Clinical decision -making in baccalaureate nursing students: A qualitative field study

Marian C Slater, University of Pennsylvania

Abstract

An important goal of baccalaureate nursing education is student nurses' development of skilled clinical decision-making. Baccalaureate nursing students' perceptions of learning clinical decision-making, the experience of clinical decision-making and the influencing factors in student nurse clinical decision-making have been investigated using Constructivist Inquiry. Data have been collected using focus group interview and participant observation of 28 senior level students from one School of Nursing. Participant observation of nursing students was conducted in two acute care settings. Data were analyzed using Lincoln and Guba's (1985) modification of the constant comparative technique. A description of student nurse clinical decision-making emerged from the study. The description was reviewed and verified by the student nurse participants. Student nurse clinical decision-making emerged as a challenging and complex phenomenon. Three interrelated processes of student nurse clinical decision-making emerged: a problem-oriented process; a priority-setting process and a validating process. Empirical knowledge, “knowing the patient”, experience, the clinical instructor, classroom instruction, staff relations and the student nurse role emerged as factors which influence student nurses' learning of clinical decision-making. Implications related to current educational practices which emphasize cognitive aspects of clinical decision-making are suggested. Findings of this study suggest that a multifaceted approach for teaching clinical decision-making may be beneficial in promoting student nurse learning and skill development in decision-making. Nursing education may need to include emphases on the cognitive, experiential and interpersonal aspects of clinical decision-making, clinical instruction and experience, classroom instruction, the social context of student nurse clinical decision-making and student nurse role development in clinical decision-making. Findings suggest the importance of a nurturing and active learning environment in facilitating student nurses' learning of clinical decision-making. Results of this study illuminate the phenomenon of student nurse clinical decision-making and the challenge nurse educators face in preparing skilled decision-makers for the 21st century, given the increasing technocratic, complex and changing health care system.

Subject Area

Nursing|Health education|Higher education

Recommended Citation

Slater, Marian C, "Clinical decision -making in baccalaureate nursing students: A qualitative field study" (1999). Dissertations available from ProQuest. AAI9953596.
https://repository.upenn.edu/dissertations/AAI9953596

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