Influences on clinical decision-making during a community placement: reflections of a student nurse

High quality care is dependent on good clinical judgement and often-complex decision making. Nurses need to be able to justify and defend their clinical decisions. In this article, a third-year nursing student reflects on an incident from a community placement involving a collaborative clinical decision. Carper's (1978) four fundamental patterns of knowing are used to analyse the decision-making process. It is shown that influences on decision-making include prior knowledge and expertise, law and accountability, and ethical principles such as respect for autonomy and beneficence. Good communication, interpersonal skills and a person-centred approach have a bearing on decision-making. It is argued that intuition also has a place and may be increasingly used with experience.