title: Preferred information sources for clinical decision making: critical care nurses' perceptions of information accessibility and usefulness.
abstract: BACKGROUND
  Variability in clinical practice may result from the use of diverse information sources to guide clinical decisions. In routine clinical practice, nurses privilege information from colleagues over more formal information sources. It is not clear whether similar information-seeking behaviour is exhibited when critical care nurses make decisions about a specific clinical practice, where extensive practice variability exists alongside a developing research base.
  
  
  OBJECTIVE
  This study explored the preferred sources of information intensive care nurses used and their perceptions of the accessibility and usefulness of this information for making decisions in clinically uncertain situations specific to enteral feeding practice.
  
  
  METHODS
  An instrumental case study design, incorporating concurrent verbal protocols, Q methodology and focus groups, was used to determine intensive care nurses' perspectives of information use in the resolution of clinical uncertainty.
  
  
  RESULTS
  A preference for information from colleagues to support clinical decisions was observed. People as information sources were considered most useful and most accessible in the clinical setting. Text and electronic information sources were seen as less accessible, mainly because of the time required to access the information within the documents.
  
  
  CONCLUSIONS
  When faced with clinical uncertainty, obtaining information from colleagues allows information to be quickly accessed and applied within the context of a specific clinical presentation. Seeking information from others also provides opportunities for shared decision-making and potential validation of clinical judgment, although differing views may exacerbate clinical uncertainty.
  
  
  CONCLUSIONS
  The social exchange of clinical information may meet the needs of nurses working in a complex, time-pressured environment but the extent of the evidence base for information passed through verbal communication is unclear. The perceived usefulness and accessibility of information is premised on the ease of use and access and thus the variability in information may be contributing to clinical uncertainty.
authors.affiliation: Sydney Nursing School (MO2), The University of Sydney, Sydney, NSW, Australia. andrea.marshall@sydney.edu.au
authors.forename: Andrea P
authors.initials: AP
authors.lastname: Marshall
authors.forename: Sandra H
authors.initials: SH
authors.lastname: West
authors.forename: Leanne M
authors.initials: LM
authors.lastname: Aitken
mesh_terms: D000328:Adult; D000465:Algorithms; D002755:Choice Behavior; D003422:Critical Care / Q000379:methods / Q000706:statistics & numerical data*; D004750:Enteral Nutrition / Q000379:methods; D055318:Evidence-Based Nursing / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D048108:Nursing Informatics / Q000379:methods / Q000706:statistics & numerical data*; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D055815:Young Adult