Abstract
The Clinical Decision-Making (CDM) is essential for the nursing professional practice. However, newly nursing bachelor graduates are not always ready to make clinical decisions. Therefore, the identification of self-confidence and anxiety as emotional barriers during this process will allow teaching/learning strategies to generate educational strategies of teaching-learning that support its development. The objective is to evaluate the levels of self-confidence and anxiety in newly nursing bachelor graduates and compare them to each CDM´s dimension. The method for this study was descriptive, comparative and cross-sectional. The“<i>Nursing Anxiety and Self-Confidence with Clinical Decision Making Scale</i> (NASC-CDM)” was applied. Results: It was found that 69% of the newly nursing bachelor graduates had a high level of self-confidence and 66% a low level of anxiety. Significant statistical differences were found in the levels of self-confidence of the newly nursing bachelor graduates in accordance with their employment situation; the averages in the anxiety level were higher, although there were no significant statistical differences. It can be concluded that the higher level of self-confidence possessed by the newly nursing bachelor graduates, the lower the level of anxiety, with the exception of those who have nursing working experience. It is necessary for nursing educators to emphasize the development of skills for knowing and acting, because students need to incorporate them cognitively and intuitively in the complete clinical scenario, in order to have one or more options of decision. The low self-confidence level and the high anxiety level are emotional barriers that intervene in CDM, because they block or interfere the assertive decision-making process. This explains why deliberative strategies have to be implemented in the curricular level.
Highlights
To carry out the Clinical Decision-Making (CDM) during the professional exercise, nurses in service must be aware of different options for actions once the problems and/or needs have been identified and the cues within each situation have been properly assessed
The tool “Nursing Anxiety and Self-Confidence with Clinical Decision Making Scale (NASC-CDM)” was applied with previous consent from the author [8]. It measures the levels of self-confidence and anxiety during the CDM process through two subscales, which both form a hybrid scale
This study found that newly nursing bachelor graduates who had a high level in the dimension Knowing and acting, had a high level of anxiety; this could reinforce the idea that novice nurses often need to integrate knowledge, technical skills, develop and increase the CDM skills and through this trajectory, generate high levels of anxiety as stated in the research by Flores-Villavicencio and cols. [21]
Summary
To carry out the Clinical Decision-Making (CDM) during the professional exercise, nurses in service must be aware of different options for actions once the problems and/or needs have been identified and the cues within each situation have been properly assessed. Several authors have defined CDM as a dynamic, comprehensive and complex process which depends on the volitional act [1]; CDM requires critical and reflexive thinking skills, clinical reasoning to process data and formulate hypothesis [2, 3], considering the relevant previous knowledge, both theoretical and practical [4] that allows the American Journal of Nursing Science 2019; 8(2): 59-67 selection of a choice between the diverse alternatives of action, in order to make clinical judgments which bring as an outcome the assertive care of the patient and at the same time, the solution to health problems [5,6,7]. White [8] pointed out that CDM is a skill that marks a difference between the nursing professional staff and the technical staff due to academic training, since in the higher level, tools for the construction of clinical thinking are acquired
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