Nurses' reflections on problems associated with decision-making in critical care settings.
The present study investigated nurses' perceptions of the problems associated with their decision-making in critical care settings. This paper reports a survey of 230 Australian practising critical care nurses. In responses to a set of structured questions concerning various difficulties in making decisions, it was found that between 22 and 56% of nurses reported to be experiencing difficulties on a weekly or more frequent basis "due to knowledge base', "lack of time to make decisions', "lack of time to implement decisions', and "personal values conflicts with other staff'. Nearly one-third (30.3%) of the respondents indicated that they disagreed with other staff who were responsible for making decisions in their units on at least a weekly basis. The nurses were also invited to comment in writing on their concerns in a variety of areas. Major sources of nurse dissatisfaction included: treatment decisions for patients with poor prognoses; disharmony with medical staff concerning decision autonomy issues, especially with junior doctors; time constraints on nursing care: the demands of new intensive care technology upon the nurses' knowledge bases; and the need for in-service education to address this problem. The paper concludes with arguments for the use of in-depth interviews to further study these issues.
Bucknall
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School of Behavioural Health Sciences, La Trobe University, Bundoora, Australia.
Thomas
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D000328:Adult; D002983:Clinical Competence; D003422:Critical Care / Q000523:psychology*; D003657:Decision Making; D005260:Female; D006801:Humans; D008875:Middle Aged; D009726:Nurses / Q000523:psychology* / Q000706:statistics & numerical data; D019555:Physician-Nurse Relations; D017009:Professional Autonomy; D011795:Surveys and Questionnaires; D013850:Thinking; D013997:Time Factors; D014739:Victoria