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Autonomy, evidence and intuition: nurses and decision-making.

Michael Traynor1, Maggie Boland, Niels Buus

  • 1School of Health and Social Sciences, Middlesex University, London, UK. m.traynor@mdx.ac.uk

Journal of Advanced Nursing
|May 26, 2010
PubMed
Summary

Nurses represent clinical decision-making as a balance of indeterminate judgment and technical knowledge, with personal experience serving as the ultimate guide. This discourse protects professional autonomy against external scrutiny.

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Area of Science:

  • Nursing Studies
  • Sociology of Professions
  • Healthcare Decision-Making

Background:

  • Professional work is traditionally defined by decision-making autonomy and control.
  • Sociologists Jamous and Peloille conceptualized professional work using the 'Indeterminacy/Technicality ratio'.
  • The evidence-based practice movement has increased technical decision-making in healthcare, prompting analysis of nurses' responses.

Purpose of the Study:

  • To examine how nurses represent their professional clinical decision-making processes.
  • To apply Jamous and Peloille's 'Indeterminacy/Technicality ratio' concept to nurses' decision-making representations.

Main Methods:

  • Three focus groups were conducted with qualified nurses in London.
  • Discussions on decision-making influences were tape-recorded, transcribed, and analyzed using discourse analysis.
  • Participants shared their perspectives on factors influencing their clinical judgments.

Main Results:

  • Nurses' decision-making was influenced by both indeterminate (tacit judgment) and technical (codified) factors.
  • Personal experience was identified as the primary arbiter in decision-making.
  • Nurses' discourse simultaneously asserted professional autonomy and defended it against external criticism.

Conclusions:

  • Nurse education should foster discussions on the role of 'irrational' aspects in decision-making.
  • Understanding these tacit elements is crucial for recognizing credible professional nursing practice.
  • Integrating discussions on indeterminacy and experience can strengthen professional identity in nursing.