title: Autonomy, evidence and intuition: nurses and decision-making.
abstract: OBJECTIVE
  This paper is a report of a study conducted to examine how nurses represent professional clinical decision-making processes, and to determine what light Jamous and Peloille's 'Indeterminacy/Technicality ratio' concept can shed on these representations.
  
  
  BACKGROUND
  Classic definitions of professional work feature autonomy of decision-making and control over the field of work. Sociologists Jamous and Peloille have described professional work as being high in 'indeterminacy' (the use of tacit judgements) relative to technicality (activity able to be codified). The rise of the evidence-based practice movement has been seen as increasing the realm of technical decision-making in healthcare, and it is relevant to analyse nurses' professional discourse and study how they respond to this increase.
  
  
  METHODS
  Three focus groups with qualified nurses attending post-qualifying courses at a London university were held in 2008. Participants were asked to talk about influences on their decision-making. The discussions were tape-recorded, transcribed and subjected to discourse analysis.
  
  
  RESULTS
  Participants described their decision-making as influenced by both indeterminate and technical features. They acknowledged useful influences from both domains, but pointed to their personal 'experience' as the final arbiter of decision-making. Their accounts of decision-making created a sense of professional autonomy while at the same time protecting it against external critique.
  
  
  CONCLUSIONS
  Pre- and post-registration nurse education could encourage robust discussion of the definition and roles of 'irrational' aspects of decision-making and how these might be understood as components of credible professional practice.
authors.affiliation: School of Health and Social Sciences, Middlesex University, London, UK. m.traynor@mdx.ac.uk
authors.forename: Michael
authors.initials: M
authors.lastname: Traynor
authors.forename: Maggie
authors.initials: M
authors.lastname: Boland
authors.forename: Niels
authors.initials: N
authors.lastname: Buus
mesh_terms: D003657:Decision Making; D017144:Focus Groups; D019983:Guideline Adherence; D006801:Humans; D019545:Intuition; D009726:Nurses / Q000523:psychology*; D017009:Professional Autonomy; D036301:Qualitative Research