An exploratory study of clinical decision-making in five countries

Purpose: To identify the cognitive processes nurses use in their decision-m aking in long- and short-term care settings in five countries, and the demo graphic variables associated with their decision-making. Method and Samples: The instrument used was a 56-item questionnaire that ha s been shown to be reliable in earlier studies. The sample consisted of fiv e convenience samples of registered nurses working in either geriatric ward s (n = 236) or acute medical-surgical wards (n = 223) in hospitals or nursi ng homes in Canada, Finland, Sweden, Switzerland, and the United States. Findings: Five models of decision-making were identified on the basis of fa ctor analysis. They represent both analytical and intuitive cognitive proce sses. Analytical cognitive processes were emphasized in information collect ion, problem definition, and planning of care, and intuitive cognitive proc esses were emphasized in planning, implementing, and evaluating care. Profe ssional education, practical experience, field of practice, and type of Kno wledge were significantly associated with decision-making models as well as with country of residence of the participants, The highest proportion of a nalytically oriented decisionmakers was found among nurses in long-term car e, the decision-making of nurses in shortterm cave was more intuitively ori ented. Conclusions: The results indicate that decision-making of participants vari ed from country to country and in different nursing situations. Future rese arch should be focused on reasons for these differences, the relationship b etween the task and the nurses' type of knowledge, and how nurses use their knowledge to make decisions in different nursing situations. (C) 2001 SIGM A THETA TAU INTERNATIONAL.