This exploratory study was designed to add to the body of knowledge related to clinical decision-making. It had two purposes. The first was to develop, clarify, and elaborate concepts that describe nurses' clinical decision-making. The second was to observe and describe activities for gathering information used by nurses in the clinical environment. Six experienced nurses were observed while they interacted with patients at the beginning of their shift. Subjects were asked during post-observation interviews to describe what they were thinking about when they asked patients questions. A five-stage model that described the decision-making process evolved from the analysis of data. Experts in decision-making were asked to provide reactions to the findings with respect to its clarity, validity and usefulness.
Results of the study indicated that subjects used three modes--scanning mode, focusing mode, and a context building mode--when gathering information at the beginning of their shift in order to plan patient care. Experienced nurses used three activities for gathering information to make clinical decisions--listening or reading report, reading records, and interacting with patients.
Subjects described using information from report together with their knowledge of patients' conditions to decide what information they needed from other sources to make decisions about patients' needs. Findings suggested that subjects made decisions related to what information to gather, what information to accept as sufficient to form hypotheses or conclusions, what information area to drop, and what action to take. Subjects' verbalized that knowledge of patients' conditions and patients' responses determined if they used a scanning mode or a focusing mode to gather information.
