Volume 16, Issue 2 (May 2022)
Qom Univ Med Sci J 2022, 16(2): 94-105 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Ghanbari-Afra L, Ghanbari-Afra M. Clinical Decision-making and its Related Factors in Iranian Nurses and Nursing Students: A Systematic Review. Qom Univ Med Sci J 2022; 16 (2) :94-105
URL: http://journal.muq.ac.ir/article-1-3347-en.html
URL: http://journal.muq.ac.ir/article-1-3347-en.html
1- Department of Critical Care Nursing, Trauma Nursing Research Center, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran. , ghanbari.afra91@yahoo.com
2- Department Critical Care Nursing, Faculty of Nursing and Midwifery, Shahid Beheshti -Amir al-Momenin Departmant, Qom Universityof Medical Sciences, Qom, Iran.
2- Department Critical Care Nursing, Faculty of Nursing and Midwifery, Shahid Beheshti -Amir al-Momenin Departmant, Qom Universityof Medical Sciences, Qom, Iran.
Full-Text [PDF 5224 kb]
(771 Downloads)
| Abstract (HTML) (1597 Views)
Full-Text: (1113 Views)
Introduction
Knowledge and experience lead to the ability to make clinical decisions. Clinical decision-making is an essential skill for all nurses and includes the evaluation of patient’s status and existing evidence to decide what actions should be done for the patient. Clinical decision-making is developed and strengthened by gaining clinical experiences and depends on the clinical practice of nurses in the future. According to the results of Thompson (2013), about 34% of accidents that occur in patients in UK hospitals are due to poor decision making by nurses, of which 6% caused permanent disability and 8% caused death; half of these death cases were prevented by timely decisions of nurses. Therefore, considering the major role of nurses in providing health care and promoting community health, the World Health Organization has emphasized the decision-making power of nurses in the front line of providing health-related services. Studies conducted in Iran have generally examined clinical decision-making and its related factors using descriptive and interventional approaches. Conducting a review study in this field can help clarify and integrate the results of these studies. Therefore, this study aims to review the existing studies on clinical decision-making and its related factors in Iranian nurses and nursing students.
Methods
This is a systematic review study. In order to find related articles published in Persian and English, a search was conducted in Web of Science, MagIran, IranDoc, IranMedex, Scientific Information Database (SID), Scopus, Cochran, Google Scholar, and PubMed databases using the keywords clinical decision-making, nurse, Iran in combination with the operators of “AND” and “OR” without time limit. The search in databases was searched by two researchers. The last search was conducted in 12/19/2021. Descriptive, analytical and interventional studies on Iranian nurses were assessed for eligibility. The critical appraisal skills programme (CASP) checklist was used to evaluate the quality of articles. Inclusion criteria were: being published in both Persian or English, the objective related to the clinical decision-making of nurses working in Iranian medical centers and its related factors, published in reputable journals, availability of full-texts, and obtaining a moderate or high score after quality assessment. The studies that had low quality and irrelevant objectives, short reports, and letters to the editor were excluded. To extract the data, a data extraction form was used, which included sections such as authors' details, year of publication, study purpose, type of study, sample size, and data collection method, and results. After completing this form, the results were summarized and finally reported. Initial search yielded 27,718 articles. After excluding duplicates, articles without full text, letters to the editor, and short reports, 20 eligible articles were selected for the review.
Results
Out of 20 reviewed studies, 6 were related to nursing students, one was related to both nursing students and nurses, and the rest were related to nurses. In most studies, the clinical decision-making level of nurses was high, while the clinical decision-making level of nursing students was varied. The number of samples in the studies varied from 30 to 400. Among the studies, 7 studies used random sampling method, 6 used census method, 4 used stratified sampling method, 2 used a convenience sampling method, and 1 study used quota sampling method. The most common data collection tools were the Participation in Decision Activities Questionnaire (PDAQ)(n=5) and a researcher-made questionnaire (n=4). In six quasi-experimental studies, the clinical decision-making level of nurses and nursing students were improved after the intervention. In studies on nurses, clinical decision-making showed a significant positive relationship with age, gender, marital status, level of education, work experience in hospital, work experience in the current ward, employment status, type of ward, interest in attending the current ward, position, work shift, managerial position, knowledge, clinical experience, organizational factor, facilities, and the provided education, and hierarchical thinking style, while showed a significant negative relationship with monarchic and conservative thinking styles. In studies on nursing students, clinical decision making was positively correlated with age, gender, grade point average, school year, hospital work experience, experience of performing procedures, and provided education.
Discussion
Based on the findings of this study, the Iranian nurses' clinical decision-making level was at a good level. The increase in demographic factors (age, gender, marital status, level of education), work-related factors (work experience, current work experience in the current ward, employment status, ward type, interest in attending the current ward, clinical experience, position, work shift, managerial position), education-related factors (grade point average, academic year, experience of performing procedures, provided education), facilities, and thinking styles can improve the clinical decision-making level of nurses. Most of the studies on the clinical decision-making of nurses and its related factors are descriptive and analytical. Therefore, qualitative and experimental studies are recommended in the future, and a specific tool for determining Iranian nurses' clinical decision-making level should be designed. It is also recommended to monitor the nurses' clinical decisions to promote clinical decision-makings in hospitals.
Ethical Considerations
Compliance with ethical guidelines
The principle of protecting information and using the results of all studies was considered
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Authors contributions
All authors contributed equally in preparing all parts of the research.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
All the authors declare that there will be no conflict of interest regarding the publication of the article.
Knowledge and experience lead to the ability to make clinical decisions. Clinical decision-making is an essential skill for all nurses and includes the evaluation of patient’s status and existing evidence to decide what actions should be done for the patient. Clinical decision-making is developed and strengthened by gaining clinical experiences and depends on the clinical practice of nurses in the future. According to the results of Thompson (2013), about 34% of accidents that occur in patients in UK hospitals are due to poor decision making by nurses, of which 6% caused permanent disability and 8% caused death; half of these death cases were prevented by timely decisions of nurses. Therefore, considering the major role of nurses in providing health care and promoting community health, the World Health Organization has emphasized the decision-making power of nurses in the front line of providing health-related services. Studies conducted in Iran have generally examined clinical decision-making and its related factors using descriptive and interventional approaches. Conducting a review study in this field can help clarify and integrate the results of these studies. Therefore, this study aims to review the existing studies on clinical decision-making and its related factors in Iranian nurses and nursing students.
Methods
This is a systematic review study. In order to find related articles published in Persian and English, a search was conducted in Web of Science, MagIran, IranDoc, IranMedex, Scientific Information Database (SID), Scopus, Cochran, Google Scholar, and PubMed databases using the keywords clinical decision-making, nurse, Iran in combination with the operators of “AND” and “OR” without time limit. The search in databases was searched by two researchers. The last search was conducted in 12/19/2021. Descriptive, analytical and interventional studies on Iranian nurses were assessed for eligibility. The critical appraisal skills programme (CASP) checklist was used to evaluate the quality of articles. Inclusion criteria were: being published in both Persian or English, the objective related to the clinical decision-making of nurses working in Iranian medical centers and its related factors, published in reputable journals, availability of full-texts, and obtaining a moderate or high score after quality assessment. The studies that had low quality and irrelevant objectives, short reports, and letters to the editor were excluded. To extract the data, a data extraction form was used, which included sections such as authors' details, year of publication, study purpose, type of study, sample size, and data collection method, and results. After completing this form, the results were summarized and finally reported. Initial search yielded 27,718 articles. After excluding duplicates, articles without full text, letters to the editor, and short reports, 20 eligible articles were selected for the review.
Results
Out of 20 reviewed studies, 6 were related to nursing students, one was related to both nursing students and nurses, and the rest were related to nurses. In most studies, the clinical decision-making level of nurses was high, while the clinical decision-making level of nursing students was varied. The number of samples in the studies varied from 30 to 400. Among the studies, 7 studies used random sampling method, 6 used census method, 4 used stratified sampling method, 2 used a convenience sampling method, and 1 study used quota sampling method. The most common data collection tools were the Participation in Decision Activities Questionnaire (PDAQ)(n=5) and a researcher-made questionnaire (n=4). In six quasi-experimental studies, the clinical decision-making level of nurses and nursing students were improved after the intervention. In studies on nurses, clinical decision-making showed a significant positive relationship with age, gender, marital status, level of education, work experience in hospital, work experience in the current ward, employment status, type of ward, interest in attending the current ward, position, work shift, managerial position, knowledge, clinical experience, organizational factor, facilities, and the provided education, and hierarchical thinking style, while showed a significant negative relationship with monarchic and conservative thinking styles. In studies on nursing students, clinical decision making was positively correlated with age, gender, grade point average, school year, hospital work experience, experience of performing procedures, and provided education.
Discussion
Based on the findings of this study, the Iranian nurses' clinical decision-making level was at a good level. The increase in demographic factors (age, gender, marital status, level of education), work-related factors (work experience, current work experience in the current ward, employment status, ward type, interest in attending the current ward, clinical experience, position, work shift, managerial position), education-related factors (grade point average, academic year, experience of performing procedures, provided education), facilities, and thinking styles can improve the clinical decision-making level of nurses. Most of the studies on the clinical decision-making of nurses and its related factors are descriptive and analytical. Therefore, qualitative and experimental studies are recommended in the future, and a specific tool for determining Iranian nurses' clinical decision-making level should be designed. It is also recommended to monitor the nurses' clinical decisions to promote clinical decision-makings in hospitals.
Ethical Considerations
Compliance with ethical guidelines
The principle of protecting information and using the results of all studies was considered
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Authors contributions
All authors contributed equally in preparing all parts of the research.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
All the authors declare that there will be no conflict of interest regarding the publication of the article.
Type of Study: Review Article |
Subject:
پرستاری-جراحی-ویژه-کودکان
Received: 2021/12/20 | Accepted: 2022/03/28 | Published: 2022/03/30
Received: 2021/12/20 | Accepted: 2022/03/28 | Published: 2022/03/30
References
1. Taheri-Ezbarami Z, Mirzaie Takmili M, Kazemnejad-Leili's E. [Knowledge and clinical decision-making of nursing students of Guilan university of medical sciences in use of blood transfusion in pediatric nursing (Persian)]. Sci J Iran Blood Transfus Organ. 2020; 17(3)188-99. [Link]
2. Bjørk IT, Hamilton GA. Clinical decision making of nurses working in hospital settings. Nurs Res Pract. 2011; 2011:524918.[DOI:10.1155/2011/524918] [PMID] [PMCID] [DOI:10.1155/2011/524918]
3. Shahraki Moghaddam E, Manzari Z, Hashmati Nabavi F, Mazlom R. [The effect of Ottawa decision support framework training in an interactive workshop with and without standardized patients on clinical decisionmaking of nurses in an intensive care unit (Persian)]. Nurs Midwifery J. 2016; 14(1):66-77. [Link]
4. Thompson C, Aitken L, Doran D, Dowding D. An agenda for clinical decision making and judgement in nursing research and education. Int J Nurs Stud. 2013; 50(12):1720-6. [DOI:10.1016/j.ijnurstu.2013.05.003] [PMID] [DOI:10.1016/j.ijnurstu.2013.05.003]
5. Mosavinasab M, Shojaei K, Azodi P, Jahanpour F. [Barriers and facilitators of clinical decision making among nurses (Persian)]. Q J Nurs Manag. 2015; 4(3):9-17. [Link]
6. Thompson C, Cullum N, McCaughan D, Sheldon T, Raynor P. Nurses, information use, and clinical decision making-the real world potential for evidence-based decisions in nursing. Evid Based Nurs. 2004; 7(3):68-72. [DOI:10.1136/ebn.7.3.68] [PMID] [DOI:10.1136/ebn.7.3.68]
7. Sharif F, Jahanpour F, Salsali M, Kaveh MH. [Clinical decision making process in last year nursing students: A qualitative study (Persian)]. Iran J Nurs Res. 2010; 5(16):21-31. [Link] [DOI:10.1111/j.1440-172X.2010.01886.x]
8. Rostamniya L, Pariyad E, Asayesh H, Ghanbari V. [Determining the intensity of effective individual factors on clinical decision-making of nurses (Persian)]. Nurs Midwifery J. 2014; 11(12):971-6. [Link]
9. Critical Appraisal Skills Programme. Critical appraisal skills programme: Making sense of evidence. Oxford: Critical Appraisal Skills Programme; 2013. [link]
10. Ricoy-Cano AJ, Obrero-Gaitán E, Caravaca-Sánchez F, Fuente-Robles YM. Factors conditioning sexual behavior in older adults: A systematic review of qualitative studies. J Clin Med. 2020; 9(6):1716. [DOI:10.3390/jcm9061716] [PMID] [PMCID] [DOI:10.3390/jcm9061716]
11. Khalafi A, Parsa A, Adarvishi S, Kaviani K. [Effect of concept-mapping based learning on clinical decision making skills within nursing students in emergency unit of Ahvaz Golestan hospital (Persian)]. Educ Dev Judishapur. 2014; 5(3):247-55. [Link]
12. Nouhi E, Abdollahyar A, Fasihi Harandi T. [Effect of evidence-based nursing education in nurses' clinical decision making (Persian)]. J Educ Ethics Nurs. 2013; 2(4):43-9. [Link]
13. Jodat S, Sharifzadeh G. [The effect of concept map on nurses' critical thinking and clinical decision making in neonatal intensive cares unit (Persian)]. Iran J Med Educ. 2014; 13(11):969-78. [Link]
14. Beighi R, Abedini S. [The effect of decision making skill training on perception of clinical decision making of nursing student (Persian)]. Dev Strateg Med Educ. 2015; 2(1):4-10. [Link]
15. Manzari Z, Shahraki ME, Heshmati NF, Mazlom SR, Khaleghi E. The effects of teaching by using standardized patients on critical care nurses'clinical decision making. Iran J Crit Care Nurs. 2015; 8(2):69-78. [Link]
16. Mirsaeedi G, Lackdizagi S, Ghoojazadeh M. [Demographic factors involved in nurses' clinical decision making (Persian)]. Iran J Nurs. 2011; 24(72):29-36. [Link]
17. Karimi Noghondar M, Rahnama Rahsepar F, Golafrooz M, Mohsenpour M. [Comparison of critical thinking and clinical decision making skills among the last-semester nursing students and practicing nurses in Sabzevar university of medical sciences (Persian)]. Iran J Med Educ. 2013; 12(12):916-24. [Link]
18. Ravanipour M, Ahmadiani A, Yazdanpanah A, Soltanian A. [Assessing the relationship between self-efficacy and clinical decision-making in hospital nurse [Persian]]. Avicenna J Nurs Midwifery Care. 2015; 23(4):77-86. [Link]
19. Sharifiyana M, Zohari S, Dabirian A, Alavi H. [Evaluation of participation in clinical decision making by nurses in selected hospitals of Shahid Beheshti university of medical sciences (Persian)]. Nurs Midwifery J. 2016; 13(11):928-34. [Link]
20. Kouravand Z, Aein F, Ebadi A, Yadegarfar G. [Nurses' perception of clinical decision making in hospitals of Shahrekord university of medical sciences in 2019 (Persian)]. J Clin Nurs Midwifery. 2019; 8(3):446-54. [Link]
21. Ghafourian-Abadi S, Kamrani F. [Critical care nurses' participation in clinical decision making with physicians (Persian)]. Iran J Cardiovasc Nurs. 2016; 5(2):22-9. [Link]
22. Hassanpour E, Naderiravesh N, Safavi Bayat Z, Nasiri M, Niroumand Zandi K. [Correlation between thinking styles with clinical decision making among nurses working in educational hospitals affiliated to Tabriz university of medical sciences(Persian)]. Prev Care Nurs Midwifery J. 2014; 4(1):32-43. [Link]
23. Soheili A, Rasouli D. [Nursing students'decision-making ability in Urmia nursing and midwifery school in 2014 (Persian)]. Nurs Midwifery J. 2015; 13(3):163-9. [Link]
24. Paryad E, Javadi N, Atrkar Roshan Z, Fadakar K, Asiri S. [Relationship between critical thinking and clinical decision making in nursing students. Iran J Nurs (2008-5923) (Persian)]. 2011; 24(73):63-71. [Link]
25. Vaezi A, Dabirian A, Ameri M, Kavosi A. Nurses' viewpoint about collaboration between physicians and nurses in clinical decision-making in the hospitals of Tehran, 2011. J Res Dev Nurs Midwifery. 2013; 10(2):87-93. [Link]
26. Ramezani Badr F, SHaban M. [Evaluation of clinical decision-making skills of final year nursing students of Tehran university of medical sciences in 2009 (Persian)]. J Med Educ Dev. 2010; 2(3):17-25. [Link]
27. Arzani A, Lotfi M, Abedi A. Experiences and clinical decision-making of operating room nurses based on Benner's theory. J Babol Univ Med Sci. 2016; 18(4):35-40. [Link]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
Owned by Qom University of Medical Sciences
Published by Qom University of Medical Sciences Press
eISSN: 2008-1375
pISSN: 1735-7799
Email: journal[at]muq.ac.ir
j.mua.ac[at]gmail.com
