Assessment of Clinical Decision Making Among Nurses Working in Hospitals of Addis Ababa, Ethiopia, 2017
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Date
2017-06
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Addis Ababa University
Abstract
Background: - Decision making at clinical level is the way in which nurses perceived to arrive
at appropriate decisions in practical nursing situations. And these decisions have a direct impact
on the health status of the patients, poor clinical reasoning skill leads to increasing numbers of
adverse patient outcomes. Nurses are required to make decisions with multiple foci for example,
diagnosis, intervention, interaction and evaluation in dynamic contexts, using a diverse
knowledge base decisional pattern. However, inability to recognize clinical situation is the major
cause of errors in decisions.
Objectives: - To assess nurse’s clinical decision making approach in hospital settings, Addis
Ababa, Ethiopia, 2017.
Methods: - Institution based cross-sectional descriptive study was conducted on 390 nurses. To
determine the sample size a single proportional formula was used. Self-administered English
version questionnaire (theoretical framework developing instrument by Lauri and Sanna
Salanterä, included Hammond’s CCT) was used. The instrument used to investigate nurses’
clinical decision making patterns at clinical practice level. To explain study population in relation
to relevant variables, descriptive statistics like: frequencies and percentages were calculated. Multi
nominal logistic regression was used to show the association between CDM and associated factors
among nurses. Permission was obtained from IRB. Information obtained from participants was kept
secured and confidential.
Result: Clinical decision making score in this study ranges from 46 to 82 (mean = 65.5, SD =
4.5). Two hundred sixty two (67.2%) of the participant scored in analytical decision making
category. One hundred twenty five of respondents (32.1%) scored in the category of quasi
decision making which is a combination of both analytic and intuitive decision making process.
Out of the total 390 respondents only three (0.8%) of them categorized as using intuitive decision
making method when dealing with patient. Organizational type/private sectors (p=0.021),
clinical simulation (P=0.031) and ICU department (P=0.025) were factors associated with
clinical decision making
Conclusion and recommendation: This study found that there was clinical nurses inclination to
the use of analytical decision making to the most part, So, health delivery organizations to
encourage nurses in particular clinical situation enable them to make decision that is timely and
accurate as possible and also the use of quasi rational decision making method in there day today
nursing practice with only a very few of them making intuitive decision making method.
Organizational type (private sector), clinical simulation and ICU department were factors
associated with CDM.
Keys Words: - Clinical decision making, Nurses, Intuition, and Analytical, Quasi-rational.
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Keywords
Clinical decision making, Nurses, Intuition and Analytical, Quasi-rational