Challenges in Clinical Decision-Making for Nurses in Neonatal Intensive Care Unit (NICU): A Qualitative Study

Abstract

Objective: Clinical decision-making is one of the most difficult responsibilities of healthcare personnel in the neonatal intensive care unit (NICU). Meanwhile, nurses in NICU are facing countless challenges to take care of these neonates due to complex clinical conditions, prematurity, low birth weight, and physiological instability of the neonates, making clinical decision-making difficult. Thus, it is essential to identify and investigate the challenges in clinical decision-making for nurses in NICU. The aim of the present study was to explore the challenges that nurses face in clinical decision-making in NICU in southern Iran. Methods: The present study is a qualitative study with the content analysis in Iran from February 2023 to January 2024. Twenty-one NICU nurses participated in this study. Data were collected from individual, in-depth, and semistructured interviews. The interview questions, according to the opinion of the research team, were designed around the research question: “What are the challenges in clinical decision-making for nurses in NICU?” In order to analyze the data, the researchers used the conventional content analysis method. Results: The means of the participants’ ages and work experience were 36.52 ± 5.71 and 12.45 ± 5.83 years, respectively. Three main themes with nine subthemes were obtained in this study. The main themes were “inadequate clinical competence” (lack of knowledge about caring for neonates, lack of clinical skill and experience, and shortage of nurse practitioners in NICUs); “poor self-efficacy” (poor self-confidence, inefficient stress management, and lack of motivation); and “resistance to change” (physician-centeredness, lack of organizational support, and ambiguities about legal rights). Conclusion: The findings of the study revealed that lack of knowledge, poor clinical skills, and not having a master’s degree in neonatal intensive care adversely affect nurses’ self-confidence in providing care and making clinical decisions. Also, the common belief that physicians are superior to nurses in the organizational culture and lack of support for nurses undermines nurses’ motivation for enhancing their competence and participating in clinical decision-making. Based on the findings, managers and policy makers, by providing a supportive environment, as well as improving the knowledge and clinical skills of nurses, can encourage them to participate in clinical decision-making.