Qualified nurse during a clinical placement.
Download powerpoint The cognitive continuum. Reproduced with permission from Hamm RM. Clinical intuition and clinical analysis: In Dowie J, Elstein A, editors.
Cambridge University Press, Complexity of the task: An example of a task that is more likely to induce rational processing and draw on knowledge derived from research is the assessment and treatment of chronic venous leg ulcers. Nurses assessing and treating leg ulcers identified the helpful role of the UK Royal College of Nursing Guidelines 21 in collecting the information required for a good assessment and decision, and the design of training, audit, and feedback around the guidelines and decision making in leg ulcer care.
Form of task presentation: The relative balance in the mixture of intuition- and rationality-inducing task elements predicts the end of the continuum to which cognition is drawn. Preference for humans as information sources Both primary and acute care nurses were characterised by reliance on human sources of information as the primary means of informing situations in which they were uncertain.
Notable exceptions were local protocols and guidelines in acute care particularly in areas such as coronary care and sources of drug related information, such as the British National Formulary, drug information sheets, and pharmacists in primary care. Even when textual information was seen as accessible, human sources of information were highly rated in terms of their accessibility.
We also found that simple demographic or biographical variables, such as clinical experience, educational attainment, or role on the primary care team, were weak predictors of perspectives of accessible information sources. The scale of the relative lack of engagement with information sources can be gleaned from our observational data.
During 90 hours of observing district nurses in practice, we found that use of an information source while actually making a decision in the presence of a patient occurred only once, in the form of a telephone call to another clinician.
Rather, nurses chose not to use the systematic search-appraise-implement cycle of evidence-based decision making in real-time for real clinical decisions with rapid implied response times. Nurses described contact with research based information sources in the context of continuing professional development and formal education or training.
Other influences included being involved in the production of local protocols and guidelines and having to make sense of research such as clinical trials, or using research evidence to help resolve conflict between colleagues. Perceptions about the relative accessibility of human sources of information were mirrored when we asked nurses about the usefulness of different sources of information for clinical decision making.
Useful information sources are grounded in clinical reality As with accessibility, we identified several important perspectives on the relative usefulness of different sources of information for clinical decision making.
Each of these perspectives stressed the usefulness of sources that were based on experience rather than research. Colleagues, other members of the primary care team, or senior members of the clinical team were viewed as the most useful and accessible information sources.
In acute care, the most useful source of information across all perspectives was the CNS, who seemed to embody the characteristics of useful information sources: Given these characteristics, it is easy to understand the appeal of CNSs or other experience rich sources as a source of information.
A district nurse described a link nurse colleague a nurse who is responsible for a particular area of knowledge and practice, such as diabetes or wound care, and is often linked to the work of a CNS: They have the information there. Despite this implicit recognition, most models fail to account for the relation between decision characteristics, information use, and information processing.
For example, Lomas 22, 23 has proposed a coordinated model of research implementation, which proposes that one end point of knowledge diffusion is negotiating the application of research findings with patients during the course of clinical practice.
Moreover, we need to recognise that simply mapping the core choice at the heart of a decision such as whether it arises from uncertainty about a diagnosis, treatment, or prognosis is a necessary but insufficient condition for determining whether information is deemed relevant or rejected as irrelevant.
It is important to recognise that the strategies available to clinical decision makers can also alter their relation with information. This structured bundle of facts eg, Doppler reading, size, and history formed the basis of management decisions that that were sometimes informed by appropriate national evidence-based guidelines albeit often internalised.
Similarly, the single area of decision making in which observable text based information use was relatively common was uncertainty about medication use. This simplification induces shifts towards the rational end of the continuum.
From this perspective, it is easy to imagine how thinking about the decisions nurses face in clinical practice might have an impact on their information behaviour. Indeed, some basic elements of the evidence-based nursing process could serve to simplify decisions.
They are also expected to use the best available evidence in their judgments and decisions. The prescriptive model of evidence-based decision making—and the search-appraise-implement process that accompanies it—is an active process.Decision-making is very crucial in nursing practice.
The Nursing and Midwifery Council identifies the professional responsibility in the code of Professional Conduct (NMC, ). Nurses are expected to be responsible for their decision-making and planning appropriate care for their clients (NMC, ). 1 Abstract—Clinical judgment and decision-making is a required component of professional nursing.
Expert nurses are known for their efficient and intuitive decision-making processes, while novice nurses are known for more effortful and deliberate.
Keywords: clinical decision making in nursing, nursing decision Clinical decision making in nursing involves applying critical thinking skills to select the best available evidence based option to control risks and address patients' needs in the provision of high quality care that nurses are accountable for.
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