Exploring Nurses' Decision-Making Through the Lens of Capability: A Framework for Understanding Autonomy in Complex...

Area of Science:

• Nursing
• Healthcare Management
• Bioethics

Background:

• Nurses' decision-making autonomy in intensive care units (ICUs) is crucial for patient care.
• Understanding the factors influencing this autonomy is essential for improving healthcare delivery.
• Previous research often focused on individual competence, potentially overlooking systemic influences.

Purpose of the Study:

• To apply Amartya Sen's capability approach to analyze ICU nurses' decision-making autonomy.
• To explore how resources, conversion factors, and agency interact to shape nurses' decision-making capabilities.

Main Methods:

• Qualitative study reanalyzing data from semi-structured interviews with 39 experienced Canadian ICU nurses.
• Utilized Amartya Sen's capability approach as the conceptual framework.
• Examined interactions between resources, personal/social/institutional conversion factors, and professional agency.

Main Results:

• Nurses' decision-making capabilities involve obtaining information, interpreting it, and making actionable decisions.
• Valued outcomes include clinical effectiveness, patient comfort, and professional growth.
• Autonomy and the ability to act on decisions are constrained by resource limitations, institutional policies, interprofessional dynamics, and hierarchy.

Conclusions:

• The capability approach provides a framework for understanding how contextual conditions influence nurses' autonomy.
• It highlights the impact of structural and relational factors beyond individual competence.
• Supportive environments are needed to enhance nurses' agency and decision-making in critical care.