title: Haemodynamic instability after cardiac surgery: nurses' perceptions of clinical decision-making.
abstract: BACKGROUND
  Cardiac surgical patients are distinguished by their potential for instability in the early postoperative period, highly invasive haemodynamic monitoring technologies and unique clinical presentations as a result of undergoing cardiopulmonary bypass. Little is known about nurses' perceptions of assuming responsibility for such patients. An understanding of nurses' perceptions may identify areas of practice that can be improved and assist in determining the adequacy of current decision supports.
  
  
  OBJECTIVE
  The aim of this study was to describe critical care nurses' perceptions of assuming responsibility for the nursing management of cardiac patients in the initial two-hour postoperative period.
  
  
  METHODS
  An exploratory descriptive study based on naturalistic decision-making.
  
  
  METHODS
  Thirty-eight nurses were interviewed immediately following a two-hour observation of their clinical practice. Content analysis and a systematic thematic analysis process called 'Framework' were used to analyse the interview transcripts.
  
  
  RESULTS
  Nurses described their perceptions of managing patients in terms of how they felt about making decisions for complex cardiac surgical patients and in terms of how clinical processes unique to the admission phase impacted their decision-making. Nurses felt either daunted or stimulated and challenged when making decisions. Nurses identified handover from anaesthetists, settling in procedures and forms of collegial assistance as important processes that impacted their decision-making.
  
  
  CONCLUSIONS
  Nurses' previous experiences with similar patients influenced how they felt about making decisions during the initial two-hour postoperative period, but did not alter their views about processes important for patient safety during this time.
  
  
  CONCLUSIONS
  Feelings expressed by nurses in this study highlight the need for clinical supervision and appropriate allocation of resources during the immediate recovery period after cardiac surgery. Nurses identified ways to improve clinical processes that impacted their decision-making during the immediate recovery of cardiac surgical patients.
authors.affiliation: Alfred/Deakin Nursing Research Centre, Deakin University, Burwood, VIC, Australia. judy.currey@deakin.edu.au
authors.forename: Judy
authors.initials: J
authors.lastname: Currey
authors.forename: Jan
authors.initials: J
authors.lastname: Browne
authors.forename: Mari
authors.initials: M
authors.lastname: Botti
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000451:nursing; D002983:Clinical Competence; D003422:Critical Care / Q000379:methods; D003657:Decision Making; D005239:Fear; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000451:nursing; D024802:Nurse's Role / Q000523:psychology*; D009730:Nursing Assessment; D015404:Nursing Methodology Research; D009736:Nursing Process; D009741:Nursing Staff, Hospital / Q000193:education / Q000523:psychology*; D016528:Postanesthesia Nursing; D011182:Postoperative Care / Q000451:nursing; D017009:Professional Autonomy; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D013997:Time Factors; D014739:Victoria