Decision-making in nursing practice: An integrative literature review

Exploring communicative interactions in debriefing sessions with nursing students: A qualitative study

INTRODUCTION

Debriefing as a learning activity aims to elevate participants' competence through communicative interaction. This activity is an integral component of any formative simulation. Thus, the primary objective of this study was to explore debriefing as a communicative experience in nursing students within the context of interactive virtual simulation. The secondary objectives were: 1) To investigate the typology of interactions based on participants' discourse and 2) To identify the actions that students use to develop knowledge during debriefing.

METHOD

A qualitative exploratory study design involving six debriefing groups was conducted with 105 s-year nursing students. The debriefing sessions were analyzed following interactive virtual simulations in an in-person setting in the classroom. All sessions were recorded and transcribed verbatim. A mixed (deductive and inductive) content analysis approach was used.

RESULTS

A total of 2187 units of meaning were identified and categorized into 3 themes (interaction by participant, interaction by communicative action, and interaction by participant's communicative goal); nine subthemes (facilitator-student, student-student and student-facilitator; declarative - unidirectional, reactive - bidirectional and multidirectional-interactive; individualistic, competitive, and collaborative), and 5 categories (providing information; generating creative solutions; processing critical and deliberative information; positive interdependence and psychosocial relationships).

CONCLUSION

The students developed knowledge and practical communication skills, particularly reinforcing soft skills through collaborative interactions, predominantly multidirectional-interactive in nature. The facilitator and the interpersonal relationships among the participants fostered a safe and positive environment.

Enhancing nursing care through technology and standardized nursing language: The TEC-MED multilingual platform

PURPOSE

This study describes the design, integration, and semantic interoperability process of a minimum data set using standardized nursing language in the caring module of the TEC-MED care platform.

METHODS

The caring module was developed in three phases (2020-2022): platform concept, functional design and construction, and testing and evaluation. Phases involved collaboration among academics, information technology developers, and social/healthcare professionals. Nursing taxonomies (NANDA-I, NOC, NIC) were integrated to support the nursing process. The platform was piloted in six Mediterranean countries.

FINDINGS

The final platform features an assessment module with eight dimensions for data collection on older adults and their caregivers. A clinical decision support system links assessment data with nursing diagnoses, outcomes, and interventions. The platform is available in six languages (English, Spanish, French, Italian, Greek, and Arabic). Usability testing identified the need for improved Arabic language support.

CONCLUSIONS

The TEC-MED platform is a pioneering tool using standardized nursing language to improve care for older adults in the Mediterranean. The platform's multilingualism promotes accessibility. Limitations include offline use and mobile app functionality. Pilot testing is underway to evaluate effectiveness and facilitate cross-cultural validation of nursing taxonomies.

IMPLICATIONS FOR NURSING PRACTICE

The TEC-MED platform offers standardized nursing care for older adults across the Mediterranean, promoting consistent communication and evidence-based practice. This approach has the potential to improve care quality and accessibility for a vulnerable population.

Investigating clinical decision-making in bleeding complications among nursing students: A longitudinal mixed-methods study

AIM

To describe undergraduate nursing students' clinical decision-making in post-procedural bleeding scenarios and explore the changes from the first to the final year of their program.

BACKGROUND

Bleeding is a common complication following invasive procedures and its effective management requires nurses to develop strong clinical decision-making competencies. Although nursing education programs typically address bleeding complications, there is a gap in understanding how nursing students make clinical decisions regarding these scenarios. Additionally, little is known about how their approach to bleeding management evolves over the course of their education.

DESIGN

Longitudinal mixed-methods study based on the Recognition-Primed Decision Model.

METHODS

A total of 59 undergraduate students recorded their responses to two clinical decision-making vignettes depicting patients with signs of bleeding post-hip surgery (first year) and cardiac catheterization (final year). Their responses were analyzed using content analysis. The resulting categories capture the cues students noticed, the goals they aimed to achieve, the actions they proposed and their expectations for how the bleeding situations might unfold. Code frequencies showing the most variation between the first and final years were analyzed to explore changes in students' clinical decision-making.

RESULTS

Nearly all students focused on two primary categories: 'Bleeding' and 'Instability and Shock.' Fewer students addressed six secondary categories: 'Stress and Concern,' 'Pain,' 'Lifestyle and Social History,' 'Wound Infection,' 'Arrhythmia,' and 'Generalities in Surgery.' Students often concentrated on actions to manage bleeding without further assessing its causes. Changes from the first to the final year included a more focused assessment of instability and shifts in preferred actions.

CONCLUSIONS

This study reveals that nursing students often prioritize immediate actions to stop bleeding while sometimes overlooking the assessment of underlying causes or broader care goals. It suggests that concept-based learning and reflection on long-term outcomes could improve clinical decision-making in post-procedural care.

Critical care nurses' role in rapid response teams: A qualitative systematic review

AIM

To analyse the qualitative evidence on the role of critical care nurses in rapid response teams.

DESIGN

Qualitative systematic review.

METHODS

This qualitative systematic review employed Bettany-Saltikov and McSherry's guidelines and is reported according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research checklist. Two pairs of blinded researchers screened the articles. The data were synthesised using a thematic analysis approach.

DATA SOURCES

A systematic literature search was conducted using the CINAHL, Embase and MEDLINE databases.

RESULTS

Seven studies were included, and three main roles were identified: (1) balancing between confidence and fear in clinical encounters, (2) facilitating collaboration and (3) managing challenging power dynamics in decision-making.

CONCLUSION

Critical care nurses possess extensive knowledge and skills in providing critical care to patients experiencing deterioration on general wards. They play a vital role in facilitating collaboration between team members and ward staff. Furthermore, within the rapid response team, critical care nurses assume leadership responsibilities by overseeing the comprehensive coordination of patient care and actively engaging in the decision-making process concerning patient care.

IMPLICATIONS FOR THE PROFESSION

Highlighting the central role of critical care nurses in rapid response teams as well such a team's benefits in healthcare organisations can promote applications for funding to support further quality assurance of rapid response teams and thus enhance patient safety.

IMPACT

Health care organisations can assure the quality of rapid response team by providing economical resources and training. The education providers should facilitate and standardise curriculum for critical care nursing students to achieve necessary knowledge and skills as members in rapid response teams.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Checking nasogastric tube safety in children cared for in the community: a re-examination of the evidence base

Nasogastric tube feeding is generally considered safe provided a nasogastric aspirate with a pH ≤5.5, which indicates that the end of tube is correctly located in the stomach, can be obtained. When this is not possible, hospital attendance or admission is usually required so that an X-ray can be undertaken to check the tube's position. This practice is based on an interpretation of the evidence that places undue importance on nasogastric aspirate pH testing before every use of a tube that is already in place, with potential negative consequences for children cared for in the community and their families. Following a re-examination of the evidence base, a revised approach is proposed in this article: when a child has a tube in place, provided its position has been confirmed as correct on initial placement using aspirate pH testing, nurses can use checks other than aspirate pH testing, alongside their clinical judgement, to determine whether it is safe and appropriate to use the tube. This proposed revised approach would reduce delayed or missed administration of fluids, feeds and medicines and enable more children to remain at home.

The relationship between attitudes towards professional autonomy and nurse-nurse collaboration: A cross-sectional study

AIM

This study aimed to determine the relationship between attitudes towards professional autonomy and nurse-nurse collaboration among nurses.

BACKGROUND

Professional autonomy is crucial for nurses in today's complex and ever-changing healthcare environment. Therefore, attitudes towards professional autonomy may result in effective collaboration among nurses, one of the nursing roles and responsibilities.

METHODS

This descriptive, cross-sectional study was conducted with 685 nurses in four private hospitals affiliated with a university. Descriptive tests, correlation analysis and hierarchical regression analysis were used. An ethics committee approved this study, and the STROBE Statement guidelines for cross-sectional studies were followed.

RESULTS

Significant predictors for nurse-nurse collaboration were identified as job-related independence, autonomous clinical judgement and working unit from control variables.

CONCLUSION

This study's results provided valuable insights for nurse managers to enhance nurses' attitudes towards professional autonomy and foster collaborative work environments.

IMPLICATIONS FOR NURSING

Nurse managers can increase nurses' participation in decision-making processes and allow them to recognize their autonomy and that of their colleagues.

A bottom-up framework for nurses' protocol-based care decision-making

AIM

To develop a conceptual framework for nurses' protocol-based care decision-making.

DESIGN

Miles & Huberman's bottom-up approach to developing conceptual frameworks was followed, using data collected from a multiple embedded case study examining protocol-based decision-making by nurses in three hospital wards within a university hospital in northern Spain.

METHODS

The qualitative data from the case study, obtained through documentary analysis, observations, and interviews, underwent a secondary analysis consisting of four steps: data reduction, data display, comparison, and drawing conclusions.

RESULTS

The framework for protocol-based care decision-making comprises four components: (1) protocol-based care, as a balance between standardisation and individualised care, (2) the process, (3) the context, and (4) the elements of protocol-based care decision-making. These components and their relationship as a context-dependent, linear, variable and multifactorial process, directly influenced by the perception of risk, are described and illustrated.

CONCLUSIONS

This study provides a rigorous bottom-up framework for nurses' protocol-based care decision-making. The framework could be a valuable resource for managers, clinical nurses, educators, and researchers to guide and evaluate nurses' decision-making, leading to improved care quality and reduced variability in clinical practice. Furthermore, the framework lays a foundation for further research and practical applications.

IMPACT

This study addressed the problem of understanding nurses' protocol-based care decision-making and the need for a specific conceptual framework. The main findings of the study contribute to the development of a rigorous bottom-up framework comprising four components of protocol-based care decision-making. The framework has the potential to improve care quality, reduce variability, enhance patient safety, and increase healthcare efficiency by guiding nurses' decision-making in various healthcare settings.

NO PATIENT OR PUBLIC CONTRIBUTION

Patient or public contribution was not applicable since the study focused on nurses' decision making.

How clinicians make decisions for patient management plans in telehealth

AIM

This systematic integrative literature review explores how clinicians make decisions for patient management plans in telehealth.

BACKGROUND

Telehealth is a modality of care that has gained popularity due to the development of digital technology and the COVID-19 pandemic. It is recognized that telehealth, compared to traditional clinical settings, carries a higher risk to patients due to its virtual characteristics. Even though the landscape of healthcare service is increasingly moving towards virtual systems, the decision-making process in telehealth remains not fully understood.

DESIGN

A systematic integrative review.

DATA SOURCES

Databases include CINAHL, APA PsycInfo, Academic Search Complete, PubMed, Web of Science and Google Scholar.

REVIEW METHODS

This systematic integrative review method was informed by Whittemore and Knafl (2005). The databases were initially searched with keywords in November 2022 and then repeated in October 2023. Thematic synthesis was conducted to analyse and synthesize the data.

RESULTS

The search identified 382 articles. After screening, only 10 articles met the eligibility criteria and were included. Five studies were qualitative, one quantitative and four were mixed methods. Five main themes relevant to decision-making processes in telehealth were identified: characteristics of decision-making in telehealth, patient factor, clinician factor, CDSS factor and external influencing factor.

CONCLUSIONS

The decision-making process in telehealth is a complicated cognitive process influenced by multi-faceted components, including patient factors, clinician factors, external influencing factors and technological factors.

IMPACT

Telehealth carries higher risk and uncertainty than face-to-face encounters. CDSS, rather than bringing unification and clarity, seems to bring more divergence and ambiguity. Some of the clinical reasoning processes in telehealth remain unknown and need to be verbalized and made transparent, to prepare junior clinicians with skills to minimize risks associated with telehealth.

PATIENT OR PUBLIC CONTRIBUTION

Not applicable.

Factors influencing decision-making processes for intensive care therapy goals: A systematic integrative review

BACKGROUND

Delivering intensive care therapies concordant with patients' values and preferences is considered gold standard care. To achieve this, healthcare professionals must better understand decision-making processes and factors influencing them.

AIM

The aim of this study was to explore factors influencing decision-making processes about implementing and limiting intensive care therapies.

DESIGN

Systematic integrative review, synthesising quantitative, qualitative, and mixed-methods studies.

METHODS

Five databases were searched (Medline, The Cochrane central register of controlled trials, Embase, PsycINFO, and CINAHL plus) for peer-reviewed, primary research published in English from 2010 to Oct 2022. Quantitative, qualitative, or mixed-methods studies focussing on intensive care decision-making were included for appraisal. Full-text review and quality screening included the Critical Appraisal Skills Program tool for qualitative and mixed methods and the Medical Education Research Quality Instrument for quantitative studies. Papers were reviewed by two authors independently, and a third author resolved disagreements. The primary author developed a thematic coding framework and performed coding and pattern identification using NVivo, with regular group discussions.

RESULTS

Of the 83 studies, 44 were qualitative, 32 quantitative, and seven mixed-methods studies. Seven key themes were identified: what the decision is about; who is making the decision; characteristics of the decision-maker; factors influencing medical prognostication; clinician-patient/surrogate communication; factors affecting decisional concordance; and how interactions affect decisional concordance. Substantial thematic overlaps existed. The most reported decision was whether to withhold therapies, and the most common decision-maker was the clinician. Whether a treatment recommendation was concordant was influenced by multiple factors including institutional cultures and clinician continuity.

CONCLUSION

Decision-making relating to intensive care unit therapy goals is complicated. The current review identifies that breadth of decision-makers, and the complexity of intersecting factors has not previously been incorporated into interventions or considered within a single review. Its findings provide a basis for future research and training to improve decisional concordance between clinicians and patients/surrogates with regards to intensive care unit therapies.

Nurses' perception of uncertainty in clinical decision-making: A qualitative study

Background

Uncertainty is a common challenge for nurses in clinical decision-making, which can compromise patient care quality and safety. To address this issue, it is essential to understand how nurses perceive and cope with uncertainty in their practice.

Aim

This study aimed to explore nurses' perceptions of uncertainty in clinical decision-making using a qualitative approach.

Methods

This study was conducted with a qualitative approach and conventional content analysis in 2020. Participants consisted of 17 nurses from different wards of teaching hospitals in Northwestern Iran, recruited using the purposive sampling method. Data were collected through semi-structured interviews and analyzed simultaneously with data collection (June to December 2020). The data were analyzed using the content analysis approach suggested by Wildemuth. Data were managed with MAXQDA10 software. The analysis revealed four main themes and ten subthemes that described the nurses' experiences of uncertainty in clinical decision-making.

Results

The main themes were: difficult choice, difficult situation, insufficient judgment, and emotional burden.

Conclusions

The study participants defined uncertainty in clinical decision-making as a difficult choice that occurs in difficult situations, which influenced their clinical judgment and emotional well-being. These findings provide valuable insights for developing interventions to help nurses manage uncertainty and improve their decision-making skills and safety.

Postoperative Recovery in the Youngest: Beyond Technology

BACKGROUND

Measuring and interpreting vital signs in pediatric patients recovering from anaesthesia, particularly those up to 36 months old, is challenging. Nurses' decision-making regarding the level of monitoring must balance patient safety with individualized care. This study aimed to explore the perceptions of critical care nurses and registered nurse anesthetists regarding their experiences and actions when making decisions about vital sign monitoring for children in post-anesthesia care units (PACUs).

METHODS

A qualitative study utilizing the critical incident technique was conducted. Interviews were performed with a purposeful sample of 17 critical care nurses and registered nurse anaesthetists from two hospitals.

RESULTS

Nurses reported that the rationale for decisions concerning the need for vital sign monitoring in children was both adequate and inadequate. Actions were taken to adjust the monitoring of vital signs, optimizing conditions for assessment and ensuring the child's safe recovery.

CONCLUSIONS

The complexity of accurately monitoring children makes it challenging for nurses in the PACU to adhere to guidelines. Evidence-based care and safety are compromised when technology has limitations and is not adapted for paediatric use, leading to a greater reliance on experience and clinical assessment. This reliance on experience is crucial for reliable assessment but also entails accepting greater risks.

Decision fatigue experience of front-line nurses in the context of public health emergency: an interpretative phenomenological analysis

BACKGROUND

Decision fatigue is a new concept in the field of psychology and refers to a state of fatigue alongside impaired cognitive processing and emotional regulation ability. Previous studies have confirmed that nurses are prone to decision fatigue, and nurses who experience decision fatigue may implement nursing measures that are inconsistent with clinical evidence, thus affecting patients' benefits. COVID-19, as a large-scale global public health emergency, increased the workload and burden of nurses and aggravated decision fatigue. However, the factors leading to decision fatigue among nurses have not yet been identified.

METHODS

This study is guided by interpretative phenomenology. During the epidemic period of COVID-19: From November 2022 to February 2023, a one-to-one, semi-structured in-depth interview was conducted among nurses with decision fatigue experience who were participating in front-line work in Jilin Province using homogenous sampling. The interview recordings and related data were transcribed into text within 24 h, and data analysis was assisted by NVivo 12.0 software.

RESULTS

After a total of 14 front-line nurses were analyzed in this study, The thematic level reaches saturation, the findings present a persuasive and coherent narrative, and the study is terminated, and finally extracted and formed three core themes: "Cognition, influence and attitude of decision fatigue", "Approaching factors of decision fatigue" and "Avoidant factors of decision fatigue".

CONCLUSION

This study confirmed that decision fatigue was widespread in the work of front-line nurses, affecting the physical and psychological health of nurses, the quality of nursing work, the degree of benefit of patients and the clinical outcome. However, nursing staff do not know enough about decision fatigue, so the popularization and research of decision fatigue should be strengthened. Improve the attention of medical institutions, nursing managers and nursing staff.Some suggestions are put forward for the intervention of decision fatigue through personnel, task, tool and technology, organization and environment.

Physicians' decision making when weaning patients from mechanical ventilation: A qualitative content analysis

BACKGROUND

Weaning from mechanical ventilation is a complex and central intensive care process. This complexity indicates that the challenges of weaning must be explored from different perspectives. Furthermore, physicians' experiences and the factors influencing their decision-making regarding weaning are unclear.

OBJECTIVES

This study aimed to explore and describe the factors influencing physicians' decision-making when weaning patients from invasive mechanical ventilation in Swedish intensive care units (ICUs).

METHODS

This qualitative study used an exploratory and descriptive design with qualitative content analysis. Sixteen physicians from five ICUs across Sweden were purposively included and interviewed regarding their weaning experiences.

FINDINGS

The physicians expressed that prioritising the patient's well-being was evident, and there was agreement that both the physical and mental condition of the patient had a substantial impact on decision-making. Furthermore, there was a lack of agreement on whether patients should be involved in the weaning process and how their resources, needs, and wishes should be included in decision-making. In addition, there were factors not directly linked to the patient but which still influenced decision-making, such as the available resources and teamwork. Sometimes, it was difficult to point out the basis for decisions; in that decisions were made by gut feeling, intuition, or clinical experience.

CONCLUSION

Physicians' decision-making regarding weaning was a dynamic process influenced by several factors. These factors were related to the patient's condition and the structure for weaning. Increased understanding of weaning from the physicians' and ICU teams' perspectives may improve the weaning process by broadening the knowledge about the aspects influencing the decision-making.

Augmenting intensive care unit nursing practice with generative AI: A formative study of diagnostic synergies using simulation-based clinical cases

BACKGROUND

As generative artificial intelligence (GenAI) tools continue advancing, rigorous evaluations are needed to understand their capabilities relative to experienced clinicians and nurses. The aim of this study was to objectively compare the diagnostic accuracy and response formats of ICU nurses versus various GenAI models, with a qualitative interpretation of the quantitative results.

METHODS

This formative study utilized four written clinical scenarios representative of real ICU patient cases to simulate diagnostic challenges. The scenarios were developed by expert nurses and underwent validation against current literature. Seventy-four ICU nurses participated in a simulation-based assessment involving four written clinical scenarios. Simultaneously, we asked ChatGPT-4 and Claude-2.0 to provide initial assessments and treatment recommendations for the same scenarios. The responses from ChatGPT-4 and Claude-2.0 were then scored by certified ICU nurses for accuracy, completeness and response.

RESULTS

Nurses consistently achieved higher diagnostic accuracy than AI across open-ended scenarios, though certain models matched or exceeded human performance on standardized cases. Reaction times also diverged substantially. Qualitative response format differences emerged such as concision versus verbosity. Variations in GenAI models system performance across cases highlighted generalizability challenges.

CONCLUSIONS

While GenAI demonstrated valuable skills, experienced nurses outperformed in open-ended domains requiring holistic judgement. Continued development to strengthen generalized decision-making abilities is warranted before autonomous clinical integration. Response format interfaces should consider leveraging distinct strengths. Rigorous mixed methods research involving diverse stakeholders can help iteratively inform safe, beneficial human-GenAI partnerships centred on experience-guided care augmentation.

RELEVANCE TO CLINICAL PRACTICE

This mixed-methods simulation study provides formative insights into optimizing collaborative models of GenAI and nursing knowledge to support patient assessment and decision-making in intensive care. The findings can help guide development of explainable GenAI decision support tailored for critical care environments.

PATIENT OR PUBLIC CONTRIBUTION

Patients or public were not involved in the design and implementation of the study or the analysis and interpretation of the data.

The relationship between difficulties in emotion regulation and solution-focused thinking in nursing students

AIM

The aim of this study was to investigate the relationship between emotion regulation difficulty and solution-focused thinking in nursing students.

BACKGROUND

It is essential for nursing students to possess solution-focused thinking and emotion regulation skills to cope effectively with stressors arising from their developmental processes, the nature of education and the profession. This is crucial for enhancing the quality of nursing care.

DESIGN

The study design was cross-sectional descriptive and correlational design.

METHODS

The convenience sample of the study consisted of 416 nursing students. The research was conducted between January 20 and February 15, 2024. Data were collected in Türkiye with the difficulties in emotion regulation scale-brief form and the solution focused inventory. Data were analyzed using multivariate linear regression analysis.

RESULTS

An increase of 1 unit in the level of emotion regulation difficulty was associated with a decrease of 0.236 units in participant resource activation and 0.524 units in problem disengagement (p<.001). An increase of 1 unit in the level of emotion regulation difficulty was also associated with an increase of 0.876 units in participant goal orientation (p<.001). Grade point average, grade and age were identified as factors influencing the sub-dimensions of solution-focused thinking (p<.05).

CONCLUSIONS

The study showed that emotion regulation difficulty is an important predictor of solution-focused thinking in nursing students. Therefore, students' emotion regulation difficulties and solution-focused thinking should be evaluated by academic nurses from the beginning of students' enrollment. Also, it is recommended that intervention programs focusing on developing emotion regulation and solution-focused thinking skills for nursing students should be included and implemented in the nursing curriculum.

Views, attitudes, and reported practices of nephrology nurses regarding shared decision-making in end-of-life care

BACKGROUND

End-stage renal disease (ESRD) is the final stage of chronic kidney disease. Yet dialysis is not suitable for all ESRD patients. Moreover, while shared decision-making (SDM) is the preferred model for making medical decisions, little is known about SDM between nephrology nurses and ESRD patients in Israel.

RESEARCH OBJECTIVE

Assessing the views, attitudes, practices, and ethical dilemmas of nephrology nurses in Israel regarding SDM with ESRD patients.

METHODS

Using the descriptive quantitative approach, questionnaires were completed by 444 nephrology nurses in Israel. In addition to conducting descriptive statistics, t-tests for independent samples, f-tests for analysis of variance, and both tests for independence were also performed.

ETHICAL CONSIDERATIONS

The research aims, expected advantages and risks have been explained to respondents before completing the questionnaire to secure informed consent. Anonymity and confidentiality were ensured throughout the study. The study was approved by the Research Ethics Committee at the University of Haifa (Approval # 411/21).

RESULTS

About one-third (30%-36.5%) of nurses reported discussing quality of life issues with ESRD patients, asking about their advance directives/power of attorney, exploring cultural/religious beliefs in end-of-life care, and ask about their preferred place of death. Nurses who convey high levels of patient-centered care (68.9%, p<0.0001), have high end-of-life training (76.2%, p<0.0001), and report cooperating with interdisciplinary teams (63.8%, p = 0.0415), also reported higher SDM practices than others. Nurses who refer less patients to palliative care (70%, p<0.0001) reported higher involvement in SDM compared to other nurses.

CONCLUSIONS

Nephrology nurses in Israel do not tend to implement the SDM model, despite its potential for improving quality of life for ESRD patients and their families and increasing conservative care options. Policy makers and educators in Israel should develop and implement training programs and support in the workplace, to enhance SDM between nephrology nurses and ESRD patients.

Clinical decisions-making within diagnostic radiography - A scoping review

OBJECTIVES

To describe and synthesise literature on clinical decision-making within diagnostic radiography, to uncover the important elements, and to identify knowledge gaps for further investigation. The scoping review question was: How do diagnostic radiographers make clinical decisions?

KEY FINDINGS

Radiographers make clinical decisions before, during and after examinations. The primary source of information radiographers use is the clinical request, however, if they doubt something, they rely on their colleague's points of view rather than evidence-based practice. Many elements must be considered in the clinical decision-making process; however, lack of autonomy, sparse information on the clinical requests, and lack of time affect the process, which can lead to a barrier to effective decision-making.

CONCLUSION

Clinical decisions are made based on many different elements before, during, and after examinations in combination with different types of knowledge, as well as technical and organisational aspects within radiography clinical practice.

IMPLICATION FOR PRACTICE

There is a need to focus on giving more attention to developing the decision-making elements. In addition, there must be more focus on improving intra-professional work between radiographers and radiologists to facilitate radiographers' opportunities to act on their clinical decisions.

Barriers and Facilitators of Intuitive Decision-Making among Psychiatric Nurses: A Cross-sectional Study

Introduction

Due to the type and nature of hospitalized psychiatric patients, nurses encounter many ambiguous and complex clinical situations that require intuitive decision-making. The present study was conducted to determine the use of intuition and its barriers and facilitators among psychiatric nurses.

Methods

This study adopts a descriptive cross-sectional design and employs 123 nurses using convenience sampling in 2022. Demographic characteristics, the use of intuition in clinical practice, and the barriers and facilitators of intuition in clinical practice questionnaires were used for data collection.

Results

The results of this study showed that the mean (SD) of intuitive decision-making among psychiatric nurses was 58 (13.07) out of a range from 25-125. The use of intuition had a statistically significant correlation with age and work experience in the psychiatry ward. The use of intuitive decision-making has a statistically significant difference in gender, work shift, and education level. The biggest barrier to the use of intuitive decision-making among psychiatric nurses was "The limitations of nursing role which restrict the use of intuition in the clinical setting". The most common facilitator in the use of intuition among psychiatric nurses was "having experience and clinical knowledge leads to the use of intuition in patient care".

Conclusion

Given the low level of the use of intuition and the important role of intuitive decision-making in the quality of nursing care, nursing managers should provide some strategies for reducing the barriers to the use of intuition among nurses.

The relevance of the contribution of psychoneuroendocrinoimmunology and psychology of reasoning and decision making to nursing science: A discursive paper

AIM

Patients' death or adverse events appear to be associated with poor healthcare decision-making. This might be due to an inability to have an adequate representation of the problem or of the connections among problem-related elements. Changing how a problem is formulated can reduce biases in clinical reasoning. The purpose of this article is to explore the possible contributions of psychoneuroendocrinoimmunology (PNEI) and psychology of reasoning and decision-making (PRDM) to support a new nursing theoretical frame.

DESIGN

Discursive paper.

METHOD

This article discusses the main assumptions about nursing and nurses' ability to face patient's problems, suggesting a new approach that integrates knowledge from PNEI and PRDM. While PNEI explains the complexity of systems, highlighting the importance of systems connections in affecting health, PRDM underlines the importance of the informative context in creating a mental representation of the problem. Furthermore, PRDM suggests the need to pay attention to information that is not immediately explicit and its connections.

CONCLUSION

Nursing recognizes the patient-nurse relationship as the axiom that governs care. The integration of PNEI and PRDM in nursing theoretics allows the expansion of the axiom by providing essential elements to read a new type of relationship: the relationship among information. PNEI explains the relationships between biological systems and the psyche and between the whole individual and the environment; PRDM provides tools for the nurse's analytical thinking system to correctly process information and its connections.

IMPACT ON NURSING PRACTICE

A theoretical renewal is mandatory to improve nursing reasoning and nursing priority identification. Integrating PNEI and PRDM into nursing theoretics will modify the way professionals approach patients, reducing cognitive biases and medical errors.

NO PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public involvement in the design or writing of this discursive article.

Nurses prioritization processes to prevent delirium in patients at risk: Findings from a Q-Methodology study

BACKGROUND

This study aimed at (a) exploring how nurses prioritise interventions to prevent delirium among patients identified at risk and (b) describing the underlying prioritisation patterns according to nurses' individual characteristics.

METHODS

There was used the Q-methodology a research process following specific steps: (a) identifying the concourse, (b) the Q-sample, and (c) the population (P-set); (d) collecting data using the Q-sort table; (e) entering the data and performing the factor analysis; and (f) interpreting the factors identified.

RESULTS

There were involved 56 nurses working in medical, geriatric and log-term facilities (46; 82.2 %). The preventive intervention receiving the highest priority was 'Monitoring the vital parameters (heart rate, blood pressure, oxygen saturation)' (2.96 out of 4 as the highest priority; CI 95 %: 2.57, 3.36). Two priority patterns emerged among nurses (explained variance 44.78 %), one 'Clinical-oriented' (36.19 %) and one 'Family/caregiver-oriented' (8.60 %) representing 53 nurses out 56.

CONCLUSION

Alongside the overall tendency to prioritise some preventive interventions instead of others, the priorities are polarised in two main patterns expressing two main individual characteristics of nurses. Knowing the existence of individual patterns and their aggregation informs how to shape educational interventions.

Early warning tools and clinician 'agency' for strengthening safety culture: An integrative review

AIM

Identify and analyse literature investigating nurses' and midwives' use of early warning tools during the care of adult inpatients.

DESIGN

An integrative literature review.

METHODS

Whittemore and Knafl's (2005) framework guided this integrative review. PubMed, CINAHL, EMCARE and Google Scholar were systematically searched. The authors assessed the methodological quality of 21 papers meeting inclusion criteria and thematically analysed key data.

RESULTS

Three main themes were identified, each with further sub-themes.

CONCLUSION

Early warning tools operate within various systems and cultural contexts. However, their potential for improved patient safety may be hindered. Protocols influencing tool usage may make nurses and midwives distanced from patients and their expertise. For early warning tools to enhance patient safety, assessing their integration into practice is crucial to maximizing effectiveness.

IMPACT

This review emphasizes the importance of integrating human relationships with early warning tools for patient safety.

PATIENT OR PUBLIC CONTRIBUTION

This integrative literature review does not include patient or public input.

IMPLICATIONS FOR PRACTICE/POLICY

Adapting early warning tools to balance standardization for safety and efficiency and promoting nurses' and midwives' expertise and autonomy is required to optimize delivery of quality care and uphold patient safety.

REPORTING METHOD

The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used.

Clinical decision-making processes among graduate nurses, specialist nurses and nurse practitioners A collaborative international study

AIM

To explore clinical decision-making by comparing the processes used by three groups of nurses in the emergency departments of three hospitals: in Norway, Finland and Ireland.

BACKGROUND

Clinical decision-making in an emergency department environment is a complex process often occurring in times of crisis. It is an important aspect contributing to the quality of care. However, empirical research is limited regarding the decision-making process in different nursing roles.

METHODS

In accordance with the consolidated criteria for reporting qualitative research, a qualitative and observational study was conducted to explore clinical decision-making by comparing the processes used by three groups of nurses in the emergency departments of three hospitals: in Norway, Finland and Ireland. Six Registered Nurses, six Nurse Specialists and six Nurse Practitioners were observed. A total of 40 hours of observation was made at each setting according to a structured observation guideline, followed by clarifying questions. The data material was analysed by means of a qualitative manifest and latent content analysis.

RESULTS

Three themes arose: acting in accordance with routines, previous experience and intuition; considering patient experience; and facilitating new alternatives based on critical thinking. The Registered Nurses mainly used the first approach, the Nurse Specialists used the first and the second approaches, and the Nurse Practitioners used all three approaches.

CONCLUSIONS

The results highlight the differences in decision-making processes between these groups. Nurse Practitioners were the only group that facilitated and evaluated new alternatives using their clinical autonomy, such as stepping up and making independent and collaborative decision-making.

IMPLICATION

The results can be used in countries developing advanced practice nursing education and defining their scope of practice to inform stakeholders.

Determinants of the optimal selection of vascular access devices: A systematic review underpinned by the COM-B behavioural model

BACKGROUND

Optimal selection of vascular access devices is based on multiple factors and is the first strategy to reduce vascular access device-related complications. This process is dependent on behavioural and human factors. The COM-B (Capability, Opportunity, Motivation, Behaviour) model was used as a theoretical framework to organize the findings of this systematic review.

METHODS/AIMS

To synthesize the evidence on determinants shaping the optimal selection of vascular access devices, using the COM-B behavioural model as the theoretical framework.

DESIGN

Systematic review of studies which explore decision-making at the time of selecting vascular access devices.

DATA SOURCES

The Medline, Web of Science, Scopus and EbscoHost databases were interrogated to extract manuscripts published up to 31 December 2021, in English or Spanish.

RESULTS

Among 16 studies included in the review, 8/16 (50%) focused on physical capability, 8/16 (50%) psychological capability, 15/16 (94%) physical opportunity, 12/16 (75%) social opportunity, 1/16 (6%) reflective motivation and 0/16 (0%) automatic motivation. This distribution represents a large gap in terms of interpersonal and motivational influences and cultural and social environments. Specialist teams (teams created for the insertion or maintenance of vascular access devices) are core for the optimal selection of vascular access devices (75% physical capability, 62% psychological capability, 80% physical opportunity and 100% social opportunity).

CONCLUSION

Specialist teams predominantly lead all actions undertaken towards the optimal selection of vascular access devices. These actions primarily centre on assessing opportunity and capability, often overlooking motivational influences and social environments.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

A more implementation-focused professional approach could decrease inequity among patients and complications associated with vascular access devices.

IMPACT

Optimal selection of vascular access devices is the primary strategy in mitigating complications associated with these devices. There is a significant disparity between interpersonal and motivational influences and the cultural and social environments. Furthermore, specialized teams play a pivotal role in facilitating the optimal selection of vascular access devices. The study can benefit institutions concerned about vascular access devices and their complications.

REPORTING METHOD

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution. WHAT DOES THIS ARTICLE CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Optimal selection of vascular devices remains a growing yet unresolved issue with costly clinical and patient experience impact. Interventions to improve the optimal selection of vascular devices have focused on training, education, algorithms and implementation of specialist vascular teams; alas, these approaches do not seem to have substantially addressed the problem. Specialist vascular teams should evolve and pivot towards leading the implementation of quality improvement interventions, optimizing resource use and enhancing their role.

The effect of nomophobic behaviors among nurses on their clinical decision-making perceptions

AIM

This study aimed to explore the impact of nomophobic behaviors among hospital nurses on their clinical decision-making perceptions. This understanding can offer insights to enhance the work environment, improve the clinical decision-making ability of nurses and guide medical institutions in the management of related equipment and policy development.

BACKGROUND

The term "nomophobia" refers to the anxiety and fear individuals experience when they cannot use their smartphones or when smartphones are not accessible. Nursing clinical decision-making is a complex process, including a meticulous assessment of the patient's pathological condition and medical history, alongside the application of nursing knowledge and experiential learning rooted in critical thinking. The concept of clinical decision-making perceptions is defined as a deliberate cognitive understanding of one's decision-making processes, which significantly influences the clinical decision-making capabilities of healthcare professionals, thereby impacting the quality of patient care. The factors influencing these clinical decision-making perceptions have been the subject of extensive research. However, there is no Chinese research on the impact of nurses ' nomophobic behaviors on their clinical decision-making perception.

DESIGN

A cross-sectional descriptive survey using online-based delivery modes was used.

METHODS

A descriptive cross-sectional survey design was employed. Using convenience sampling, we surveyed the nurses from a tertiary hospital in Nanjing in May 2023. Data were gathered using a sociodemographic data form, the Nomophobia Questionnaire and the Clinical Decision-Making in Nursing Scale. Techniques including the independent sample t-test, one-way ANOVA, Pearson correlation analysis and linear regression analysis were employed to probe the degree of nomophobia and its effects on their perception of clinical decision-making. Out of 284 questionnaires gathered, 272 were deemed valid, resulting in a 95.8% effective response rate.

RESULTS

The data revealed that participants exhibited a medium level of nomophobia (54.01 ± 24.09) and clinical decision-making perceptions (144.94 ± 20.08). A robust negative correlation was discerned between nomophobia and clinical decision-making perceptions (r: -0.365, P<0.001). This study highlighted that as the degree of nomophobia intensified, nurses' clinical decision-making perceptions decreased with the increase in nomophobia.

CONCLUSION

Nomophobic behaviors can hamper nurses' perception of clinical decision-making, potentially leading to inaccuracies or errors. Nurses must use mobile phones judiciously, practice self-regulation and mitigate the disruptive effects of nomophobia on their decision-making. In addition, medical institutions should foster relevant education or craft policies to regularize mobile phone use, augmenting nurses' efficiency and decision-making prowess, enhancing patient care quality, diminishing medical errors and ensuring patient health and safety.

Exploring nurses' clinical judgment concerning the relative importance of fall risk factors: A mixed method approach using the Q Methodology

BACKGROUND

Nurses are pivotal in averting patient falls through their assessment of cues presented by patients and their environments, rendering clinical judgments regarding the risk of falling, and implementing tailored interventions. Despite the intricate cognitive processes entailed in nurses' judgment, no prior studies have explored their approach to assessing the risk of falling.

OBJECTIVE

This study aimed to examine how nurses judge the risk of falling among patients with different conditions, whether there are differences in the importance of risk factors as judged by nurses, how they justify their judgments, and what attributes of the nurses influence their judgments.

DESIGN

A mixed method approach using the Q Methodology was employed.

SETTING(S)

Three public and private hospitals in Japan.

PARTICIPANTS

Eighteen nurses participated in the study.

METHODS

Participants were tasked with ranking 36 patient scenarios, each featuring a distinct set of fall risk factors. Subsequently, post-sorting interviews were conducted to gather insights into their typical approach to assessing fall risk and the rationale behind their ranking decisions. A by-person principal component factor extraction was employed to examine differences in the rankings of the scenarios. The interview data were analyzed descriptively to elucidate the reasons behind these discrepancies.

RESULTS

Nurses engage in complex cognitive manipulations when evaluating the risk of patient falls, drawing extensively from their wealth of experience while utilizing assessment tools to support their judgments. In essence, nurses identify patients' tendency to act alone without calling a nurse, impaired gait and cognition, sedative use, drains, and limited information sharing among healthcare professionals as key fall risks. In addition, nurses vary in the importance they attribute to certain risk factors, leading to the discrimination of three distinct judgment profiles. One group of nurses judges patients with cognitive impairment and acting alone as high risk. Another group of nurses considers patients with unstable gait and acting alone as high risk. The last group of nurses sees patients wearing slippers as high risk. The post-sorting interviews revealed that their judgments are closely related to the healthcare context and patient population.

CONCLUSIONS

Nurses operate within diverse contexts, wherein they interact with patients of varying characteristics, collaborate with professionals from diverse disciplines, and have access to varying levels of human and physical resources. This nuanced understanding empowers the formulation of judgments that are finely attuned to the specific context at hand.

STUDY REGISTRATION

Not registered.

Knowledge levels of doctors and nurses working in surgical clinics about nutrients and food supplements, a multicentre descriptive study

PURPOSE

The use of nutrients and food supplements is increasing worldwide. Nutrients and food supplements frequently used in the surgical period may cause complications and side effects. This study was conducted to determine the level of knowledge about sixty-one nutrients and food supplements among doctors and nurses working in surgical clinics.

DESIGN

A multicentre descriptive, quantitative, cross-sectional study.

METHODS

The study was conducted between 15 February and 31 May 2022 with a total of 410 participants, including 143 doctors and 267 nurses, working in the surgical clinics of 8 hospitals, including public, university and private hospitals, within the borders of one province in Turkey. Data were collected face-to-face using a questionnaire developed by the researchers, which included descriptive characteristics of the doctors and nurses and questions about sixty-one nutrients and food supplements.

RESULTS

The median overall success score of the doctors and nurses participating in the study regarding the use of nutrients and food supplements was 3.20 out of 100 points, the median success score of complications and side effects of nutrients and food supplements in the surgical period was 7.06 out of 33 points, the median success score for discontinuation of nutrients and food supplements prior to surgery was 0.21 out of 16 points, and the median success score for drug interactions of nutrients and food supplements was 1.70 out of 51 points. In addition, it was found that the overall success scores of doctors and nurses regarding nutrients and food supplements increased statistically significantly with increasing age and working years. The total success score of doctors and nurses who received training in nutrients and food supplements was statistically significantly higher than that of doctors and nurses who did not receive training.

CONCLUSION

In conclusion, it was found that the level of knowledge of nutrients and food supplements among doctors and nurses working in surgical clinics was less than half or even close to zero. Therefore, it is recommended that training on nutrients and food supplements should be included in the undergraduate and postgraduate education of doctors and nurses in order to prevent complications, side effects, drug interactions and patient safety related to the use of nutrients and food supplements in the surgical period.

Clinical decision making: validation of the nursing anxiety and self-confidence with clinical decision making scale (NASC-CDM ©) into Spanish and comparative cross-sectional study in nursing students

BACKGROUND

Decision making is a pivotal component of nursing education worldwide. This study aimed to accomplish objectives: (1) Cross-cultural adaptation and psychometric validation of the Nursing Anxiety and Self-Confidence with Clinical Decision Making (NASC-CDM©) scale from English to Spanish; (2) Comparison of nursing student groups by academic years; and (3) Analysis of the impact of work experience on decision making.

METHODS

Cross-sectional comparative study. A convenience sample comprising 301 nursing students was included. Cultural adaptation and validation involved a rigorous process encompassing translation, back-translation, expert consultation, pilot testing, and psychometric evaluation of reliability and statistical validity. The NASC-CDM© scale consists of two subscales: self-confidence and anxiety, and 3 dimensions: D1 (Using resources to gather information and listening fully), D2 (Using information to see the big picture), and D3 (Knowing and acting). To assess variations in self-confidence and anxiety among students, the study employed the following tests: Analysis of Variance tests, homogeneity of variance, and Levene's correction with Tukey's post hoc analysis.

RESULTS

Validation showed high internal consistency reliability for both scales: Cronbach's α = 0.920 and Guttman's λ2 = 0.923 (M = 111.32, SD = 17.07) for self-confidence, and α = 0.940 and λ2 = 0.942 (M = 80.44, SD = 21.67) for anxiety; and comparative fit index (CFI) of: 0.981 for self-confidence and 0.997 for anxiety. The results revealed a significant and gradual increase in students' self-confidence (p =.049) as they progressed through the courses, particularly in D2 and D3. Conversely, anxiety was high in the 1st year (M = 81.71, SD = 18.90) and increased in the 3rd year (M = 86.32, SD = 26.38), and significantly decreased only in D3. Work experience positively influenced self-confidence in D2 and D3 but had no effect on anxiety.

CONCLUSION

The Spanish version (NASC-CDM-S©) was confirmed as a valid, sensitive, and reliable instrument, maintaining structural equivalence with the original English version. While the students' self-confidence increased throughout their training, their levels of anxiety varied. Nevertheless, these findings underscored shortcomings in assessing and identifying patient problems.

Promoting knowledge translation: An ecosystem approach to evidence in health

The dissemination and implementation of evidence in health contexts have been a concern of several international organizations responsible for recommending actions to health policymakers. World Health Organization has been advocating for an ecosystem of evidence to improve clinical practice and health professional education. Thus, in this article, we address the challenges to developing the evidence ecosystem from the point of view of health professional education, considering the contexts of practice and teaching, focused on knowledge translation. There are three pivotal challenges: producing qualified knowledge; adequate communication of the synthesized evidence; and institutional policy to sustain the implemented evidence in continuous and updated flow. The evidence ecosystem helps to understand these flows between the production and implementation of knowledge, based on the capacity and resources of different health systems. It needs to be developed in the field of health professional education, feedback in the contexts of practice and teaching, to contribute to third-generation knowledge being used by different users of health services.

Problem-solving processes for central venous catheter occlusion within pediatric cancer care: A qualitative study

PURPOSE

Central venous access devices play a crucial role in healthcare settings. However, there is concern regarding the high incidence of blockages occurring before the completion of treatments and existing guidelines for occlusion management are not consistently followed. To explore the decision-making and problem-solving process of occlusion management and identify enablers and barriers to implementing evidence for occlusion management in pediatric cancer care.

METHODS

A qualitative design with individual semi-structured interviews. Participants were selected by purposeful sampling from a tertiary-referral pediatric facility, and semi-structured interviews were conducted.

RESULTS

A total of 13 clinicians and 5 parents were interviewed. The thematic analysis revealed four main decision-making/problem-solving themes: 1) clinical reasoning and judgement for central venous access devices occlusion, 2) capability in central venous access devices occlusion management, 3) colleague collaboration in the escalation process and 4) lack of adequate support to manage the occlusion. This study identified positive and negative influences on the problem-solving process, including clinicians' psychological capabilities, social and physical resources, and beliefs about consequences.

CONCLUSION

This study found that clinicians in pediatric cancer care were able to manage central venous access device occlusions using clinical reasoning and judgment skills, which may conflict with evidence-based practices. The study confirmed the importance of a team approach and prior experience in managing central venous access devices in pediatric oncology settings and identified potential conflicts between clinician decisions based on the patient's current and anticipated conditions and implementation of evidence-based practice. Improving documentation and providing visual aids could benefit clinicians' problem-solving processes.

Interventions to enhance the use of Evidence Based Decision Making for Quality Care among Nurses: A Systematic Review

Background

Decision-making is the cognitive process that results in the selection of a course of action from several possible alternative options. The complexity of nurses' decisions requires a broad knowledge base and access to reliable sources of information; as well as a supportive working environment therefore requiring that decision making be evidence based with robust knowledge translation platforms to disseminate the evidence. This review aimed to assess interventions for enhancing the use of evidence-based decision making for quality care among nurses.

Methods

This study followed the Preferred Reporting Items for Systematic Review and Meta-Analysis review (PRISMA 2020) checklist. This study protocol was registered with PROSPERO number CRD42021262318.

Results

The search revealed a total of 143 papers divided as follows: PubMed- 65 papers, CINAHL 25 papers and Cochrane 53 papers. In addition, references of included studies were scanned manually for potential papers and another 46 papers extracted. A total of 133 papers were chosen for detailed extraction following removal of 10 duplicate studies.

Conclusion

Results of this review revealed that the interventions that have been used to enhance the use of evidence for decision making are majorly educational. A few interventions have taken the form of modelling, guidelines and programming. Online solutions have also been seen to enhance the use of evidence for clinical practice of nurses.

Can the Reboot coaching programme support critical care nurses in coping with stressful clinical events? A mixed-methods evaluation assessing resilience, burnout, depression and turnover intentions

BACKGROUND

Critical care nurses (CCNs) are routinely exposed to highly stressful situations, and at high-risk of suffering from work-related stress and developing burnout. Thus, supporting CCN wellbeing is crucial. One approach for delivering this support is by preparing CCNs for situations they may encounter, drawing on evidence-based techniques to strengthen psychological coping strategies. The current study tailored a Resilience-boosting psychological coaching programme [Reboot] to CCNs. Other healthcare staff receiving Reboot have reported improvements in confidence in coping with stressful clinical events and increased psychological resilience. The current study tailored Reboot for online, remote delivery to CCNs (as it had not previously been delivered to nurses, or in remote format), to (1) assess the feasibility of delivering Reboot remotely, and to (2) provide a preliminary assessment of whether Reboot could increase resilience, confidence in coping with adverse events and burnout.

METHODS

A single-arm mixed-methods (questionnaires, interviews) before-after feasibility study design was used. Feasibility was measured via demand, recruitment, and retention (recruitment goal: 80 CCNs, retention goal: 70% of recruited CCNs). Potential efficacy was measured via questionnaires at five timepoints; measures included confidence in coping with adverse events (Confidence scale), Resilience (Brief Resilience Scale), depression (PHQ-9) and burnout (Oldenburg-Burnout-Inventory). Intention to leave (current role, nursing more generally) was measured post-intervention. Interviews were analysed using Reflexive Thematic Analysis.

RESULTS

Results suggest that delivering Reboot remotely is feasible and acceptable. Seventy-seven nurses were recruited, 81% of whom completed the 8-week intervention. Thus, the retention rate was over 10% higher than the target. Regarding preliminary efficacy, follow-up measures showed significant increases in resilience, confidence in coping with adverse events and reductions in depression, burnout, and intention to leave. Qualitative analysis suggested that CCNs found the psychological techniques helpful and particularly valued practical exercises that could be translated into everyday practice.

CONCLUSION

This study demonstrates the feasibility of remote delivery of Reboot and potential efficacy for CCNs. Results are limited due to the single-arm feasibility design; thus, a larger trial with a control group is needed.

Clinical reasoning skill of nurses working in teaching medical centers in dealing with practical scenarios of King's model concepts

BACKGROUND

The present study was conducted to determine clinical reasoning of nurses working in teaching medical centers in dealing with practical scenarios of King's concepts.

METHODS

The study population in this cross-sectional descriptive-analytical study comprised 133 nurses. Data were collected using scenarios based on the King's model. Data were analyzed in SPSS-16.

FINDINGS

Mean age of the participating nurses was 27.71 ± 8.1 years.The clinical reasoning score was less than average in most participating nurses, and had a significant relationship with education(P < 0.05), service ward(P < 0.001)and organizational position(P < 0.05). In the multivariate analysis of factors relating to clinical reasoning, higher education level (B = 9.5, P = 0.018) and organizational position (B = 4.3, P = 0.017) were predictors of clinical reasoning score.

DISCUSSION

Existing nursing models such as King's, which is closely related to clinical reasoning, can be used more in educational and clinical systems, and as a clinical guide for promoting the clinical reasoning of nurses and students.

Decision-making process regarding passive euthanasia: Theory of planned behavior framework

BACKGROUND

Nurses have an essential role in caring for end-of-life patients. Nevertheless, the nurse's involvement in the passive euthanasia decision-making process is insufficient and lower than expected.

OBJECTIVES

To explore factors associated with nurses' intention to be involved in non-treatment decisions (NTD) regarding passive euthanasia decision-making versus their involvement in the palliative care of patients requesting euthanasia, using the Theory of Planned Behavior (TPB) framework.

DESIGN

A cross-sectional study utilizing a random sample.

PARTICIPANTS AND RESEARCH CONTEXT

The study was conducted in one of the largest hospitals in Israel among 125 nurses employed in internal and surgical care wards. Data was collected through face-to-face interviews between March and April 2019.

METHOD

A closed structured questionnaire was developed according to TPB instructions. A paired sample t test and two multiple hierarchical regressions were conducted. Variance explained (R2) and the significance of F change were calculated for each regression. The study used the STROBE statement guideline.

ETHICAL CONSIDERATIONS

The study was approved by the hospital's Helsinki Committee (#20.11.2017).

FINDINGS

A paired sample t test revealed that nurses' involvement in the palliative care of patients requesting passive euthanasia was significantly higher than in NTD regarding euthanasia. Regression analyses revealed that nurses' position and attitudes explain their intention to be involved in decision-making; attitudes and perceived behavioral control explain nurses' intention to be involved in the care of patients requesting euthanasia.

CONCLUSIONS

According to the TPB, nurses' attitudes explained their intention to participate in decision-making regarding passive euthanasia. It is recommended to enhance open discussion of this complex issue to encourage nurses' willingness to participate in NTD decision-making regarding euthanasia.

Maximization delays decision-making in acute care nursing

The maximization personality trait refers to the tendency to face decision-making situations along a continuum from exhaustively analysing all the options (maximize) to choosing the one that exceeds a subjective threshold of acceptability (satisfy). Research has revealed the influence of maximizing on decision making, although little is known about its possible role in high risk and high uncertainty situations. A sample of 153 active Spanish nurses, with an average experience of 11 years, completed a maximization questionnaire and responded to written vignettes depicting time-demanding decision making in which three options were offered, representing delayed action, non-action, and immediate action. Two vignettes presented critical situations related to acute care during the COVID-19 pandemic, whilst two vignettes presented non-nursing scenarios. People high in maximization took longer to choose and were more likely to choose non-action. No relationship was found between maximization score and the subjective experience of the person making the choice. Maximization had no significant correlation with years of experience nor perceived expertise. Greater perceived expertise was associated with lower indecision and greater confidence. When participants answered nursing vignettes, they took longer to respond, but chose less delayed action and more immediate action. Our results suggest that maximization plays only a relative role in acute care decision-making in nursing, as compared to contextual variables and expertise. They also support a domain general approach to this personality trait. Findings are consistent with Nibbelink and Reed's Practice-Primed Decision Model for nursing.

The Relationship Between Psychological Empowerment and Clinical Decision-Making Among Staff Nurses in Governmental Hospital in Al-Baha, Saudi Arabia

Background The Saudi Arabian government has published its 2030 vision for improving health care to meet worldwide standards for the nursing profession. To fulfill this vision, building large-scale healthcare facilities is necessary. Among the most common occupations, nursing is vital to health care systems. Although working in health care institutions is challenging, demanding, and comprehensive, they are created to save lives and enhance patient satisfaction. Therefore, health care organizations must seek to develop psychologically empowered and decision-making nurses who can help meet clients' demands and enhance patient care, safety, quality, and outcomes. This study aims to determine the association between psychological empowerment (PE) and clinical decision-making (CDM) among staff nurses. Methods This study employed a quantitative cross-sectional correlation design. Three Saudi Ministry of Health-affiliated hospitals in the Al-Baha region were included. The sample size was calculated using the Raosoft online sample size calculator, with a total of 318 participants. The study sample included nurses working in inpatient, outpatient, and critical care departments. Convenience sampling techniques with inclusion and exclusion criteria were employed. An online survey with three sections was used for data collection: sociodemographic characteristics, the psychological empowerment instrument, and the nursing decision-making instrument. Data collection began at the beginning of February 2023 and was completed by the beginning of April 2023. Results The participants were 318 nurses working in critical areas, inpatient, and outpatient departments at three governmental hospitals in the Al-Baha region. Overall, 285 participants (89.6%) had a high level of PE, and the majority, 263 participants (82.7%), exhibited flexible-oriented decision-making. Approximately three-quarters of the sample, 281 participants (88.4%), were female, and more than half of the staff nurses, 187 participants (58.8%), were married. The majority of participants, 250 (78.6%), had a bachelor's degree. Regarding professional experience, most staff nurses, 134 participants (42.1%), had between one and five years of experience, and the majority worked in inpatient units, 160 participants (50.3%), while 104 (32.7%) worked in critical care. Conclusion The current study found a significant association between nurses' PE and CDM. Nurses with the highest PE were the most flexible in their CDM. Moreover, the findings of this study offer some points that nurse managers and leaders can use to generate empowerment and make their staff better decision-makers. One recommendation is to develop training and coaching programs to enhance PE among staff nurses, thereby raising their work meaningfulness, which would reflect in better CDM. Additionally, this study recommends that future research be conducted to examine how PE affects CDM.

Evaluating the Importance of Clinical Judgment in Entry-Level Nursing

BACKGROUND

This study investigated the extent to which clinical judgment is important in entry-level nursing practice.

METHOD

A task analysis linkage study methodology based on a large-scale, comprehensive practice analysis was used for the study. The practice analysis validated more than 200 entry-level nursing tasks, and the linkage study sought to evaluate the importance of clinical judgment overall and for each specific task expectation.

RESULTS

The results provide confirmatory evidence of the importance of clinical judgment. In addition, the work provides a comprehensive list of entry-level tasks and their associated clinical judgment importance.

CONCLUSION

Clinical judgment is a vital skill at entry into the profession and is expected to grow over time. This study offers insights on the extent to which clinical judgment is a necessary skill and provides direct evidence of its importance for specific entry-level tasks. [J Nurs Educ. 2024;63(3):156-162.].

Standardized training nurses's humanistic care practice ability: A cross-sectional survey in western China during COVID-19

AIM

This study aims to investigate the current status and determinants of humanistic care practice abilities among standardized training nurses in China during the post-COVID-19 era, as well as to propose management strategies.

DESIGN

A cross-sectional study.

METHODS

Deliberately chosen were 517 standardized training nursing students from a provincial-level training facility in western China.

RESULTS

The respondents had a mean ± SD age of 21.23 ± 1.34 years, and 92.0% of them voluntarily opted for the nursing profession. Almost all (99.8%) respondents had at least a college degree. The standardized training nurses scored an average of (130.31 ± 14.18) on humanistic care ability, which was significantly related to some sociodemographic variables. The average scores for the five dimensions of nursing communication ability, psychological adjustment ability, moral and legal application ability, nursing aesthetic ability, and care practice ability were 30.78, 17.61, 32.23, 18 and 31.67, respectively. All these dimensions showed positive correlations with the overall score of humanistic care practice ability.

A comparative vignette study: Evaluating the potential role of a generative AI model in enhancing clinical decision-making in nursing

AIM

This study explores the potential of a generative artificial intelligence tool (ChatGPT) as clinical support for nurses. Specifically, we aim to assess whether ChatGPT can demonstrate clinical decision-making equivalent to that of expert nurses and novice nursing students. This will be evaluated by comparing ChatGPT responses to clinical scenarios to those of nurses on different levels of experience.

DESIGN

This is a cross-sectional study.

METHODS

Emergency room registered nurses (i.e. experts; n = 30) and nursing students (i.e. novices; n = 38) were recruited during March-April 2023. Clinical decision-making was measured using three validated clinical scenarios involving an initial assessment and reevaluation. Clinical decision-making aspects assessed were the accuracy of initial assessments, the appropriateness of recommended tests and resource use and the capacity to reevaluate decisions. Performance was also compared by timing response generations and word counts. Expert nurses and novice students completed online questionnaires (via Qualtrics), while ChatGPT responses were obtained from OpenAI.

RESULTS

Concerning aspects of clinical decision-making and compared to novices and experts: (1) ChatGPT exhibited indecisiveness in initial assessments; (2) ChatGPT tended to suggest unnecessary diagnostic tests; (3) When new information required re-evaluation, ChatGPT responses demonstrated inaccurate understanding and inappropriate modifications. In terms of performance, the mean number of words utilized in ChatGPT answers was 27-41 times greater than that utilized by both experts and novices; and responses were provided approximately 4 times faster than those of novices and twice faster than expert nurses. ChatGPT responses maintained logical structure and clarity.

CONCLUSIONS

A generative AI tool demonstrated indecisiveness and a tendency towards over-triage compared to human clinicians.

IMPACT

The study shows that it is important to approach the implementation of ChatGPT as a nurse's digital assistant with caution. More study is needed to optimize the model's training and algorithms to provide accurate healthcare support that aids clinical decision-making.

REPORTING METHOD

This study adhered to relevant EQUATOR guidelines for reporting observational studies.

PATIENT OR PUBLIC CONTRIBUTION

Patients were not directly involved in the conduct of this study.

Have our backs-medical-surgical nurses' safety culture experiences: An inductive qualitative descriptive study

AIM

This study aims to describe medical-surgical registered nurses' experiences with safety culture.

DESIGN

Qualitative, Inductive descriptive.

METHODS

Registered nurses were recruited from a Midwestern community hospital in the United States using purposive sampling. The participants were interviewed using semi-structured interview questions from February 6, 2020-April 9, 2020. Safety huddles were observed and key documents were collected. The interviews were transcribed and analyzed using inductive qualitative content analysis. The COREQ checklist was followed.

RESULTS

A total of 16 registered nurses were interviewed. Six themes emerged: Time to know my patient to keep them safe, using my gut and nursing interventions, getting extra eyes on the patient, not always having what is needed to provide safe care, organization prioritizes patient safety, and learning: have our backs. No Patient or Public Contribution.

A cross-sectional study of discipline-based self-perceived digital literacy competencies of nursing students

AIMS

This study offers an empirical exploration of self-assessed digital competencies of students, most of whom studied in nursing courses, using a discipline-based self-assessment survey tool. A range of digital competencies were explored: information and communication technology proficiency and productivity, information literacy, digital creation, digital research, digital communication, digital learning and development, digital innovation, digital identity management and digital well-being.

DESIGN

A cross-sectional empirical study.

METHODS

Quantitative data were collected from November to December 2021 via a questionnaire survey administered to students. Quantitative results were reported through descriptive statistical analysis. Mann-Whitney (U-test) and Kruskal-Wallis non-parametric statistical tests were used to identify statistically significant differences based on age demographics and pre- or post-registration course. Thematic analysis was utilized for survey open-ended questions data.

RESULTS

Students reported low competencies in the following digital literacy dimensions, all of which were imperative for their studies and for their future professional careers: information literacy, digital research, digital innovation. Significant statistical subgroup differences were found between age demographics and pre/post-registration within most of the digital competence dimensions. The survey open-ended comments revealed that students encountered challenges around digital skills they had mostly developed via everyday life experiences and trial-and-error approaches.

CONCLUSION

Increasing awareness of existing digital gaps and offering tailored digital skills enhancement can empower students as future-proof evidence-based practitioners in an evolving digital healthcare landscape.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Highlights the importance of embedding digital literacy within nursing study programmes, as preparation for comprehensive patient healthcare.

IMPACT

Offers insights into digital competencies gaps of nursing students. Proposes targeted educational digital skills training interventions. Stresses the value of academic staff supporting nursing students to develop digital skills in important areas of professional practice.

REPORTING METHOD

JBI critical appraisal checklist. No patient or public contribution.

Patterns of information literacy and their predictors among emergency department nurses: a latent profile analysis based on the person-context interaction theory

BACKGROUND

With the development of information technology, information has been an important resource in clinical medicine, particularly within the emergency department. Given its role in patient rescue, the emergency department demands a high level of information literacy from nurses to effectively collect, analyze, and apply information due to the urgency and complexity of emergency nursing work. Although prior studies have investigated the information literacy of nursing staff, little has been undertaken in examining the patterns of information literacy and their predictors among emergency department nurses.

AIM

To clarify the subtypes of information literacy among nurses in the emergency department and explore the factors affecting profile membership.

METHODS

A cross-sectional study was conducted among a convenience sample of 2490 nurses in the emergency department from April to June 2023. The clinical nurses completed the online self-report questionnaires including the general demographic questionnaire, information literacy scale, self-efficacy scale and social support scale. Data analyses involved the latent profile analysis, variance analysis, Chi-square tests and multivariate logistic regression.

RESULTS

Four latent profiles were identified: 'Low information literacy (Class 1)', 'Moderate information knowledge (Class 2)', 'High information knowledge and support (Class 3)' and 'High information literacy (Class 4)', accounting for 20.14%, 42.11%, 23.36% and 14.39%, respectively. Each profile displayed unique characteristics representative of different information literacy patterns. Age, years of work, place of residence, hospital grade, title, professional knowledge, using databases, reading medical literature, participating in information literacy training, self-efficacy, and social support significantly predicted information literacy profile membership.

CONCLUSIONS

Information literacy exhibits different classification features among emergency department nurses, and over half of the nurses surveyed were at the lower or middle level. Identifying sociodemographic and internal-external predictors of profile membership can aid in developing targeted interventions tailored to the needs of emergency department nurses. Nursing managers should actively pay attention to nurses with low information literacy and provide support to improve their information literacy level.

RELEVANCE TO CLINICAL PRACTICE

Insights from the current study of the latent profile analysis are beneficial to hospital managers in understanding the different types of emergency department nurses' information literacy. These insights serve as a reference for managers to enhance nurses' information literacy levels.

Cultural Adaptation and Psychometric Evaluation of the Nursing Decision-Making Instrument Into European Portuguese

Introduction

Nurses are continually faced with multiple demands to make decisions in their clinical practice. The Nursing Decision-Making Instrument (NDMI) assesses nurses' decision-making styles during the several stages of this process.

Objectives

To adapt the NDMI into European Portuguese and evaluate the psychometric properties of the Portuguese version in a population of Portuguese nurses.

Methods

Descriptive study design was used to examine psychometric properties of NDMI. Nonprobability convenience sample of 339 Portuguese direct-care nurses. Data were collected using a questionnaire comprising sociodemographic and professional data and the NDMI-Portuguese version (NDMI-PT). An exploratory factor analysis (EFA; n = 125) and a confirmatory factor analysis (CFA; n = 214) were carried out using IBM SPSS (v. 24) and AMOS (v. 22).

Results

The EFA revealed a structure of four latent factors, which represent the reorganized stages of the decision-making process. The CFA found a good overall fit of the model (χ2/df = 2.13; comparative fit index [CFI] = 0.91; goodness of fit index [GFI] = 0.82; Tucker-Lewis Index [TLI] = 0.90; root mean square error of approximation [RMSEA] = 0.07; maximum-likelihood expected cross-validation index [MECVI] = 3.13). The psychometric analysis of the theoretical structure revealed that the four factors reflect the decision-making stages and have a better overall fit than the empirical structure (χ2/df = 1.82; CFI = 0.94; GFI = 0.86; TLI = 0.93; RMSEA = 0.06; MECVI = 2.55). The analysis of the construct reliability of the NDMI-PT revealed that the overall internal consistency was excellent (α=0.96).

Conclusions

This study revealed that the empirical and theoretical structures were appropriate and valid for the sample under analysis. The NDMI-PT is a reliable and valid tool for assessing nurses' decision-making styles. Studies should be conducted to gain further insight into the robustness of this validated tool.

Could Spatial Awareness Affect Situation Awareness: A Conceptual Examination

PURPOSE

The purpose of this study was to explore the relationship between situation awareness (SA) and the physical environment in patient rooms through building a conceptual model.

BACKGROUND

Nurses work in very complicated and dynamic environments where having high levels of SA could be critical for their performance. Studies have also shown that nurses' awareness of the physical environment and patient room is a part of their awareness of dynamic situations in which nurses' spatial awareness may play a role in SA. Despite literature outlining the importance of SA, there is a lack of studies exploring the relationship between the two.

METHOD

A literature review was conducted for the study from nursing and psychology databases. Thirty-three articles, books, and dissertations from a scoping review were included for in-depth review.

RESULTS

An in-depth review of the harvested literature indicated that there is in fact a relationship between these two phenomena. Founded on Endsley's model of SA, the literature review in this study offers a conceptual model that articulates a plausible causal pathway between the physical environment and SA.

CONCLUSIONS

There are a lot of studies focusing on SA and various aspects of it related to nursing, but almost none mention the physical environment and its impact on SA. The current inquiry suggests that spatial awareness plays a prominent role in SA.

Nurse management of noradrenaline infusions in intensive care units: An observational study

BACKGROUND

Intensive care nurse management of noradrenaline (norepinephrine) infusions is a common and essential clinical competency for patient haemodynamic support. Nurses titrate and wean noradrenaline infusions to a target blood pressure in a dynamic, high-risk, and unpredictable environment. Titration and weaning are complex interventions, and blood pressure goals are often variable.

OBJECTIVES

The aim was to examine how nurses used blood pressure targets when escalating, weaning, and titrating noradrenaline in intensive care patients admitted for haemodynamic management and explore patient blood pressure responses to changes in noradrenaline doses.

METHODS

In this naturalistic observational study, noradrenaline dose changes were classified as escalation, weaning, and titration changes and analysed to explore nursing practice. The study was undertaken in two adult medical/surgical intensive care units in Melbourne, Australia. Participants included intensive care nurses and patients who received noradrenaline infusions for haemodynamic support.

RESULTS

Observations of 14 nurse-patient dyads provided 25 h of blood pressure and noradrenaline dose data. Patient participants received weight-adjusted maximum noradrenaline doses of between 0.06 mcg/kg/min and 0.87 mcg/kg/minute, with those in the escalation group receiving dose increases of up to 5 mcg to achieve blood pressure goals. During weaning, patients maintained or increased their blood pressure as noradrenaline doses were decreased. Nurses consistently maintained blood pressures at higher than target goals, and despite constant fluctuations, they only documented blood pressure readings hourly.

CONCLUSIONS

Intensive care nurses managed noradrenaline to achieve mean arterial pressure targets that were variable and not evidence based. The disconnection between observed blood pressure fluctuations and nurse documentation of patient blood pressures was reflected in titration practices. Discrepancies between documented and actual blood pressures raised issues about data used by nurses and doctors to inform clinical practice on noradrenaline management.

Assessing Knowledge, Usage, and Perceptions of the Frazier Free Water Protocol: A Pilot Study

INTRODUCTION

Dysphagia is very common among hospitalized patients and is associated with increased length of hospital stay, morbidity, and mortality. Diet restrictions for dysphagia cause dehydration and discontent. The Frazier Free Water Protocol (FFWP) was developed to improve hydration and quality of life in dysphagia patients by establishing the safety of allowing sips of water between meals. Despite these potential benefits, we hypothesized that the FFWP is not widely utilized. We sought to determine barriers to utilization by assessing the familiarity, usage, and perceptions of the FFWP among health-care providers at our institution.

METHODS

We distributed an anonymous questionnaire to a convenience sample of nurses in the hospital during daily huddles. The questionnaire was adapted from a validated framework to assess provider acceptability of health-care interventions.

RESULTS

Of the 66 surveys distributed, we had 58 completed (88%). Only 10 nurses (17%) had heard of the "FFWP" by name. For those that were familiar with the indications, benefits, and risks of giving free water to patients with dysphagia (n = 18), less than half (39%) reported doing so. No nurses that had less than 10 y of patient care experience gave water to dysphagia patients, even if they knew the indications, benefits, and risks. Similarly, less than a fifth (19%) of all nurses surveyed were comfortable giving water to dysphagia patients, but comfort increased for some if the protocol was recommended by a speech-language pathologist (33%) or physician (13%). Nursing experience of >10 y or in intensive care settings did not yield significant differences in knowledge, usage, or comfort level than those with less years or nonintensive care experience, respectively.

CONCLUSIONS

Nurses are essential to the implementation of the FFWP, yet many are unfamiliar and uncomfortable with utilizing it. Education about the protocol is necessary to improve patient outcomes and quality of life. We plan to provide targeted education about the FFWP as well as assess other members of the health-care team, in an attempt to increase utilization of the protocol and improve dysphagia management.

Decision-making in nursing research and practice-Application of the Cognitive Continuum Theory: A meta-aggregative systematic review

AIM

To explore how the Cognitive Continuum Theory has been used in qualitative nursing research and to what extent it has been integrated in the research process using the Qualitative Network for Theory Use and Methodology (QUANTUM).

BACKGROUND

Theory, research and nursing are intrinsically linked, as are decision-making and nursing practice. With increasing pressure on nurses to improve patient outcomes, systematic knowledge regarding decision-making is critical and urgent.

DESIGN

A meta-aggregative systematic review.

METHODS

DATABASES: CINAHL, Medline, PsycINFO, Embase and PubMed were searched from inception until May 2022 for peer-reviewed research published in English. Seven studies were included and assessed for methodological quality using the Joanna Briggs Institute checklist for qualitative research. A meta-aggregative synthesis was conducted using Joanna Briggs methodology. The QUANTUM typology was used to evaluate the visibility of the Cognitive Continuum Theory in the research process.

RESULTS

The review identified five synthesised findings, namely: 1. the decision-making capacity of the individual nurse, 2. nurses' level of experience, 3. availability of decision support tools, 4. the availability of resources and 5. access to senior staff and peers. Only two of seven studies rigorously applied the theory. The included studies were mainly descriptive-exploratory in nature.

CONCLUSION

The transferability of the Cognitive Continuum Theory was demonstrated; however, evolution or critique was absent. A gap in the provision of a patient-centric approach to decision-making was identified. Education, support and research is needed to assist decision-making. A new Person-Centred Nursing Model of the Cognitive Continuum Theory has been proposed to guide future research in clinical decision-making.

RELEVANCE TO CLINICAL PRACTICE

Nurses make numerous decisions every day that directly impact patient care, therefore development and testing of new theories, modification and revision of older theories to reflect advances in knowledge and technology in contemporary health care are essential.

Using a handheld UV device for disinfection in the patient care environment: A descriptive qualitative study

Frontline nurses play a critical role in the prevention of healthcare-acquired infections (HAIs) through daily practices of hand hygiene and decontamination of surfaces. Despite these practices, environmental contamination and HAIs persist. Emerging use of UV light at wavelengths safe for human exposure provides additional strategies for disinfecting the patient care environment. The purpose of this qualitative study is to explore frontline nursing feedback regarding a novel handheld UV device prototype. A convenience sample of nurses were invited to participate in facilitated individual or small group discussions led by one member of the research team. Thematic analysis of discussion transcripts was completed by two members of the research team. Sixteen registered nurses participated. Four themes found in the study were time considerations, complexity, safety (patient and nurse), and characteristics of technology to improve patient care. Findings suggest that while nursing staff are willing to use technology, it must be considered valuable to patient care and should not hinder the provision of care. Inclusion of inputs from nursing staff for development of technology identifies potential barriers to acceptance and use in the practice environment.

[Development of Nursing Clinical Judgment Scale]

PURPOSE

This study aimed to develop a nursing clinical judgment scale (NCJS) and verify its validity and reliability in assessing the clinical judgment of nurses.

METHODS

A preliminary instrument of the NCJS comprising 38 items was first developed from attributes and indicators derived from a literature review and an in-depth/focus interview with 12 clinical nurses. The preliminary tool was finalized after 7 experts conducted a content validity test based on a data from a preliminary survey of 30 hospital nurses in Korea. Data were collected from 443 ward, intensive care unit, emergency room nurses who voluntarily participated in the survey through offline and online for the verification of the construct validity and reliability of the scale.

RESULTS

The final scale comprised 23 items scored on a 5-point Likert scale. Six factors- integrated data analysis, evaluation and reflection on interventions, evidence on interventions, collaboration among health professionals, patient-centered nursing, and collaboration among nurse colleagues - accounted for 64.9% of the total variance. Confirmatory factor analysis supported the fit of the measurement model, comprising six factors (root mean square error of approximation = .07, standardized root mean square residual = .04, comparative fit index = .90). Cronbach's α for all the items was .92.

CONCLUSION

The NCJS is a valid and reliable tool that fully reflects the characteristics of clinical practice, and it can be used effectively to evaluate the clinical judgment of Korean nurses. Future research should reflect the variables influencing clinical judgment and develop an action plan to improve it.

'Everything's adaptable': A qualitative study of how nurses make decisions in sustained home-visiting care with mothers and children experiencing adversity

AIMS

To explore nurse decision-making processes in the delivery of sustained home-visiting care for mothers of young children who are experiencing adversity.

DESIGN

Qualitative descriptive research design using focus group interviews.

METHODS

Thirty-two home-visiting nurses participated in four focus group interviews exploring their decision-making in the care they provide to families. The data were analysed using a reflexive thematic analysis approach.

RESULTS

Four steps of a recurring stepwise decision-making process were identified: (1) information gathering; (2) exploring; (3) implementing; (4) checking. The facilitators and barriers to effective decision-making processes were also identified and included elements relating to good relationship skills, a good attitude, high quality training and mentoring and resources.

CONCLUSION

The findings indicate that a recurring stepwise process of decision-making requires both analytical and intuitive approaches. The intuition required by home-visiting nurses is to sense unvoiced client needs and identify the right time and way to intervene. The nurses were engaged in adapting the care in response to the client's unique needs while ensuring the fidelity of the programme scope and standards. We recommend creating an enabling working environment with cross-disciplinary team members and having well-developed structures, particularly the feedback systems such as clinical supervision and case reviews. Enhanced skills to establish trusting relationships with clients can help home-visiting nurses make effective decisions with mothers and families, particularly in the face of significant risk.

IMPACT

This study explored nurse decision-making processes in the context of sustained home-visiting care, which has been largely unexplored in the research literature. Understanding the effective decision-making processes, particularly when nurses customize or individualize the care in response to the client's unique needs, assists with the development of strategies for precision home-visiting care. The identification of facilitators and barriers informs approaches designed to support nurses in effective decision-making.

Complementary and alternative medicine carts in the inpatient rehabilitation unit: Access and nurses' use

PURPOSE

To determine if increased accessibility to complementary and alternative medicine (CAM) increases the usage of CAM interventions.

METHODS

A prospective pre-post study with a "run-in" design in a hospital with two inpatient rehabilitation floors was used. Data were analyzed with SAS v9.4.

RESULTS

CAM use before implementation was 2.8 (1.0); after implementation, 3.1 (0.56).

CONCLUSION

Greater access to CAM materials did not significantly increase their use (P = .233). Aromatherapy was used more after increased availability, but heat and cold application decreased. Nurses valued CAM even though independent practice was not fully supported.