Clinical decision-making by nursing staff according to their perceptions of patients' abnormalities

Abstract

Objective: This study was designed to clarify characteristics of the events recognized by nursing staff members and of their clinical decision-making according to their perceptions of patients' abnormalities. Methods: Episodes of abnormalities perceived in patients by nursing staff members were extracted through group-system discussion involving 15 such staff members of the surgical ward, and the contents were analyzed. Results: The events perceived by the nursing staff members included abnormal drowsiness, changes in facial expression, slow reactions, hypo-activities, unexpected symptoms, incoherent words, and offensive odors apparently associated with a physical disorder. Thus, the contents were non-verbal signs based on several observations made by the nursing staff while providing nursing care. The findings for clinical decision-making at the time of perception of abnormalities included "sensation that has not previously been experienced", "unusual sensation", and "sensation of inconsistency of information about the patient". It was revealed that both the analytical decision regarding data and experience on "the patient" and the non-analytical decision based on nursing experience of "such a patient" were put to practical use. Conclusion: The nursing staff members perceived patients' abnormalities from subtle non-verbal signs and made clinical decisions by freely using the analysis based intuitively on their logical analyses and experience.