Strategies and criteria for clinical decision making in critical care nurses: a qualitative study.

PURPOSE: To explore the reasoning strategies and criteria for clinical decision making used by Iranian critical care nurses.

DESIGN AND 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.

FINDINGS: 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.

CLINICAL RELEVANCE: 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.