Model of clinical decision-making ability and handover evaluation of emergency department nurses for inbound patients

Emergency department handovers are vital for patient safety. However, factors influencing nurses' clinical decision-making ability in inbound handovers remain insufficiently understood. We aimed to construct a hypothetical model of factors influencing clinical decision-making ability and handover evaluation among emergency department nurses for inbound patients in the emergency department.

Structural equation modelling was utilised to verify the goodness-of-fit of the model and the significance of the paths. Data were collected from 223 emergency department nurses using a structured web-based self-report survey conducted from 28 to 29 August 2023. Confirmatory factor analysis and structural equation modelling were performed.

The final model showed an improved fit compared with the initial model. Clinical decision-making ability was directly influenced by knowledge-sharing behaviour, autonomy, and critical thinking disposition, and indirectly by work complexity, nursing work environment, knowledge-sharing behaviour, and autonomy. Handover evaluation was directly influenced by nursing work environment, knowledge-sharing behaviour, and clinical decision-making ability, with indirect effects from work complexity, nursing work environment, knowledge-sharing behaviour, and critical thinking disposition.

We established a structural model that provides a foundation for educational programmes and interventions to enhance emergency department nurses' clinical decision-making and handover performance.