Page 31 - ACCCN's Critical Care Nursing

8 S C O P E O F C R I T I C A L C A R E

TABLE 1.1 Australian and international critical care nurses decision-making research

Author [Country] Sample Data collection Findings
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Bucknall, 2000 18 CC nurses (range of Observation (2-hour periods) Three types of decision:
[Australia] levels and experiences; ● evaluation (51%)
all had completed a CC ● communication (30%)
course) ● intervention (19%)
Average: 238 decisions/2 hours (i.e. 2.0/min)
Currey & Worrall-Carter, 12 CC nurses with 2+ years’ Clinical decision record (of Five types of decision:
2001 [Australia] CC experience from 3 2-hour periods) and focus ● intervention (40%)
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units groups ● communication (26%)
● assessment (19%)
● organisation (13%)
● education (2%)
Average: 395 decisions/2 hours (i.e. 3.3/min)
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Aitken, 2003 [Australia] 8 expert CC nurses with 5+ Thinking aloud (2-hour periods) Hypotheses developed as a framework for decision
years’ CC experience and follow-up interview making
A combination of strategies used to gather data
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Currey & Botti, 2006 CC nurses from 2 Observation followed by Clinical processes that affected decision making
[Australia] metropolitan hospitals; semi-structured interview following the settling in phase post cardiac
18 inexperienced surgery were:
(≤3 years) and 20 ● handover from anaesthetists
experienced CC nurses ● settling in procedures
(>3 years). ● collegial assistance.
15 nurses (13 inexperienced) felt daunted by
decision making while 7 nurses (1 inexperienced)
felt challenged with a sense of being stimulated,
excited and positive.
Currey, Browne & Botti Same as above Observation in 2 phases: Quality of haemodynamic decision making in the 2
(2006) [Same study 1st phase comprised hours post cardiac surgery was influenced by
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as above] [Australia] unstructured, narrative decision complexity, nurses’ level of experience,
observational data; 2nd and forms of decision support provided by
phase comprised a 2-page nursing colleagues.
structured observation Experience was a dominant influence in recognising
checklist. Followed up by patterns of haemodynamic cues that were
interview. suggestive of complications.
Adherence to evidence-based practice also
influenced quality of decision making.
Aitken, 2008 [Australia] 7 CC nurses with a CC Observation and/or thinking A range of concepts related to the assessment and
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qualification, >5 years aloud, along with follow-up management of sedation needs. Assessment
CC experience, and interviews included:
working ≥2 days/week ● patient’s condition
● response to therapy
● multiple sources of information during
assessment
● consideration of relevant history
● consideration of the impact on physiology and
pathophysiology
● implications of treatment
● options in treatment.
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Hough, 2008 [USA] 15 CC nurses from 4 units, In-depth, semi-structured The presence of a role model or mentor to help
with varied experience interviews guide the ethical decision-making process,
and education levels through reflection-in-action, was critical for
focused ethical discourse and the decision
making.
Enhanced ethical decision making occurred
through experiential learning.
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Thompson, 2008 245 Dutch, UK, Canadian Vignettes with decision Time pressure significantly reduced the nurses’
[various countries] and Australian whether or not to contact a decision tendency to intervene.
registered nurses senior nurse/doctor. The There were no statistically significant differences in
working in surgical, proportion of true positives decision-making ability between years of generic
medical, ICU or HDU (the patient is at risk of a clinical experience.
critical event and the nurse There were statistically significant differences in
takes action) and false decision-making ability between years of critical
positives (the nurse takes care experience when participants were not
action when it was not under time pressure: those with greater critical
warranted) was calculated. care experience performed better.
Under time pressure, there were no differences in
decision-making ability between years of critical
care experience.