Processes used by nurses to make decisions in the clinical practice setting

Area of Science:

• Nursing
• Cognitive Science
• Healthcare Decision-Making

Background:

• Understanding the cognitive processes underlying clinical decision-making is crucial for improving patient care.
• Nurses in acute care settings face complex, time-sensitive decisions daily.
• Previous research has not fully elucidated the covert cognitive strategies employed by nurses.

Purpose of the Study:

• To examine the decision-making processes utilized by nurses in real-world acute care environments.
• To identify and describe the covert cognitive processes involved in nursing practice.
• To categorize the distinct approaches nurses take when making clinical judgments.

Main Methods:

• A qualitative research design was employed.
• Seventeen (17) nurses from acute care settings participated in the study.
• Data were collected through direct observation and semi-structured interviews.
• Constant comparative analysis was used to interpret the qualitative data.

Main Results:

• Two primary categories of nursing decision-making emerged: the goal-directed process and the rule-out process.
• The goal-directed process focuses on achieving a specific objective.
• The rule-out process involves generating and systematically eliminating hypotheses to identify problems, causes, or necessary actions.

Conclusions:

• Nurses utilize distinct cognitive strategies to navigate complex clinical situations.
• The identified goal-directed and rule-out processes offer a framework for understanding nursing judgment.
• Further research can build upon these findings to enhance nursing education and clinical practice guidelines.