Clinical decision-making in the intensive care unit: A concept analysis |
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| Affiliation: | 1. Ph.D. Student, Oakland University School of Nursing, Rochester, MI 48309, USA;2. Clinical Adjunct Faculty, University of Michigan School of Nursing, Ann Arbor, MI 48109, USA;3. Critical Care Medicine Unit Staff Nurse, University of Michigan Health System, Ann Arbor, MI 48109, USA;1. Department of Speech Pathology, Division of Allied Health, Austin Health, Melbourne, Australia;2. Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia;3. Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Australia;4. Institute of Breathing and Sleep, Austin Health, Melbourne, Australia;5. Department of Intensive Care, Austin Health, Melbourne, Australia;6. Department of Critical Care, University of Melbourne, Melbourne, Australia;7. Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia;8. Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia;9. Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Australia;10. Physiotherapy, The University of Melbourne, Melbourne, Australia;11. Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, Tübingen, Germany;12. Redenlab, Melbourne, Australia;1. Department of Emergency Medicine, Niguarda Ca'' Granda, Milan, Italy;2. Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy;3. Department of Anesthesia and Intensive Care Medicine, Niguarda Ca'' Granda, Milan, Italy;1. Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan;2. Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan;3. School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan;4. Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan;5. Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan;1. Department of Anesthesia and Intensive Care Medicine, Nordland Hospital, N-8049, Norway;2. The Faculty of Nursing and Health Sciences, Nord University, Bodø 8026, Norway;3. Nordland Hospital, Bodø 8076, Norway;4. Nordland Heart Center, Bodø, Norway;5. Nord University, Norway;6. Department of Health and Care Sciences, Faculty of Health Sciences, UiT. The Arctic University of Norway, Campus Harstad, Havnegata 5, Harstad 9480, Norway;7. Professional and Research Nurse at National Resource Center for Chronic Neurological Diseases, Knorrebakken Housing Units, Knorrebakken 2, Harstad 9411, Norway;1. Swedish Red Cross University College, SE-141 21 Huddinge, Sweden;2. Karlstad University, Department of Health Science, Faculty of Health, Science, and Technology, Sweden;3. Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden;4. Lulea University of Technology, Department of Health, Education and Technology, Division of Nursing and Medical Technology, SE-97187 Luleå, Sweden |
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| Abstract: | AimTo operationally define clinical decision-making as it relates to intensive care unit nursing.BackgroundClinical decision-making is an intricate cognitive process that is demanding on intensive care nurses due to the severity of their patients’ illnesses, consistent exposure to high-stakes situations, and prevalent patient mortality. When compromised, it can lead to adverse patient events. However, clinical decision-making specific to the intensive care unit is a concept seldom defined in nursing research.DesignConcept analysis.MethodsUsing Walker and Avant’s eight-step method, nursing databases were searched for studies between 1980 and 2022 describing the antecedents, defining attributes, consequences, and empirical referents of clinical decision-making in the intensive setting.FindingsIntensive care unit clinical decision-making is a complex cognitive process in which nurses recognize a clinical problem in their patient and respond promptly by implementing interventions to improve their patient’s rapidly and frequently changing health status to a more favorable condition in an intensive care setting. The defining attributes are: assessment of the patient situation, prompt recognition of cues, efficient comprehension of patient data abnormalities, prior knowledge and experience, prompt response to the clinical problem(s), colleague collaboration, formulation of interventions to treat clinical problem(s), and appraisal of risks/benefits.ConclusionIntensive care unit clinical decision-making is a skill that is different from traditional clinical decision-making in nursing. Prompt action characterizes this concept due to the unstable health status of these patients. More research on this concept is needed to enhance nurse performance and patient outcomes in intensive care.Implications for clinical practiceA definition of this concept opens doors for potential studies on promoting effective decision-making among intensive care nurses. This can improve the safety and outcomes of critically ill patients. Additionally, it generates new questions regarding how nursing schools and hospital orientation programs can promote and develop competent decision-making skills in future intensive care nurses. |
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| Keywords: | Clinical decision-making Cognition Concept analysis Critical care High acuity Intensive care Judgment Nurse Nursing |
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