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.

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.

[Structural Equation Modeling on Clinical Decision Making Ability of Nurses]

PURPOSE

The purpose of this study was to construct and test a hypothetical model of clinical decision-making ability of nurses based on the Decision Making Process model and the Cognitive Continuum theory.

METHODS

The data were collected from nurses working at 11 hospitals in Busan, Daejeon, and South Gyeongsang Province from June 30 to August 1, 2017. Finally, the data from 323 nurses were analyzed.

RESULTS

The goodness-of-fit of the final model was at a good level (χ²/df=2.46, GFI=.87, AGFI=.84, IFI=.90, CFI=.90, SRMR=.07, RMSEA=.07) and 6 out of 10 paths of the model were supported. The clinical decision-making ability was both directly and indirectly affected by task complexity and indirectly affected by experiences, autonomy, and work environment. Specifically, it was strongly directly affected by analytical competency but was insignificantly affected by intuitive competency. These variables accounted for 66.0% of clinical decision-making ability.

CONCLUSION

The nurses' clinical decision-making ability can be improved by improving their analytical competency. Therefore, it is necessary to organize nursing work, create a supportive work environment, and develop and implement various education programs.