Conceptualising a system for quality clinical decision-making in nursing

Abstract

Quality clinical decision-making in nursing is the essence of quality nursing care delivery. The purpose of this article is to conceptualise a system for quality clinical decision-making in nursing. A system for quality clinical decision-making in nursing was conceptualised based on a review of the literature pertaining to clinical decision-making. To that effect, both published and unpublished references were reviewed. The review revealed two predominant theoretical perspectives of the process of clinical decision-making: a positivistic perspective and a postmodernistic perspective. These perspectives are respectively exemplified by an information-processing approach and the intuitive approach to clinical decision-making in nursing. The strengths and weaknesses of both approaches were explored and, as a result, a third theoretical approach emerges: the idea of a dialectic, integrative, interactive approach that culminates in the conceptualisation of a system for quality clinical decision-making in nursing. According to a system for quality clinical decision-making, clinical decision-making is viewed as an open system in which both approaches, described as a "piece-meal" approach (Tabak & Bar-Tal, 1996:1-2) and an intuitive approach (Benner, 1984) can be used in a complementary manner to achieve quality clinical decisions in nursing. As a feedback mechanism to promote or improve the quality of clinical decisions in nursing, standards for quality clinical decision-making are proposed in an exemplary manner. In addition, a system for quality clinical decision-making in nursing capitalises on the heritage of the nursing process. Considering the changes and the complexities associated with clinical decision-making in nursing, the system accommodates recent knowledge development activities in nursing, such as developments in nursing classification systems and the classification of nursing-sensitive patient outcomes.