Relationship Between Participation in Clinical Decision-making and Organizational Culture Among Nurses in Intensive Care Units of Hospitals Affiliated to Iran University of Medical Sciences

Abstract

Background & Aims The nurse’s ability to make an effective clinical decision affects the quality of care and differentiates professional nurses from non-professional ones. Many individual and organizational factors affect clinical decision-making of nurses. This study aims to examine the relationship between participation in clinical decision-making and organizational culture of nurses in intensive care units (ICUs) of selected hospitals in Tehran, Iran Materials & Methods This is a descriptive-correlational study. Participants were 317 nurses working in the ICUs of hospitals affiliated to Iran University of Medical Sciences, who were selected with proportional stratified sampling and sequential sampling methods. The data collection tools were the clinical decision-making questionnaire of Kyalo (2008) and the organizational culture assessment instrument of Cameron and Quinn (1990). The obtained data was analyzed in SPSS statistical software, version16. Descriptive indices (Mean±SD, frequency, percentage) were used to describe the data, and Pearson’s correlation test, independent t-test, and chi-square test were used to examine the relationships between the study variables. Results Among nurses, 88.5% were female, 86.5% had a bachelor’s level, and 39.6% were working in the ICU general. Their mean age was 34.65 years, and their mean nursing experience and the work experience in the ICU was 10.38 and 7.25 years, respectively. The mean score of clinical decision-making was 70.16±11.65, which was higher than the cutoff point (>54), indicating that the participation of nurses in clinical decision-making was high. The dominant organizational culture in the current situation was the market culture. In the preferred situation, the organizational dominant culture was the clan culture. Organizational culture in the current situation had no significant relationship with clinical decision-making (P=0.13), but this relationship was significant in the preferred situation (P=0.014). Clinical decision-making in nurses with clan culture was significantly higher than in those with market culture (P=0.013). Conclusion The current organizational culture in the selected hospitals is different from their preferred organizational culture. Despite the significance of relationship between ICU nurses’ participation in clinical decision-making and organizational culture in the preferred situation, the relationship is weak. More studies are needed with a larger sample size. Considering that the clan culture is the preferred culture, planning is needed to establish the clan culture in the hospitals to increase the participation of ICU nurses in clinical decision-making.