Abstract
BackgroundNurses' practice takes place in a context of ongoing advances in research and technology. The dynamic and uncertain nature of health care environment requires nurses to be competent decision-makers in order to respond to clients' needs. Recently, the public and the government have criticized Iranian nurses because of poor quality of patient care. However nurses' views and experiences on factors that affect their clinical function and clinical decision-making have rarely been studied.MethodsGrounded theory methodology was used to analyze the participants' lived experiences and their viewpoints regarding the factors affecting their clinical function and clinical decision-making. Semi-structured interviews and participant observation methods were used to gather the data. Thirty-eight participants were interviewed and twelve sessions of observation were carried out. Constant comparative analysis method was used to analyze the data.ResultsFive main themes emerged from the data. From the participants' points of view, "feeling competent", "being self-confident", "organizational structure", "nursing education", and "being supported" were considered as important factors in effective clinical decision-making.ConclusionAs participants in this research implied, being competent and self-confident are the most important personal factors influencing nurses clinical decision-making. Also external factors such as organizational structure, access to supportive resources and nursing education have strengthening or inhibiting effects on the nurses' decisions. Individual nurses, professional associations, schools of nursing, nurse educators, organizations that employ nurses and government all have responsibility for developing and finding strategies that facilitate nurses' effective clinical decision-making. They are responsible for identifying barriers and enhancing factors within the organizational structure that facilitate nurses' clinical decision-making.
Highlights
Nurses' practice takes place in a context of ongoing advances in research and technology
Feeling competent The importance of feeling competent in the clinical setting was identified by a majority of the participants while they talked about the most important factors influencing their clinical decision-making
Participants explained that effective clinical decision-making depends on the one's capability to gather, understand, and integrate the data with a focus on the patients' needs and identifying the clinical situation
Summary
Nurses' practice takes place in a context of ongoing advances in research and technology. BMC Nursing 2004, 3 http://www.biomedcentral.com/1472-6955/3/2 responsible to meet the public's increasing need for accessible, affordable, quality health care. They are searching for strategies to more appropriately utilize the workforce and appeal to strategies such as decentralization and privatization [2]. Nurses are the largest group of serving staff in health service organizations [2] Their practice takes place in a context of ongoing advances in research and technology, which in turn changes the complexity of nursing care requirements [3]. They should be able to sift and synthesize information, make decisions and appropriately implement these decisions to solve their clients' problems in the context of a multidisciplinary team
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