Critical thinking and clinical decision making in critical care nursing: a pilot study.
OBJECTIVE
This pilot study examined the relationship of education level, years of critical care nursing experience, and critical thinking (CT) ability (skills and dispositions) to consistency in clinical decision making among critical care nurses. Consistency was defined as the degree to which intuitive and analytical decision processes resulted in similar selection of interventions in tasks of low and high complexity.


METHODS
The study was nonexperimental and correlational.


METHODS
Critical care nurses (n = 54) from adult critical care units in 3 private teaching hospitals. The majority of nurses held a BSN or MSN and had an average of 9 years of direct clinical experience in the care of the critically ill.


RESULTS
Decision-making consistency decreased significantly between low-complexity and high-complexity tasks. Both intuitive and analytical decision processes produced clear intervention selections in the low-complexity task, although the analytical process resulted in a more complete specification of interventions. In the high-complexity task, however, only the intuitive process resulted in a clear, plausible, and safe specification of interventions. Education and experience were not related to CT ability, nor was CT ability related to decision-making consistency. Only greater years of critical care nursing experience increased the likelihood of decision-making consistency.


CONCLUSIONS
Overall, intuitive decision processes resulted in more clinically consistent selection of interventions across tasks. More investigation is needed to examine the influence of decision heuristics, and the conceptualization and measurement of CT abilities among practicing nurses.
Hicks
Frank D
FD
Rush University College of Nursing, Chicago, Illinois, USA.
Merritt
Sharon L
SL
Elstein
Arthur S
AS
D000328:Adult; D002983:Clinical Competence; D003422:Critical Care; D003657:Decision Making; D005260:Female; D016304:Hospitals, Private; D006784:Hospitals, Teaching; D006801:Humans; D019545:Intuition; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009736:Nursing Process; D010865:Pilot Projects; D013041:Specialties, Nursing; D011795:Surveys and Questionnaires; D013647:Task Performance and Analysis; D013850:Thinking; D014481:United States