A study of decision making among U.S. psychiatric nurses

Clinical decision making in undergraduate nursing students: A mixed methods multisite study

BACKGROUND

Clinical decision making is an integral part of what nurses do, yet little is known about how students learn how to make clinical decisions or about the nature of the clinical decisions they make-whether intuitive or analytical. This multischool, multistate embedded mixed methods study was conducted to better understand these phenomena within the context of Hammond's Cognitive Continuum Theory. The content for this manuscript was taken from the primary author's dissertation.

METHODS

Students (N = 168) completed the NDMI-Revised 2014; followed by focus groups.

RESULTS

Three quarters of the participants (n = 127) scored in the quasi-rational range of clinical decision making indicating they are flexible making decisions dependent on the situation. Six themes described how students made clinical decisions.

CONCLUSIONS

Participants were flexible decision makers who used the help of others, lessons learned, the wisdom of nurses, experience, the situation at hand, and systematic cognitive processing to make clinical decisions.

Psychiatric patients: how can we decide if you are in pain?

How do psychiatric nurses make decisions about pain management for hospitalized psychiatric patients? This is the question addressed by this research. Using an exploratory, naturalistic interview approach, 20 nurses and managers in varied settings described their decision making when providing pain relief. Analysis of these narratives indicates that decision making about pain, in this unique context, is influenced by a number of intrapersonal and interpersonal factors such as the patients' needs, history, and diagnosis; nurses' beliefs about pain tolerance and drug addiction; collegial pressure; and unit safety. For example, diagnosis and patient history impact pain relief negatively, while the responsibility to maintain a safe environment imposes pressure to administer medication. Although, in a psychiatric unit, the nurse-patient relationship is essential to the healing process, nurses often face a dilemma as to whether the pain medication will contribute to healing or exacerbate the patient's issues. In psychiatric wards, the means of recovery are far less clear, tangible, and immediate than in other clinical settings. Recommendations are made for better preparing and supporting nurses to work effectively in these practice settings where pain relief is confounded by addiction and psychiatric diagnoses.

Nurses' perceptions of mental health assessment in an acute inpatient setting in New Zealand: a qualitative study

This qualitative study explores the perceptions of mental health nurses regarding assessment in an acute adult inpatient setting in Central Auckland. Fourteen mental health nurses took part in semistructured interviews answering five open-ended questions. The analysis of data involved a general inductive approach, with key themes drawn out and grouped into four categories (roles, attitudes, skills and knowledge) in order to explore the meaning of information gathered. The outcome of the study acknowledged the importance of contextual factors such as the physical environment and bureaucratic systems, as well as values and beliefs present within the unit. The participants expressed concern that their input to assessment processes was limited, despite belief that 24-hour care and the nature of mental health nursing generally suggested that a crucial role should exist for nurses. In order for nurses to be established as central in the assessment process on the unit the study concludes that a nursing theoretical framework appropriate for this acute inpatient setting needs to be developed.