Decision Making in Nursing Practice: A Concept Analysis

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.

Comparative study between high-fidelity simulation and medium-fidelity simulation in decision-making of nursing students: experimental study

OBJECTIVE

to compare the decision-making of Nursing students, before and after theoretical training on basic life support, using the practice of high-fidelity simulation and medium-fidelity simulation.

METHOD

an experimental study was developed, pre- and post-test type, with quantitative, descriptive and inferential analysis, with theoretical training on basic life support and clinical simulation practices, and with evaluation of knowledge and decision-making of Nursing students, at three different moments - before the simulation scenario (T0), after the simulation scenario (T1) and after clinical teaching (T2).

RESULTS

51 students participated in the research, with an average age of 20.25±3.804, of which 92.2% were female. Statistically significant differences (F=6.47; p=0.039) were evident regarding the definition of the problem and development of objectives in decision-making in the experimental group.

CONCLUSION

Nursing students demonstrate an adequate level of knowledge and a good decision-making process, based on the most current instruments produced by scientific evidence, in clinical simulation scenarios in basic life support, and this innovative methodology should be deepened in the Nursing teaching.

HIGHLIGHTS

(1) Clinical simulation promotes good decision-making of Nursing students.(2) Students demonstrated adequate knowledge about basic life support.(3) Knowledge and practice define the fidelity of clinical simulation.(4) Basic life support can be developed by high-fidelity simulation.

Effectiveness of caring behaviours course on decision-making and caring behaviours in undergraduate nursing students: An experimental study

BACKGROUND

Although caring is a core principle of the nursing profession, students often lack the knowledge, comprehension and ability to integrate care into all aspects of nursing practice. Students may have few opportunities to practise caring behaviours on patients who create the impression of providing care and elicit a feeling of receiving care. Studies of strategies to enhance caring behaviours in nursing education are limited.

AIM

This experimental study aimed to examine the effect of nursing caring behaviours course based on interactive learning strategies on the caring behaviours and decision-making abilities of nursing students.

METHODS

A purposive sample of 50 undergraduate students was recruited from a faculty of nursing. Students in the intervention group (n = 24) received 2 h of training per week for 14 weeks in accordance with caring behaviours course based on interactive learning strategies including discussion, brainstorming, concept mapping, reflection and simulation training. Nursing students in the control group (n = 26) received training according to other elective courses in the curriculum. Data were measured at the baseline time point, 7th week and 14th week with the Caring Behaviours Inventory and Nursing Decision-Making Instrument. Chi-square test, Mann-Whitney U-test, Friedman test and mixed repeated measures ANOVA were used to assess the data.

RESULTS

No significant difference was determined in terms of baseline caring behaviours and decision-making scores between the intervention and control groups (p > 0.05). A significant difference in caring behaviours between the two groups and time effect was not found (p > 0.05). However, there was a significant interaction between time and groups (F = 3.484, p = 0.047). There was a significant increase in the decision-making in intervention groups over time (F = 9.372, p < 0.001) and interaction between time and groups (F = 4.160, p = 0.019).

CONCLUSIONS

A deliberate strategy to raise students' awareness of caring behaviours and incorporate interactive learning methods into education enhances both caring behaviours and clinical decision-making.

Psychometric Evaluation of the Decision Fatigue Scale among Korean Registered Nurses

Nurses make decision for patients and the quality of nurses' decision making can affect patient outcomes. For some reason, nurses are experiencing impaired decision making and it can negatively impact patient care. A valid and reliable instrument to assess decision fatigue may let people know about the concept and guide the development of new policies or interventions for Korean nurses' decision fatigue. This study aimed to evaluate the psychometric properties of the Korean version of the decision fatigue scale. The design was a cross-sectional descriptive study and convenience sampling was used to recruit participants. A total of 247 nurses from across South Korea participated in an online survey. The survey consisted of demographic questionnaires, decision fatigue scale, nursing practice environment scale, and compassion fatigue scale. It was validated through confirmatory factor analysis that the Korean version of the decision fatigue scale was a single factor with the same structure as the original scale. The Korean version of the decision fatigue scale showed significant correlations with compassion fatigue, and the scale showed appropriate internal consistency. This study established well enough the psychometric characteristics of the Korean version of decision fatigue.

Connecting to Theory and Science: Avoiding Rule of Thumb Shortcuts

This article centers on the topic of decision-making and the importance of connections to a theory and science that honors the dignity of persons by focusing on decisions that are person-centered.

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.

Role of emotions in the clinical decision-making process of the hospital nurse: A multicentre qualitative study

While for a long-time emotional reaction and moral distress, have been primarily investigated for the possible outcomes of the nursing decision-making process rather than in terms of their role as antecedents of the final decision taken. The primary study's aim is to explore how inpatient nurses' decision-making takes place in different care settings, with a special focus on the role played by emotions during decision-making. The secondary aim is to explore the subjective experience of hospital nurses in relation to successful and unsuccessful decision-making situations. Multicentre qualitative study, consisting of three phases with different designs: participatory study, grounded theory study, and phenomenological study. Participants will be nurses and may be doctors with various levels of professional experience working in hospital, outpatient, or ward settings. Participants will be recruited through different sampling (purposive and convenience). Data will be collected through focus groups and in-depth interviews with nurses working in different hospital care settings. The researchers expect to find themes that will contribute to a better understanding of the role of emotions in decision-making. The results of this study have the potential of providing important implications to support nurses in the recognition and management of their emotions during the decision-making process.

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.

Factors Influencing Medication Administration Outcomes Among New Graduate Nurses Using Bar Code-Assisted Medication Administration

Paramount to patient safety is the ability for nurses to make clinical decisions free from human error. Yet, the dynamic clinical environment in which nurses work is characterized by uncertainty, urgency, and high consequence, necessitating that nurses make quick and critical decisions. The aim of this study was to examine the influence of human and environmental factors on the decision to administer among new graduate nurses in response to alert generation during bar code-assisted medication administration. The design for this study was a descriptive, longitudinal, observational cohort design using EHR audit log and administrative data. The study was set at a large, urban medical center in the United States and included 132 new graduate nurses who worked on adult, inpatient units. Research variables included human and environmental factors. Data analysis included descriptive and inferential analyses. This study found that participants continued with administration of a medication in 90.75% of alert encounters. When considering the response to an alert, residency cohort, alert category, and previous exposure variables were associated with the decision to proceed with administration. It is important to continue to study factors that influence nurses' decision-making, particularly during the process of medication administration, to improve patient safety and outcomes.

Reducing paediatric unintended extubation: A standardized bundle approach

BACKGROUND

Unintended extubation (UE) is a serious risk associated with endotracheal intubation. In the paediatric population, UE can lead to significant patient harm. On average, each UE increases ICU and hospital length of stay by 5.5 and 6.5 days respectively and costs an additional $36 000. The international benchmark rate of UE for quality analysis cited in the literature is <1 per 100 ventilator days. The United States organization Solutions for Patient Safety (SPS) developed and introduced a bundle to reduce UE with a goal of ≤0.95 per 100 ventilator days.

AIM

The aim of this quality improvement project was to determine the baseline rate of UE in a 20-bed mixed medical/surgical PICU in the Pacific Northwest of the United States, implement the SPS bundle for UE prevention, and assess adherence to the bundle, and subsequent rate of UE.

STUDY DESIGN

The IHI Model for Improvement Plan-Do-Study-Act (PDSA) was used to guide the development, implementation, and assessment of the SPS UE Bundle standardizing the management of endotracheal tubes. Adherence to the bundle was measured through peer-to-peer audits. Rates of adherence and UE were monitored on line charts.

RESULTS

Baseline rate of UE was 1.83 per 100 ventilator days; 23 weeks post implementation of the bundle the rate of UE was reduced to 0.38 UE per 100 ventilator days, F(7, 9) = 4.685, p = 0.027. The mean bundle adherence was 92%.

CONCLUSIONS

This quality improvement initiative confirms that high adherence to the SPS UE Bundle may significantly reduce rates of UE in PICU settings.

RELEVANCE TO CLINICAL PRACTICE

Use of the SPS evidence-based discrete UE bundle and high adherence to the bundle can standardize practise and may reduce unintended extubation in the paediatric population.

Exploring the role of personality, perfectionism, and self-compassion on the relationship between clinical decision-making and nurses' wellbeing

BACKGROUND

Clinical decision-making is a core competency of the nursing role, with nurses having to make decisions surrounding patient care and patient safety daily. With decision-making being linked to psychological outcomes, it is important to consider potential areas that may support or hinder nurses' wellbeing whilst navigating clinical decisions.

AIM

The present study sought to investigate the relationship between clinical decision-making and moral distress, and further explore the role of personality, perfectionism, philotimo (a virtue describing the desire to do right by oneself and others, aligning with one's sense of morality), and self-compassion.

DESIGN

An online cross-sectional survey was conducted using Qualtrics. Associations between clinical decision-making and moral distress, burnout, personality, perfectionism, philotimo, and self-compassion were examined using univariate and multivariate statistics.

METHODS

One hundred and forty-three nurses from the United Kingdom completed an online questionnaire. Eligibility criteria included individuals who had practised in the nursing profession for a minimum of six months. To ensure that all participants were practising across the United Kingdom, the eligibility criteria was made clear in the study advertisement, and the consent form. The consent form required participants to confirm that they reached these criteria to proceed with the study.

RESULTS

Results revealed that clinical decision-making was associated with moral distress experience, and that both openness to experience, and philotimo mediated this relationship, independently. In addition to this, self-compassion was significantly associated with clinical decision-making across senior banded nursing roles, but this was non-significant for junior banded nursing roles.

CONCLUSION

Findings highlight the role of individual differences when looking at the impact of clinical decision-making upon nurses' wellbeing and offers explanation for any variance in moral distress experience across nursing professionals. This research identifies fundamental differences between junior and senior nurses in relation to clinical decision-making and self-compassion that should be considered in future research.

Ambiguities in Preventing Infections in Nursing Homes: Care Workers Experiences and Implications for Future Policies

Preventing infections in nursing homes is highly challenging, given the ambiguous nature of nursing homes as care institutions and places to live. Yet, little is known about how care workers experience preventing infections in this context. Understanding the ambiguities experienced by care workers in nursing homes when enacting infection prevention is crucial to preparing for future health crises. This study investigates and identifies the ambiguities care workers faced and experienced when preventing infections during the COVID-19 pandemic. Interviews and observations were combined to capture narratives and behaviors related to infection prevention and care work. By using thematic analysis, three types of ambiguity were identified: (a) an Ambiguous sense of purpose, (b) Environmental ambiguity, and (c) Information ambiguity. The findings provide a nuanced understanding of the ambiguities care workers face and experience in nursing homes when preventing infections and indicate that such ambiguities impact their behaviors and attitudes. From this study, it is possible to conclude that policymakers must consider nursing homes' ambiguous characteristics in infection prevention programs.

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.

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.

Decision making among residents in training of obstetrics and gynecology: A qualitative exploration in Pakistani context

Medical decision-making is critical and the decisions are made under uncertain, complex, and dynamic conditions. In this regard, practitioners' experiences and perceptions may provide a bottom-up knowledge of the issues, as well as a corresponding support system that assists them in learning to make decisions in critical situations. The current study aimed to examine these experiences in the Pakistani context. We interviewed 14 trainee residents (aged 26 to 34 years) from tertiary care hospitals. Using inductive thematic analysis, we explored a participant-centered perspective on the support system and decision-making process. Findings reveal that the major challenges to decision-making include uncertain and complex situations, hospital-related constraints, and sociocultural context. Both non-critical and critical case management are used in individual and group decision-making processes. The residents use knowledge-based, emotional, and instrumental support to make decisions. The study gave practitioners and academics a transdisciplinary platform to explore the cognitive, social, and behavioral aspects of decision-making in the healthcare industry.

Pain assessment & management decision-making in pediatric critical care

PURPOSE

The aim of this study was to explore how nurses in the Pediatric Intensive Care Unit (PICU) reach their pain management decisions in children who are mechanically ventilated and chemically paralyzed.

DESIGN AND METHODS

A qualitative descriptive design was used following a quantitative phase of a multi-method study. Eighteen PICU nurses participated in semi-structured interviews aiming at understanding how they assess pain and make management decisions. Content analysis was used to guide coding and generate themes.

RESULTS

Three major themes were identified: 1) Assessment or cues that nurses use to trigger a pain assessment; 2) Mental models or patterns that nurses create to interpret cues to guide decision-making; 3) External factors that inhibit or facilitate decision-making. Overall, nurses rely on physiological cues to assess pain. From there, a large amount of variation exists on how nurses interpret those cues to make their pain management decision. External factors such as unit culture, perceived barriers and facilitators, and the nurse's experiences impacted how decisions are made.

CONCLUSIONS

Variation exists in the mental models' nurses create to make their pain management decision in this population. Nurses reported confusion on pain and sedation scale selection and various documentation practices for pain assessment. "Assume pain present" was identified as a concept and documentation practice that may guide decisions; further research is needed.

PRACTICE IMPLICATIONS

Development of clinician decision support tools that not only aid their understanding of reliable pain cues but also help create clear documentation practices may help nurses make pain management decisions.

Ethics positions of nursing students in clinical decision-making

BACKGROUND

Ethics positions, consisting of the two fundamental dimensions of idealism and relativism, influence individuals' decision-making significantly. Particularly in an applied field such as nursing, the ethics positions of nurses can play a significant role in clinical decisions. Therefore, it is important to know the factors affecting the ethics positions of nurses in clinical decision-making.

AIM

The aim of the study is to examine the factors affecting the ethics positions of nursing students in clinical decision-making.

RESEARCH DESIGN

This is a two-phase sequential explanatory mixed methods study designed in accordance with the COREQ criteria. A participant Information Form and the Ethics Position Questionnaire were used to collect quantitative data. Qualitative data were obtained through focus group interviews.

ETHICAL CONSIDERATIONS

This study was conducted after receiving written permission from X University Ethics Board. Additionally, permission was obtained from the participating nursing faculty.

PARTICIPANTS

Among the fourth-year nursing students, 180 students participated in the quantitative phase and 30 students in the qualitative phase of the study.

RESULTS

The quantitative data analysis showed that the idealism sub-dimension mean scores of the participants were higher than the relativism sub-dimension mean scores. The analysis of the qualitative data resulted in four main themes that influence participants' ethics positions in clinical decision-making: (1) attitudes of role models in clinical practice (staff nurses/mentors/lecturers), (2) resources related to clinical practice (labs, hospitals/classrooms), (3) health system (hospital policies/school policies), and (4) personal differences (act with emotion/act with logic).

CONCLUSION

The results showed that the health system, role models in the clinic, personal differences, and skill-related resources affect the ethics positions of nursing students in clinical decision-making. In this regard, awareness can be raised by providing training to nursing students by academic instructors on ethics positions and the factors that are determined to affect ethics positions in clinical decision-making.

Work climate from the perspective of nurses: qualitative research

Introduction

This study aims to determine the nurses' view of the work climate. A positive work climate is one of the keys determining factors in improving nurse outcomes and affects patient satisfaction with care.

Methods

In this qualitative research, a semi-structured interview was used to understand nurses' perceptions of their work environment. The participants' responses were recorded and transcribed. Between November and December 2021, 22 nurses participated in the study. Purposive sampling was used to choose nurses for the research, and interviews were performed with these nurses utilizing a semi-structured interview form. The interviews were analyzed using a theme analysis.

Results

The themes identified in the data centered on four dominant elements that together shaped the prevailing work climate: participation in making decisions, companionship, job satisfaction, and changes they expect.

Conclusion

It is necessary to implement meetings at the level of departments and hospitals, where employees will receive support from the authorities and learn how they can improve the working climate.

Implications for nursing management

Research findings on the working climate can help hospital managers makers design interventions to create a good working environment for nurses.

Development and Contribution of a Serious Game to Improve Nursing Students' Clinical Reasoning in Acute Heart Failure: A Multimethod Study

Clinical reasoning is essential for nurses and nursing students to recognize and intervene when hospitalized patients present acute heart failure. Serious games are digital educational interventions that could foster the development of clinical reasoning through an engaging and intrinsically motivating learning experience. However, elements from a playful approach (eg, rewards, narrative elements) are often absent or poorly integrated in existing serious games, which may limit their contribution to learning. Thus, we developed and studied the contribution of a novel serious game on nursing students' engagement, intrinsic motivation, and clinical reasoning in the context of acute heart failure. We adopted a multimethod design and randomized 28 participants to receive two serious game prototypes in a different sequence, one that fully integrated elements of a playful approach (SIGN@L-A) and one that offered only objectives, feedback, and a functional aesthetic (SIGN@L-B). Through self-reported questionnaires, participants reported higher levels of engagement and intrinsic motivation after using SIGN@L-A. However, negligible differences in clinical reasoning scores were found after using each serious game prototype. During interviews, participants reported on the contribution of design elements to their learning. Quantitative findings should be replicated in larger samples. Qualitative findings may guide the development of future serious games.

Nursing Students' Fear of Negative Evaluation and Perceptions of Clinical Decision-Making

BACKGROUND

Nursing is a profession based on theoretical knowledge and practice, and the clinical decision-making process is important. Many factors affect the fear of negative evaluation, and fear of a negative evaluation is a potential variable that can affect clinical decision-making.

METHOD

This descriptive cross-sectional study included undergraduate nursing students (n = 283).

RESULTS

Nursing students' fear of a negative evaluation and clinical decision-making scale scores were 31.92 ± 08.51 and 149.18 ± 13.67, respectively. No significant relationship was identified between the scores (p > .05).

CONCLUSION

The fear of a negative evaluation was not associated with nursing students' perceptions of clinical decision-making. To reduce nursing students' fear of a negative evaluation and improve their clinical decision-making ability, appropriate training programs should be developed and implemented by nursing educators and administrators. [J Nurs Educ. 2023;62(6):325-331.].

Developing a reflection and analysis tool (We-ReAlyse) for readmissions to the intensive care unit: A quality improvement project

BACKGROUND

Readmissions to the intensive care unit are associated with poorer patient outcomes and health prognoses, alongside increased lengths of stay and mortality risk. To improve quality of care and patients' safety, it is essential to understand influencing factors relevant to specific patient populations and settings. A standardized tool for systematic retrospective analysis of readmissions would help healthcare professionals understand risks and reasons affecting readmissions; however, no such tool exists.

PURPOSE

This study's purpose was to develop a tool (We-ReAlyse) to analyze readmissions to the intensive care unit from general units by reflecting on affected patients' pathways from intensive care discharge to readmission. The results will highlight case-specific causes of readmission and potential areas for departmental- and institutional-level improvements.

METHOD

A root cause analysis approach guided this quality improvement project. The tool's iterative development process included a literature search, a clinical expert panel, and a testing in January and February 2021.

RESULTS

The We-ReAlyse tool guides healthcare professionals to identify areas for quality improvement by reflecting the patient's pathway from the initial intensive care stay to readmission. Ten readmissions were analyzed by using the We-ReAlyse tool, resulting in key insights about possible root causes like the handover process, patient's care needs, the resources on the general unit and the use of different electronic healthcare record systems.

CONCLUSIONS

The We-ReAlyse tool provides a visualization/objectification of issues related to intensive care readmissions, gathering data upon which to base quality improvement interventions. Based on the information on how multi-level risk profiles and knowledge deficits contribute to readmission rates, nurses can target specific quality improvements to reduce those rates.

IMPLICATIONS FOR CLINICAL PRACTICE AND RESEARCH

With the We-ReAlyse tool, we have the opportunity to collect detailed information about ICU readmissions for an in-depth analysis. This will allow health professionals in all involved departments to discuss and either correct or cope with the identified issues. In the long term, this will allow continuous, concerted efforts to reduce and prevent ICU readmissions. To obtain more data for analysis and to further refine and simplify the tool, it may be applied to larger samples of ICU readmissions. Furthermore, to test its generalizability, the tool should be applied to patients from other departments and other hospitals. Adapting it to an electronic version would facilitate the timely and comprehensive collection of necessary information. Finally, the tool's emphasis comprises reflecting on and analyzing ICU readmissions, allowing clinicians to develop interventions targeting the identified problems. Therefore, future research in this area will require the development and evaluation of potential interventions.

Path model on decision-making ability of clinical nurses

AIMS AND OBJECTIVES

To identify and examine the relationship between the factors influencing the decision-making ability of clinical nurses in hospitals, South Korea, and to establish a model, to verify the fit and the effect.

BACKGROUND

Clinical nurses are exposed to environments and situations where they make continuous decisions according to the need of direct treatment and nursing.

DESIGN

This study used a cross-sectional descriptive design, relation prediction modelling and adheres to the STROBE guidelines.

METHODS

The model construction was based on the information processing theory by Hansen and Thomas (Nursing Research, 17, 436, 1968). The model consists of 5 exogenous variables (expertise, critical thinking disposition, knowledge-sharing behaviour, nursing work environment, and decision-making stress) and 3 endogenous variables (analytic-systematic decision-making type, intuitive-interpretive decision-making type and decision-making ability). Participants were 274 clinical nurses, who were working at two hospitals in Seoul, South Korea. The data was analysed using SPSS WIN 18.0 and AMOS 20.0 program. Path analysis to verify the hypothetical model was used, and the fit was evaluated by χ² /df, GFI, AGFI, NFI, CFI and RMSEA. Data were collected from March to May 2017.

RESULTS

The fit index of the modified path model was χ² /df = 2.25, GFI = .972, AGFI = .929, NFI = .967, CFI = .981 and RMSEA = .068. The analytic-systematic decision-making type had the greatest direct effect on the clinical nurses' decision-making ability, which is the final outcome variable, followed by significant direct and indirect effects on critical thinking disposition.

CONCLUSION

This study suggests that the clinical nurses' decision-making ability in hospitals were leadingly influenced by analytic-systematic decision-making type and critical thinking disposition.

RELEVANCE TO CLINICAL PRACTICE

In the nursing practice, nurses need to pay attention the analytic-systematic decision-making type and critical thinking disposition for improving decision-making ability of clinical nurses in hospitals.

Factors influencing decisions about neurogenic bladder and bowel surgeries among veterans and civilians with spinal cord injury

OBJECTIVE

This study investigated factors influencing surgical decision-making (DM) to treat neurogenic bladder and bowel (NBB) dysfunction for veterans and civilians with spinal cord injury (SCI) in the United States (US).

DESIGN

Semi-structured interviews complemented by survey measures.

SETTING

Community-dwelling participants who received treatment at a major Midwestern US medical system, a nearby Veterans Affairs (VA) facility, and other VA sites around the US.

PARTICIPANTS

Eighteen participants with SCI who underwent surgeries; completed semi-structured interviews and survey measures.

INTERVENTIONS

Not applicable.

OUTCOMES MEASURES

Semi-structured interviews were coded to reflect factors, DM enactment, and outcomes, including surgery satisfaction and quality of life (QOL). Quantitative measures included COMRADE, Ways of Coping Questionnaire, Bladder and Bowel Treatment Inventory, PROMIS Global Health and Cognitive Abilities scales, and SCI-QOL Bladder and Bowel short form.

RESULTS

Themes identified about factors influencing DM included: recurrent symptoms and complications; balancing dissatisfaction with NBB management against surgery risks; achieving independence and life style adjustments; participant's driven solutions; support and guidance and trust in doctors; and access and barriers to DM. DM enactment varied across surgeries and individuals, revealing no clear patterns. Most participants were satisfied with the surgery outcomes. Some differences in demographics were observed between veterans and civilians.

CONCLUSIONS

We have attempted to illustrate the process of NBB DM as individuals move from factors to enactment to outcomes. Attending to the complexity of the DM process through careful listening and clear communication will allow clinicians to better assist patients in making surgical decisions about NBB management.

The Relationship Between Job Crafting and Nurses' Happiness in Bisha Region, Kingdom of Saudi Arabia

Background Job crafting is an example of constructive behavior in which workers aggregate resources to meet their needs and succeed at work. Individuals may change job boundaries and social relationships at their convenience to feel closer to what they consider the perfect workplace. Aim To analyze the relationship of job crafting with nurses' happiness. Method A quantitative cross-sectional study was conducted on 441 nurses from Saudi Arabia. Data were collected using an electronic questionnaire (Google Drive). This questionnaire includes demographic factors, a Job Crafting Scale (JCS), and the Oxford Happiness Questionnaire (OHQ). Ethical considerations were strictly followed in the present study. Result The results revealed that most nurses had a high level of job crafting. The overall mean score of JCS was (91.2 ± 11.8). The present results demonstrate that the overall mean happiness score was at a moderate level. The overall mean OHQ score was 3.98 ± 4.25, and there was a significant positive correlation between the OHQ score according to the increasing structural domain (r=0.246), decreasing hindering job demands (r=0.220), increasing social job resources (r=0.176), increasing challenging job demands (r=0.212), and the overall total JCS (r=0.252). This indicates that the increase in job happiness is correlated with the increase in job crafting. Conclusion Job crafting has a positive significant relation with nurses' happiness. It is the responsibility of nurse managers and educators in the healthcare industry to provide a suitable work environment, beginning with including employees in decision-making and duties through leadership empowerment and providing support programs, and activities to increase the job happiness and job crafting experienced by nurses.

The Relationship Between Lifelong Learning Perceptions of Pediatric Nurses and Self-Confidence and Anxiety in Clinical Decision-Making Processes

This study was conducted to evaluate the relationship between lifelong learning perceptions of pediatric nurses and self-confidence and anxiety in clinical decision-making processes. One of the most important ways to adapt to change in the developing and changing health care environment worldwide and in evidence based nursing care is lifelong learning. The most essential characteristics of a lifelong learner are reflection, questioning, enjoying learning, understanding the dynamic nature of knowledge and engaging in learning by actively seeking learning opportunities so that evidence-based nursing care can be achieved. Pediatric nurses were included in this descriptive, correlational and cross-sectional study. The study was based on pediatric nursing in the pediatric clinics of a hospital in the capital of  Turkiye between April and July 2021. It was determined that the mean scores of lifelong learning differed according to gender, education level, length of service in the profession and the unit in which each individual worked, and these differences were statistically significant. Pediatric nurses' lifelong learning level explained the three subdimensions of self-confidence in clinical decision-making. The results of the regression analysis indicate that lifelong learning levels of the pediatric nurses did not significantly predict their scores on the subdimensions of anxiety with clinical decision-making scale. Positive effects on clinical decision-making in the nursing process can be achieved if the tendencies of pediatric nurses toward lifelong learning are sufficient. Assessing nurses' lifelong learning perceptions is an essential step toward implementing evidence-based care for pediatric patients. Clinical decision-making skills can be supported by increasing nurses' lifelong learning awareness.

Investigating the clinical decision-making of nursing students using high-fidelity simulation, observation and think aloud: A mixed methods research study

AIMS

The aim of this study was to investigate nursing students' clinical decision-making by using high-fidelity simulation of a deteriorated patient scenario.

DESIGN

A convergent parallel mixed methods research design was used consisting of quantitative and qualitative data collection.

METHODS

Twenty-three students completed the Health Science Reasoning Test before and after the simulation between October 2015 and June 2016. They were presented with a simulated scenario and asked to 'think aloud' during and after the simulation. The students were audio-video recorded and observations were collected by the researcher.

RESULTS

There was a significant moderate increase in the 'deduction' and 'analysis' sub-scale scores and overall test score, suggestive of improved analytical decision-making processes through the simulation experience. Think-aloud and observation data identified that students predominantly applied 'forward' reasoning during the simulated 'patient's' deterioration, focusing mainly on cue acquisition. 'Backward' reasoning with a focus on cue interpretation was most prominent in the debriefing data, in line with the survey outcomes. Accurate cue interpretation of critical, key cues appeared more useful than the total number of cues in solving the main clinical case problem.

CONCLUSION

Students learn different clinical decision-making skills during the simulation compared to what they learn from debriefing. Using observation and think-aloud methods have significant benefits for researchers seeking to optimize the evaluation of the clinical decision-making process.

Differences in Critical Thinking and Decision Making among Critical Care and Non-Critical Care Nurses

Critical thinking and decision-making are essential for nurses to identify and analyze judgments for nursing care. Hence, this study aims to determine critical thinking and clinical decision-making among critical and non-critical care nurses. A cross-sectional study was conducted among 237 nurses using a self-administered questionnaire. This study discovered that critical and non-critical care nurses had a modest level of critical thinking and clinical decision-making. The findings of this study can serve as a guide for nursing administration employees in implementing effective techniques to enhance the critical thinking skills of nurses in on-the-job training and orientation programs for nursing staff.

Clinical judgement in nursing - An evolutionary concept analysis

AIMS

The aim of this concept analysis was to develop a contemporary operational definition of Clinical Judgement in nursing.

DESIGN

Concept analysis.

METHODS

Rodgers' evolutionary method of concept analysis. Throughout the study, the authors followed the SRQR checklist.

RESULTS

This concept analysis guided the development of an operational definition of clinical judgement, within the context of nursing, articulated as Clinical judgement is a reflective and reasoning process that draws upon all available data, is informed by an extensive knowledge base and results in the formation of a clinical conclusion.

CONCLUSION

The purpose of this concept analysis was to propose a detailed definition of clinical judgement in nursing, that reflected its theoretical base within today's contemporary healthcare system. Using Rodgers' evolutionary method of concept analysis, surrogate terms, attributes, antecedents and consequences were identified, and a contemporary definition was developed. No patient or public contribution was required to design or undertake this research.

A Concept Analysis of Nurses' Clinical Decision Making: Implications for Korea

The study's purpose was to identify the meaning and the attributes of Korean nurses' clinical decision making. A sequential and systematic literature review with reflection according to the conceptual analysis method of Walker and Avant was used in this study. Data sources included the National Assembly Library, the National Digital Science Library, ProQuest, PubMed, MEDLINE, and CINAHL. Finally, twenty-six articles were included in this concept analysis. The concept of Korean nurses' clinical decision making consisted of the following attributes: clinical reasoning, choosing and applying challenging alternatives, and professional assessment and resetting. Antecedents consisted of: recognizing complex and diverse patient situations with high uncertainty, the need to solve problems according to priority, prior experience in clinical decision making, and interrelationships with fellow medical staff. Consequences consisted of: providing high-quality nursing services, improving the patient's safety, and increased satisfaction with clinical decision making. Based on these results, the conceptual attributes of Korean nurses' clinical decision making had slightly different characteristics but were organically interrelated. The results of analyzing the concept of Korean nurses' clinical decision making provide a better understanding of it and contribute to expanding nursing knowledge and developing a valid and reliable measurement.

Relationships between Violence Experience, Resilience, and the Nursing Performance of Emergency Room Nurses in South Korea

In urgent situations where tensions and conflicts are amplified, emergency room nurses are vulnerable to violence and are exposed to dangerous situations because they are confronted by patients or caregivers. This study sought to examine the relationship between violence experience, resilience, and nursing performance among emergency room nurses in South Korea. A cross-sectional descriptive design was used. The study participants included 130 nurses working in the emergency room of a general hospital. Measures included the general characteristics list, the violence experience tool, the resilience tool, and the nursing performance tool. Data were collected from February to March 2021. In this study, among the forms of violence experienced by emergency room nurses, verbal violence was most prevalent. The violence experiences showed significant differences according to age, clinical experience, work experience in the emergency room, position, and job satisfaction. Resilience displayed significant differences according to marital status, clinical experience, position, average monthly salary, and job satisfaction. Nursing performance showed significant differences based on gender, age, marital status, clinical experience, work experience in the emergency room, position, average monthly salary, and job satisfaction. There was a positive correlation between resilience and nursing performance. This study suggests that emergency room nurses in Korea experienced more verbal violence than other types of violence. The violence experiences, resilience, and nursing performance showed significant differences according to the general and job-related characteristics of the study participants. Concrete strategies and interventions to reduce the frequency of experiences of verbal violence among emergency room nurses, increase their resilience, and improve the nursing performance of emergency room nurses are needed.

Nurses' Clinical Decision-Making in a Changed COVID-19 Work Environment: A Focus Group Study

This study aims to explore how a changed COVID-19 work environment influences nurses’ clinical decision-making. Data were collected via three focus groups totaling 14 nurses working in COVID-19 pandemic wards at a Danish university hospital. The factors influencing decision-making are described in three themes; navigating in a COVID-19 dominated context, recognizing the importance of collegial fellowship, and the complexities of feeling competent. A strong joint commitment among the nurses to manage critical situations fostered a culture of knowledge-sharing and drawing on colleagues’ competencies in clinical decision-making. It is important for nurse leaders to consider multiple factors when preparing nurses not only to work in changing work environments, but also when nurses are asked to work in environments and specialties that deviate from their usual routines.

Factores que influyen en el proceso de toma de decisiones de los enfermeros en los hospitales universitarios iberoamericanos

Resumen Objetivo: analizar los factores que influyen en el proceso de toma de decisiones de los enfermeros en hospitales universitarios iberoamericanos. Método: estudio de caso, con enfoque cualitativo, de tipo multicéntrico, realizado con 30 enfermeros iberoamericanos. Los datos fueron recolectados mediante entrevistas semiestructuradas, analizados por categorías temáticas e interpretados según el marco teórico de la obra Diseño de Organizaciones Eficientes. Resultados: se identificó que el proceso de toma de decisiones permea el desarrollo de las competencias de los enfermeros, se ve influenciado por la formación en gestión en salud y las experiencias individuales previas. Surgieron las siguientes categorías: Preparación técnico-científica en la toma de decisiones; Jerarquización del proceso de toma de decisiones; y Ejercicio profesional autónomo. Conclusión: la ausencia/presencia de una jerarquización rígida, así como la preparación técnico-científica y la autonomía son factores que limitan o amplían el abanico de posibilidades en la toma de decisiones de los enfermeros, que se reflejan en la gestión del cuidado. Por lo tanto, hay que incentivar las discusiones sobre este tema, con el fin de promover la autonomía de los enfermeros para la toma de decisiones y favorecer la reducción de la burocracia en los procesos que impiden/dificultan el avance de estos servicios.

Influencing factors in the nurses' decision-making process in Ibero-American university hospitals

OBJECTIVE

to analyze the factors that influence nurses' decision-making process in Ibero-American university hospitals.

METHOD

a case study with a qualitative approach and of the multicenter type, carried out with 30 Ibero-American nurses. The data were collected through semi-structured interviews, analyzed by thematic categories and interpreted according to the theoretical framework of Creating Effective Organizations.

RESULTS

it was identified that the decision-making process permeates the development of nurses' own competencies, suffering influences from health management training and previous individual experiences. The following categories emerged: Technical-scientific preparation in decision-making; Hierarchization of the decision-making process; and Autonomous professional practice.

CONCLUSION

the absence/presence of a rigid hierarchy, as well as technical-scientific preparation and autonomy, are factors that limit or expand the range of possibilities in nurses' decision-making, with consequences in care management. Thus, discussions about this theme should be encouraged, in order to promote nurses' autonomy for decision-making and favor a reduction of bureaucracy in the processes that prevent/hinder advances in these services.

Influencing factors in the nurses’ decision-making process in Ibero-American university hospitals

Abstract Objective: to analyze the factors that influence nurses’ decision-making process in Ibero-American university hospitals. Method: a case study with a qualitative approach and of the multicenter type, carried out with 30 Ibero-American nurses. The data were collected through semi-structured interviews, analyzed by thematic categories and interpreted according to the theoretical framework of Creating Effective Organizations. Results: it was identified that the decision-making process permeates the development of nurses’ own competencies, suffering influences from health management training and previous individual experiences. The following categories emerged: Technical-scientific preparation in decision-making; Hierarchization of the decision-making process; and Autonomous professional practice. Conclusion: the absence/presence of a rigid hierarchy, as well as technical-scientific preparation and autonomy, are factors that limit or expand the range of possibilities in nurses’ decision-making, with consequences in care management. Thus, discussions about this theme should be encouraged, in order to promote nurses’ autonomy for decision-making and favor a reduction of bureaucracy in the processes that prevent/hinder advances in these services.

Being torn by inevitable moral dilemma: experiences of ICU nurses

Background

Ethical decision-making of nurses could affect patients’ recovery and also decrease medical costs. To make ethical decisions, ICU nurses experience complicated ethical conflicts. Considering the multi-dimensional process of ethical decision-making, the present study was conducted to describe the experiences of ICU nurses regarding ethical decision making.

Method

The present research is a qualitative study with conventional content analysis approach that was done in 2020. Fourteen ICU nurses were interviewed using a semi-structured in-depth interview method. The interviews were recorded, transcribed verbatim, and analyzed using Granheim and Landman approach.

Results

Being torn by inevitable moral dilemma was defined as the main category which contained the categories of conflict with professional self, feeling squeezed between self-authority and demands of others, and Surrounded by organizational limitations.

Conclusions

Results of the present study showed that moral dilemma is a situation in which the nurses are forced to choose between two options based on their equipment and facilities. In these situations, the nurses would hesitate between their internal conflicts and confusion between choosing their own benefits and patients’ benefits. To prevent ethical challenges in decision making, it is necessary to educate healthcare team about ethical dilemmas and empower the personnel for encountering ethical challenges.

Do Personal Differences and Organizational Factors Influence Nurses' Decision Making? A Qualitative Study

Decision-making processes (DMPs) can be altered by several factors that might impact patient outcomes. However, nurses’ views and experiences regarding the multitude of personal and organizational factors that may facilitate or inhibit their decision-making abilities have rarely been studied. Purpose: To explore the personal and organizational factors that influence nurse DMPs in clinical settings at Ministry of Health hospitals (MOH). Method: A qualitative research design was conducted. A purposive sample of 52 nurses was recruited from general and critical wards in two major Ministry of Health hospitals in Hail, Saudi Arabia. A total of eight focus groups (semi-structured interviews) were conducted to elicit participant responses. Results: In this study, the personal differences covered nurses’ experience, physical and psychological status, autonomy, communication skills, values, and cultural awareness. Organizational factors included the availability of resources, organizational support, workload, the availability of educational programs, the availability of monitoring programs, and the consistency and unity of policies, rules, and regulation applications. Conclusions: The major contribution of this study is the comprehensive illustration of influential factors at both the personal level and the organizational level that impact DMPs to achieve desired outcomes for patients and health organizations. This study utilizes a framework that could explain the nature of nurse DMPs.

Clinical Decision-Making in Nursing Scale (CDMNS-PT©) in nursing students: translation and validation

OBJECTIVES

to validate, for the Portuguese population, the Clinical Decision-Making Nursing Scale© (CDMNS©).

METHODS

this methodological study involved 496 nursing students who filled in a questionnaire created using sociodemographic and academic data, and the scale to evaluate the making of decisions in nursing.

RESULTS

the confirmatory factorial analysis showed that the adjustment of the factorial structure has good quality, being made up by three factors (X2/gl = 2.056; GFI = 0.927; CFI = 0.917; RMSEA = 0.046; RMR = 0.039; SRMR = 0.050). For the scale to be reliable, it had to include only the reliability of the scale required it to be constituted by 23 items, with correlation values that varied from 0.184 and 0.610, and a global Cronbach's Alpha of 0.851, which showed its good reliability.

CONCLUSIONS

the CDMNS-PT© is valid and reliable, showing a high potential to be used in clinical practice and investigation.

Care management instruments used by nurses in the emergency hospital services

OBJECTIVE

To describe the instruments used by nurses for the management of care in face of the demands of the emergency hospital service.

METHOD

This is a qualitative study, with triangulation of data from interviews, focus groups, and documents, conducted with nurses from an Emergency Hospital Service in a state in southern Brazil. Data were subjected to thematic content analysis.

RESULTS

Seventeen nurses participated in the study. The categories emerging from this study were view of the whole picture, definition of priorities, and physical instruments. These instruments are used by nurses to manage multiple tasks and provide adequate care to patients with different levels of complexity, in the face of an intense and unpredictable work process due to the constant demand for care.

CONCLUSION

The instruments used by nurses in their work process are mainly skills and attitudes developed as a coping strategy at an intense and complex work environment.

Illness scripts in nursing: Directed content analysis

Aims

To explore the possible extension of the illness script theory used in medicine to the nursing context.

Design

A qualitative interview study.

Methods

The study was conducted between September 2019 and March 2020. Expert nurses were asked to think aloud about 20 patient problems in nursing. A directed content analysis approach including quantitative data processing was used to analyse the transcribed data.

Results

Through the analysis of 3912 statements, scripts were identified and a nursing script model is proposed; the medical illness script, including enabling conditions, fault and consequences, is extended with management, boundary, impact, occurrence and explicative statements. Nurses often used explicative statements when pathophysiological causes are absent or unknown. To explore the applicability of Illness script theory we analysed scripts’ richness and maturity with descriptive statistics. Expert nurses, like medical experts, had rich knowledge of consequences, explicative statements and management of familiar patient problems.

Conclusion

The knowledge of expert nurses about patient problems can be described in scripts; the components of medical illness scripts are also relevant in nursing. We propose to extend the original illness script concept with management, explicative statements, boundary, impact and occurrence, to enlarge the applicability of illness scripts in the nursing domain.

Impact

Illness scripts guide clinical reasoning in patient care. Insights into illness scripts of nursing experts is a necessary first step to develop goals or guidelines for student nurses’ development of clinical reasoning. It might lay the groundwork for future educational strategies.

Contextualising clinical reasoning within the clinical swallow evaluation: A scoping review and expert consultation

Background

This study explored the available literature on the phenomenon of clinical reasoning and described its influence on the clinical swallow evaluation. By exploring the relationship between clinical reasoning and the clinical swallow evaluation, it is possible to modernise the approach to dysphagia assessment.

Objectives

This study aimed to contextualise the available literature on clinical reasoning and the CSE to low-middle income contexts through the use of a scoping review and expert consultation.

Method

A scoping review was performed based on the PRISMA-ScR framework. The data was analysed using thematic analysis. Articles were considered if they discussed the clinical swallow evaluation and clinical reasoning, and were published in the last 49 years.

Results

Through rigorous electronic and manual searching, 12 articles were identified. This review made an argument for the value of clinical reasoning within the clinical swallow evaluation. The results of the study revealed three core themes related to the acquisition, variability and positive impact of clinical reasoning in the clinical swallow evaluation.

Conclusion

The results of this review showed that the clinical swallow evaluation is a complex process with significant levels of variability usually linked to the impact of context. This demonstrates that in order to deliver effective and relevant services, despite challenging conditions, healthcare practitioners must depend on clinical reasoning to make appropriate modifications to the assessment process that considers these salient factors.

Clinical reasoning in nursing students: A concept analysis

AIM

The aim of this analysis is to clarify the concept of clinical reasoning in nursing students.

BACKGROUND

Sound clinical reasoning is the most important skill required in professional nursing and understanding of this concept is emphasized as a basis for clinical reasoning development in nursing education curricula.

DESIGN

Rodgers' concept analysis method was used to achieve a clear and understandable definition.

DATA SOURCE

Resources published from 2000 to 2020 were identified via electronic databases.

REVIEW METHODS

A review of the literature was completed, and the data were analyzed to identify the Surrogate and related terms, attributes, antecedents and consequences of the concept.

RESULTS

This concept is a holistic and recursive cognitive process that has a dynamic and flexible nature to perceive the patient's condition, select the best practice to respond to the situation, and learn from the situation. Clinical reasoning in nursing students emerges despite professional standards; discipline-specific knowledge, cognitive perception, critical thinking, learning experiences, and intuitive ability, and the requirements of the professional system affect its establishment in the nursing discipline. Clinical reasoning is the cognitive process underlying clinical judgment, appropriate decision making, improvement of nursing quality, metacognitive awareness, and professional competence in nursing, whose achievement, generally, paves the way for nursing professionalization and development that are important steps toward independence in the nursing profession.

CONCLUSIONS

The present concept analysis clarifies the concept of clinical reasoning as a complex thinking process that should be considered as a fundamental thinking skill in nursing program.

Parental Decision-Making in Pediatric Intensive Care: A Concept Analysis

The development of nursing knowledge requires a close relationship between theory, research, and practice. The purpose of the analysis of the concept of "parental decision-making in pediatric critical care" is to facilitate nurses' therapeutic care of critically ill children and their families. To construct, structure, and give meaning to the concept, we use our experience in the field, critical reading of the literature, and careful analysis of data that have emerged about parental decision-making in pediatric intensive care. Several factors affect parent's ability to act as decision-makers: the psychosocial and physical disorders they develop, the subordination of their parental roles by the health care team, and the child's critical state of health. While different disciplines, including nursing, have well described the decision-making concept, parental decision-making in the context of pediatric intensive care has not been as well delineated. Nursing science recognizes the importance of decision-making and has incorporated the concept as an essential domain of its philosophical and disciplinary interests. Following the method proposed by Walker and Avant, the concept was analyzed, attributes, background, and consequences described. A model case was presented and discussed. An operational definition emerges, providing knowledge for professional nursing practice and will be the basis for an essential theoretical development around this phenomenon. Parents' recognition, the promotion of family-centered care, and shared decisions are ideal for encouraging parental participation.

The validity and reliability of clinical judgement and decision-making skills assessment in nursing: A systematic literature review

OBJECTIVES

To appraise the validity and reliability of approaches to assessing the clinical decision-making skills of nurses, and use findings to inform the assessment of students as they transition to newly qualified nurses.

DESIGN

The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were used to conduct the review.

DATA SOURCES

Medline, CINAHL and the British Nursing Index were searched from inception to November 2019.

REVIEW METHODS

Studies were grouped according to their assessment approach following a competency framework with findings presented as a narrative synthesis.

RESULTS

38 articles were included in the review which assessed clinical decision-making in a variety of settings; clinical practice, simulation, written examinations and self-assessment. Multi-level rubric and checklist approaches demonstrated good validity and reliability in practice and simulation settings, and the former was effective at differentiating between students at different stages of their training. Written, case study examinations were also effective at assessing clinical decision-making, although an optimum structure for their presentation was not possible to discern. Students tended to score themselves more highly than faculty staff when undertaking rubric-based self-assessments.

CONCLUSIONS

Findings suggest that the best approach to assess clinical decision-making for final year students is to use several low-stakes, snap-shot summative assessments in practice environments, which are marked using a multi-level observational rubric. To assure reliability, it is recommended that a small team of expert practice assessors undergo regular training and peer review, have protected time to complete their assessor role and are appropriately supported.

Nurse-Led Mobile Health Clinics: An Opportunity for Student Scholarship and Faculty Practice

BACKGROUND

The benefits of nurse-led mobile clinics to the communities they serve have been adequately documented in the nursing and health literature. Nurse-led clinics are credited with a variety of positive outcomes from improving access to care to helping build healthier communities. However, the impact of nurse-led clinics on nursing education has not been as widely discussed.

METHOD

A nurse-led, mobile health clinic was established to serve individuals and families facing financial crisis and provide a practice site for students and faculty.

RESULTS

Students developed nursing skills, including leadership, cultural awareness, active listening, critical thinking, effective communication, and collaboration. In the first 4 years of operation, 30 students have been assigned to the mobile clinic and approximately 2,250 visitors received free health care.

CONCLUSION

These findings can inform the implementation of nursing curriculum or activities specifically designed for student involvement in nurse-led mobile health clinics and the development and advancement of nursing skills. [J Nurs Educ. 2020;59(10):594-596.].