Strategies and criteria for clinical decision making in critical care nurses: a qualitative study.
OBJECTIVE
To explore the reasoning strategies and criteria for clinical decision making used by Iranian critical care nurses.


METHODS
In this qualitative descriptive study, 14 critical care nurses from four educational hospitals affiliated with Tehran University of Medical Sciences (TUMS) participated. Data were collected through semistructured in-depth interviews. Content analysis was used to analyze the data. The interviews were transcribed verbatim and analyzed concurrently with the data collection.


RESULTS
Three main themes emerged concerning the reasoning strategies: intuition, recognizing similar situations, and hypothesis testing. Three other main themes emerged regarding the participants' criteria for clinical decision making: the patients' risk-benefits, organizational necessities, and complementary sources of information.


CONCLUSIONS
The findings of this study provided a deep understanding of the reasoning strategies and criteria used by Iranian critical care nurses regarding their clinical decision making. Participants demonstrated use of a range of reasoning strategies and criteria. The cause for using different decision-making strategies and criteria was not entirely clear and may have been related to different patients' situations, nurses' knowledge and their previous experiences, interdisciplinary professional relationships, and kinds of decisions included determining the patient's problems, selecting appropriate care, and deciding whether or not to perform decisions of care.


CONCLUSIONS
Deeper understanding of how nurses make decisions in the stressful environment of the critical care units provide useful information to facilitate making more efficient decisions as well as promoting the outcomes of independent and collaborative nursing care interventions.
Ramezani-Badr
Farhad
F
Postgraduate Department, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran. Ramezani.badr@gmail.com
Nasrabadi
Alireza Nikbakht
AN
Yekta
Zohre Parsa
ZP
Taleghani
Fariba
F
D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003422:Critical Care / Q000379:methods*; D003657:Decision Making; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D019545:Intuition; D007492:Iran; D008128:Logic; D008297:Male; D024802:Nurse's Role / Q000523:psychology; D015404:Nursing Methodology Research; D009736:Nursing Process / Q000458:organization & administration*; D009741:Nursing Staff, Hospital / Q000193:education / Q000458:organization & administration / Q000523:psychology*; D036301:Qualitative Research; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D014163:Transfer, Psychology