third-space fluid shift. How well do they fare?
1School of Nursing and Midwifery, Flinders University, PO Box 2100, Adelaide, SA 5001, Australia. Karen.wotton@flinders.edu.au
Summary
Critical care nurses demonstrated superior clinical decision-making skills in identifying third-space fluid shifts compared to gastrointestinal surgical nurses. Their expertise stemmed from a blend of analytical reasoning and pattern recognition, enhancing patient care for elderly surgical patients.
Area of Science:
- Nursing
- Clinical Decision-Making
- Physiology
Background:
- Nurses' expertise is defined by knowledge application in treatment decisions.
- Clinical decision-making involves hypothetico-deductive methods and intuitive judgment.
- Understanding nurses' cognitive processes is crucial for improving patient outcomes.
Purpose of the Study:
- To explore clinical decision-making processes in experienced critical care and gastrointestinal surgical nurses.
- To ascertain nurses' knowledge of third-space fluid shift in elderly surgical patients.
- To compare decision-making approaches between two expert nursing groups.
Main Methods:
- Interpretive study design.
- Semi-structured interviews with nurses (n=10).
- Think aloud protocol for clinical scenario analysis.
Main Results:
- Gastrointestinal nurses identified cues but not the specific problem (third-space fluid shift).
- Critical care nurses utilized both hypothetico-deductive reasoning and pattern recognition.
- Critical care nurses demonstrated in-depth knowledge and accurate identification of third-space fluid shift.
Conclusions:
- Critical care nurses' work environment, education, and unit culture foster proactive physiological reasoning.
- Findings inform practice guidelines and curriculum development for nursing education.
- Enhanced understanding of expert nurses' decision-making can improve care for elderly surgical patients.