Page 92 - Encyclopedia of Nursing Research

CLInICAL DECISIon MAKInG n 59

(Catolico, navas, Sommer, & Collins, 1996). aspect of understanding the significance of
Researchers have investigated the process, the data acquired and in making the cor-
types, and quality of clinical decision mak- rect decision. nurses gain a sense of saliency C
ing. Catolico et al. (1996) studied decision in clinical decision making with increased
making of practicing staff nurses. It was experience (Banning, 2008). In a study of
demonstrated that nurses with better com- novice and expert nurses in an intensive care
munication skills had a greater frequency of unit, it was demonstrated that expert nurses
actual decision-making practices. Intuition used a wider range of cues, and more cues
was a critical component of clinical decision that identified impending problems, in their
making in a qualitative study of novice nurse clinical decision making (Hopkins, Aitken, &
practitioners (Kosowski & Roberts, 2003). Duffield, 2009).
Some researchers have looked at approaches When investigating the decision- making
such as informatics or algorithms to aid deci- process, researchers have used simulations,
sion making. Gillespie and Peterson (2009) together with interviews regarding the
showed that that the use of a decision-making thought processes individuals use to reach
framework to guide clinical decision making decisions. The quality of decision making
by novice nurses fostered the development of is defined as having the ability to make fre-
their knowledge, skill, and confidence. quently required decisions (Catolico et al.,
A critical issue in clinical decision mak- 1996). That aspect of decision making has
ing is the educational level, preparation, and been studied by using computer-assisted
experience of the nurses who are formulat- simulations requiring nurses to make deci-
ing decisions. Studies have explored the sions in controlled clinical situations. To
decision-making process of student nurses, investigate clinical decision making by nurse
staff nurses, and nurse practitioners. A group practitioners, the nurses care for patients via
of nursing students were given didactic and computer and interactive videos. Decision
interactive teaching sessions on clinical deci- support technology serves as an adjunct
sion making. Students’ decision making was to, not as a replacement for, actual clinical
in accordance with the decision making of decision making. Advanced practice nurses
experts significantly more often than that of integrate clinical decision systems into their
the student nurses who did not receive the practices is to provide more objective, scien-
decision-making content (Shamian, 1991). A tifically derived, technology-based data for
study in the United Kingdom demonstrated their patient care decisions (Traynor, Boland,
that nurses having a college education were & Buus, 2010). There are some inherent diffi-
significantly better at decision making than culties with technology-based decision sup-
their colleagues educated in diploma pro- port systems. nurses who are unfamiliar or
grams (Girot, 2000). Advanced practice uncomfortable with the technology are less
nurses in specialty practices tend to generate likely to value the utilization of the systems
fewer hypotheses in their clinical decision (Weber, Crago, Sherwood, & Smith, 2009).
making. Those nurses must be aware that nurses have a professional responsibil-
formulating a diagnosis too early in the data- ity to provide patients with opportunities
gathering phase precludes the possibility of to participate in clinical decision making.
considering all options (Lipman & Deatrick, However, patients’ preferences to partici-
1997). nurses with case-related experiences pate vary greatly. Patient participation in
are more likely to choose appropriate inter- clinical decision making has been studied
ventions. A study of nurse practitioners by from a variety of perspectives. In a study of
White, nativio, Kobert, and Engberg (1992) more than 400 patients, it was shown that
concluded that case content expertise is cru- females, those with a high school or college
cial for clinical decision making from the education, and those with previous hospital