A view from the outside: Nurses' clinical decision making in the twenty first century

Abstract

Objective: The purpose of this paper is to highlight some observations of clinical decision making processes made by culturally and linguistically diverse nurses (CALD), in relation to elderly patients in particular. It will explore some of the potentially serious professional and legal implications for nurses when there is an over reliance on experiential knowledge and routine tasks without mindful application of evidence and consideration of the ethico-legal imperatives. Setting: The CALD nurses in the study were enrolled in competency based assessment programs (CBAP) in two universities in Melbourne, Victoria between 2005 and 2006 in preparation for their professional registration in Australia. Participants: Following ethical approval from the relevant universities and participating hospitals, a purposive sample was chosen followed by theoretical sampling. Fourteen CALD nurses and three teachers, who were directly involved in the clinical supervision of the nurses during their placement took part. Primary Argument: Using some in vivo quotes to highlight what appear to be less than optimal decision making process by nurses, it will be argued that sound decision making in clinical practice is ideally based on a combination of factors; amongst them professional judgement and a sound knowledge base, supported by principles of physical/psychological assessment and ethical principlism. Conclusion: The views of nurses who are new to the system can foster reflection on practices that have become routine, potentially lacking in application of scientific knowledge, and therefore a potential threat to patient safety with associated legal implications for the nurse.