Decision-making in paediatric nurses caring for infants with bronchioloitis: A think aloud study

To describe the decision-making processes of paediatric nurses caring for infants with bronchiolitis receiving high-flow nasal cannula (HFNC) therapy.

A qualitative exploratory design using the think-aloud technique and protocol analysis was employed. A purposive sample of paediatric nurses from two regional hospitals completed two simulated clinical scenarios involving infants with bronchiolitis on HFNC therapy and verbalised their real-time thoughts and decision-making. Audio-recorded verbal protocols were transcribed verbatim, and analysed using referring phrase, assertional, and script analyses. The study adhered to the consolidated criteria for reporting qualitative research (COREQ) reporting guidelines.

Paediatric nurses (n = 13) predominantly focused on physiological parameters when making decisions about HFNC therapy. Their reasoning reflected either a logical or hypothetico-deductive approach aligned with weaning guidelines or reliance on heuristics and clinical experience. These approaches highlight the interplay between protocol adherence and intuitive judgement in caring for critically ill infants.

When caring for infants with bronchiolitis on HFNC therapy paediatric nurses' decision-making balances standardised protocols with intuitive reasoning. Understanding of these processes can inform improvements in education, policy and practice, supporting nurses to make competent evidence-based decisions and provide responsive, individualised care. Findings may also guide the development of bedside clinical decision support tools to enhance safety and consistency in HFNC management.