Aims and objectives
To identify and summarise factors and processes related to registered nurses’ patient care decision‐making in medical–surgical environments. A secondary goal of this literature ...review was to determine whether medical–surgical decision‐making literature included factors that appeared to be similar to concepts and factors in naturalistic decision making (NDM).
Background
Decision‐making in acute care nursing requires an evaluation of many complex factors. While decision‐making research in acute care nursing is prevalent, errors in decision‐making continue to lead to poor patient outcomes. Naturalistic decision making may provide a framework for further exploring decision‐making in acute care nursing practice. A better understanding of the literature is needed to guide future research to more effectively support acute care nurse decision‐making.
Design
PubMed and CINAHL databases were searched, and research meeting criteria was included. Data were identified from all included articles, and themes were developed based on these data.
Results
Key findings in this review include nursing experience and associated factors; organisation and unit culture influences on decision‐making; education; understanding patient status; situation awareness; and autonomy.
Conclusions
Acute care nurses employ a variety of decision‐making factors and processes and informally identify experienced nurses to be important resources for decision‐making. Incorporation of evidence into acute care nursing practice continues to be a struggle for acute care nurses. This review indicates that naturalistic decision making may be applicable to decision‐making nursing research.
Relevance to clinical practice
Experienced nurses bring a broad range of previous patient encounters to their practice influencing their intuitive, unconscious processes which facilitates decision‐making. Using naturalistic decision making as a conceptual framework to guide research may help with understanding how to better support less experienced nurses’ decision‐making for enhanced patient outcomes.
Effective nurse decision making is essential for best patient outcomes in the acute care nurse practice environment. The purpose of this study was to explore acute care RNs' perceptions of clinical ...decision making for a patient who experienced a clinical event. Clinical events include changes in patient condition and are manifested by fever, pain, bleeding, changes in output, changes in respiratory status, and changes in level of consciousness. Naturalistic decision making framework supported the exploration of important contextual factors associated with decision making, provided new information for nursing science, and served as the conceptual framework for this research. Data collected from interviews of 20 acute care nurses were analyzed using qualitative content analysis. The emergent categories included Awareness of Patient Status, Experience and Decision Making, Following Established Routine, Time Pressure, Teamwork/Support From Staff, Goals, Education, Resources, Patient Education, Consideration of Options to Meet Goals, and Nursing Roles. Acute care nurses incorporated a wide variety of complex factors when decision making. This study sought to improve understanding of the factors nurses found important to their decision making for the potential development of improved decision support in the electronic health record.
Errors in decision making and communication play a key role in poor patient outcomes. Safe patient care requires effective decision making during interdisciplinary communication through communication ...channels. Research on factors that influence nurse and physician decision making during interdisciplinary communication is limited. Understanding influences on nurse and physician decision making during communication channel selection is needed to support effective communication and improved patient outcomes. The purpose of the study was to explore nurse and physician perceptions of and decision-making processes for selecting interruptive or noninterruptive interdisciplinary communication channels in medical-surgical and intermediate acute care settings. Twenty-six participants (10 RNs, 10 resident physicians, and six attending physicians) participated in semistructured interviews in two acute care metropolitan hospitals for this qualitative descriptive study. The Practice Primed Decision Model guided interview question development and early data analysis. Findings include a core category, Development of Trust in the Communication Process, supported by three main themes: (1) Understanding of Patient Status Drives Communication Decision Making; (2) Previous Interdisciplinary Communication Experience Guides Channel Selection; and (3) Perceived Usefulness Influences Communication Channel Selection. Findings from this study provide support for future design and research of communication channels within the EHR and clinical decision support systems.
The purpose of this article is to present the derivation of the Practice Primed Decision Model from a naturalistic decision-making framework for use in guiding future nursing decision-making ...research.
Acute care nurses make decisions in demanding environments under the influence of many factors. The influence of these factors on nurse decision-making is not well understood leading to gaps in understanding how to best support acute care nurse decision-making.
The strategy of theory derivation was used in the development of a new model for use in nursing research. This model incorporates important elements identified in naturalistic decision making, a Recognition Primed Decision Model and an integrative review of nurse decision-making literature.
The new model, Practice Primed Decision Model, provides a new perspective to guide nurse decision-making research. This model includes factors influential to the nurse decision-making process that is more realistic in time limited, high stakes decision-making situations.
Critical care nurses practice in a challenging environment that requires responses to patients with complex, often unstable health conditions. The electronic health record, access to clinical data, ...and Clinical Decision Support Systems informed by data from clinical databases are informatics tools designed to work together to facilitate decision-making in nursing practice. The complex decision-making environment of critical care requires informatics tools that support nursing practice through integration of current evidence with clinical data. Recommendations include continuing efforts toward the development of clinical decision support tools based on patient data that include predictive models to support increased patient safety.
PDF
