Clinical judgement and decision‐making in nursing – nine modes of practice in a revised cognitive continuum

Abstract

This paper is a report of an evaluation of cognitive continuum theory and identification of revisions required for application to clinical judgement and decision-making in nursing. The importance of nurses' developing and applying sound clinical judgement is reflected in an international classification of nursing practice. Cognitive continuum theory synthesizes rival and complementary approaches to decision theory in an accessible format, which has been applied in medicine, and various nursing scholars have advocated its use to enhance the effectiveness of nurses' clinical judgement and decision-making. Parse's structure and process criteria are applied in critiquing the relevance of cognitive continuum theory to nursing. Cognitive continuum theory illustrates how different judgement tasks are suited to different thought processes and how matching the two can optimize decision-making. However, existing modes of inquiry applied to medicine emphasize experimental research, ignoring many alternative approaches used in nursing. A revised version of the cognitive continuum is developed, incorporating examples of nursing judgements and decisions, a broader evidence base, an ethical dimension, and evaluative competence criteria. The revised cognitive continuum promotes awareness of the nature and the variety of patient-centred judgement tasks and decisions in nursing, how to select the most suitable intervention tactic from available options, and the fallibility of all forms of human judgement from intuitive/experiential to analytic/rational. Hence, it is recommended for use as an educational tool and practice guide to facilitate theory development and the practice of judgement and decision-making in nursing.