Decision-making phenomena described by expert nurses working in urban community health settings

Decision making by expert community health nurses was explored using qualitative research methods. Each subject described a crucial incident, a clinical situation where their independent decision making made a positive difference in a client's outcome. Subjects were given instructions to record a crucial incident in writing. After completing each written incident, subjects were asked five interview questions related to the incident. Subject's verbal responses to questions were audiotaped. Content analysis methods were used to analyze data. Findings suggest that decision making in clinical practice in both a rational and intuitive process. Themes emergent from data describing decision making included the following: focus, type, and purpose of the decision making; characteristics of the decision maker; sequencing of events; data collection methods; facilitators and barriers to decision making; and nursing roles in the decision-making process. Conclusions of the study include recommendations for continued research of decision making using qualitative methods allowing flexibility necessary to explore phenomena representing the essence of nursing practice. A clearer understanding of decision making is essential now and in the next century as nurses increase independent practice roles in community health settings.