Assessment of clinical decision-making ability of critical care nurses

Enhancing clinical decision making: development of a contiguous definition and conceptual framework

Clinical decision making is a term frequently used to describe the fundamental role of the nurse practitioner; however, other terms have been used interchangeably. The purpose of this article is to begin the process of developing a definition and framework of clinical decision making. The developed definition was "Clinical decision making is a contextual, continuous, and evolving process, where data are gathered, interpreted, and evaluated in order to select an evidence-based choice of action." A contiguous framework for clinical decision making specific for nurse practitioners is also proposed. Having a clear and unique understanding of clinical decision making will allow for consistent use of the term, which is relevant given the changing educational requirements for nurse practitioners and broadening scope of practice.

Decrease new graduate nurse orientation costs by using HESI Exit Exam scores

Predicting workplace success is becoming increasingly important because the cost of orienting new nurse graduates is increasing at such an alarming rate. This study assessed the effectiveness of the HESI Exit Exam in measuring entry-level competencies of novice nurses. Findings indicate that the HESI Exit Exam was an effective predictor of workplace competency for new graduates (N = 108) assigned to acute care and critical care units in a large, tertiary care hospital.

Decrease new graduate nurse orientation costs by using HESI exit exam scores

Predicting workplace success is becoming increasingly important because the cost of orienting new nurse graduates is increasing at such an alarming rate. This study assessed the effectiveness of the HESI Exit Exam in measuring entry-level competencies of novice nurses. Findings indicate that the HESI Exit Exam was an effective predictor of workplace competency for new graduates (N = 108) assigned to acute care and critical care units in a large, tertiary care hospital.

The level of knowledge of respiratory physiology articulated by intensive care nurses to provide rationale for their clinical decision-making

The combination of intensive care knowledge, and the ability to articulate analytical decision-making processes to the interdisciplinary team, enhances the clinical credibility of the intensive care unit (ICU) nurse. The objective of this paper is to outline a study firstly, assessing ICU nurses' ability in articulating respiratory physiology to provide rationale for their clinical decision-making and secondly, the barriers that limit the articulation of this knowledge. Using an evaluation methodology, multiple methods were employed to collect data from 27 ICU nurses who had completed an ICU education programme and were working in one of two tertiary ICUs in New Zealand. Quantitative analysis showed that nurses articulated a low to medium level of knowledge of respiratory physiology. Thematic analysis identified the barriers limiting this use of respiratory physiology as being inadequate coverage of concepts in some ICU programmes; limited discussion of concepts in clinical practice; lack of clinical support; lack of individual professional responsibility; nurses' high reliance on intuitive knowledge; lack of collaborative practice; availability of medical expertise; and the limitations of clinical guidelines and protocols. These issues need to be addressed if nurses' articulation of respiratory physiology to provide rationale for their clinical decision-making is to be improved.

Clinical Judgments About Endotracheal Suctioning: What Cues Do Expert Pediatric Critical Care Nurses Consider?

Making accurate and timely judgments based on multiple ways of knowing is an essential skill in critical care nursing practice. Studies have proposed that positive patient outcomes are linked to expert judgments in a variety of critical care situations; however, little is known about clinical judgments related to specific critical care nursing interventions. This article presents a qualitative nursing research study which examined the cues that expert pediatric critical care nurses used in making clinical judgments about suctioning intubated and ventilated, critically ill children. The participants' words and actions attest that the 'sensing' and 'thinking' of the process of cue use, are interwoven with, and integral to, the 'doing,' which is the process of skilled performance.