NURSES REFLECTIONS ON PROBLEMS ASSOCIATED WITH DECISION-MAKING IN CRITICAL CARE SETTINGS

The present study investigated nurses' perceptions of the problems ass ociated with their decision-making in critical care settings. This pap er reports a survey of 230 Australian practising critical care nurses. In responses to a set of structured questions concerning various diff iculties in making decisions, it was found that between 22 and 56% of nurses reported to be experiencing difficulties on a weekly or more fr equent basis 'due to knowledge base', 'lack of time to make decisions' , 'lack of time to implement decisions', and 'personal values conflict s with other staff'. Nearly one-third (30.3%) of the respondents indic ated that they disagreed with other staff who were responsible for mak ing decisions in their units on at least a weekly basis. The nurses we re also invited to comment in writing on their concerns in a variety o f areas. Major sources of nurse dissatisfaction included: treatment de cisions for patients with poor prognoses; disharmony with medical staf f concerning decision autonomy issues, especially with junior doctors; time constraints on nursing care; the demands of new intensive care t echnology upon the nurses' knowledge bases; and the need for in-servic e education to address this problem. The paper concludes with argument s for the use of in-depth interviews to further study these issues.