ABSTRACT
Background: Nurses' clinical decision-making, i.e., the data collection, analysis, and evaluation process through which they reach clinical judgements and makes clinical decisions, is at the core of nursing practice and essential to provide safe and quality care. Instruments to assess nurses' perceptions of their clinical decision-making abilities or skills have been developed for research and education. Thus, it is essential to determine the most valid and reliable instruments available to reflect nurses' self-reported clinical decision-making accurately. Objective: To evaluate the measurement properties of self-reported clinical decision-making instruments in nursing. Methods: A systematic review based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) was conducted (PROSPERO registration: CRD42022364549). Five bibliographical databases were searched in July 2022 using descriptors and keywords related to nurses, clinical decision-making, and studies on measurement properties. Two independent reviewers conducted reference selection and data extraction. The evaluation of the instruments' measurement properties involved assessing the quality of the studies, the quality of each measurement property (i.e., validity, reliability, responsiveness), and the quality of evidence based on the COSMIN. Results: Nine instruments evaluated in eleven studies with registered nurses or nursing students from various clinical contexts were identified. Five of the nine instruments were originals; four were translations or adaptations. Most focused on analytical and intuitive decision-making, although some were based on clinical judgment and clinical reasoning theories. Structural validity and internal consistency were the most frequently reported measurement properties; other properties, such as measurement error, criterion validity, and responsiveness, were not assessed for any instruments. A gap was also identified in the involvement of nurses or nursing students in the instrument development process and the content validity assessment. Six instruments appear promising based on the COSMIN criteria, but further studies are needed to confirm their validity and reliability. Conclusions: The evidence regarding instruments to assess nurses' self-reported clinical decision-making is still minimal. Although no instruments could be recommended based on the COSMIN criteria, the Nurses Clinical Reasoning Scale had the most robust supporting evidence, followed by the adapted version of the Clinical Decision Making in Nursing Scale. Future efforts should be made to systematically assess content validity through the involvement of the target population and by ensuring that the results of other measurement properties, such as reliability, measurement error, or hypothesis testing, are rigorously assessed and reported. Tweetable abstract: Despite limited evidence, this COSMIN review identified six promising instruments to assess nurses' clinical #decision-making, especially the Nurses Clinical Reasoning Scale and an adaptation of the Clinical Decision Making in Nursing Scale. #nursingresearch #nursingeducation.
ABSTRACT
AIM: To explore the knowledge content and structure of nursing students' decision-making in a high-stake clinical situation of postpartum hemorrhage using the Recognition-Primed Decision Model. BACKGROUND: According to research on clinical judgment, a nurse's expectations for a patient situation are central to the clinical decision-making process. However, little research has addressed the expectation concept and its relationship with the nurse's knowledge. Grounded in the naturalistic decision-making paradigm, the Recognition-Primed Decision Model provides a potential framework to describe the content and structure of nurses' knowledge and expectations as they unfold in high-stake clinical situations, such as postpartum hemorrhage. As it is typically used in studies of expert decision-making, it is crucial to test the adequacy of the Model with a student population and refine the research methods for using this framework. DESIGN: Descriptive design where qualitative data were analyzed using qualitative and quantitative methods. METHODS: A convenience sample of 53 students enrolled in a maternal and child health course in the Fall of 2021 was formed. As part of an online exercise to prepare for a simulation, they read a vignette presenting the story of a woman experiencing postpartum hemorrhage and recorded their answers to questions designed to probe their decision-making. Recordings were transcribed and subjected to content analysis based on the four components of recognition according to the Recognition-Primed Decision Model (i.e., cues, expectations, goals and actions). FINDINGS: All participants recognized the postpartum hemorrhage. Their knowledge was organized into clusters representing the potential causes (i.e., tone, trauma, tissue and thrombin) and consequences (i.e., hemodynamic instability) of postpartum hemorrhage, as well as other potential issues (e.g., pain and comfort, baby and partner, infection). Although students could identify relevant cues and actions, they had difficulties articulating their longer-term goals and expectations for the mother and care outcomes. CONCLUSIONS: This study showed the potential of the Recognition-Primed Decision Model to organize the content and structure of the knowledge that supported nursing students' decision-making in a high-stake situation. The findings suggest that their knowledge disproportionately focuses on the cause-and-effect relations between cues and actions. They invite further consideration of longer-term goals and expectations in nursing education to prepare students to anticipate events and assess patient responses appropriately.
