Journal of.Advanced .K'ursing. 1982. 7, 435-^46 Nursing decision making in critical care areas Andrea Baumann RN BSCN MSCN .Assistant Professor and Frances Bourbonnais RN BScN MN Assistant Professor, School ofNursing, University ofOttawa, 770 King Edward, Ottawa. Ontario, Canada KIN 6 m Acceptedfor publication 13 .April 1982 BAUMANN A. & BOURBONNAIS F.(l9m Journal ofAdvanced Nursing, 7,435-446 Nursing decision making in critical care areas This exploratory study sought to idetitify factors that critical care nurses consider relevant in making rapid patient care decisions; to explore the decision making ofthese nurses in crisis situations; and to identify critical patient care situations where rapid nursing decisions are made. The convenience sample consisted of 50 nurses in critical care settings. A semi-structured interview with a critical care case study was utilized to examine the nurses' decision making. Open ended responses were transformed into fixed categories for tabulation. The findings suggested that: 1 knowledge and experience were the most important factors influencing rapid decision making; 2 although the nurses identified the appropriate decisions in a given crisis situation they had difficulty providing a theoretical rationale for their decisions; 3 the given case study and the 50 crisis situations identified by the subjects indicated that many nursing decisions for critically ill patients were carried out prior to physician assistance. A demographic data questionnaire that examined age, nursing experience, formal education and continuing education ofthe subjects determined that the majority ofthe nurses were under 30 years old, had either less than 1 year of experience or 7-9 years in critical care, were graduates ofa 2-year diploma programme, and took continuing education courses at the community college level. BACKGROUND OF THE STUDY Decision making in business management is well documented in the literature (Simon 1971, Massie Critical care areas often require that nurses make & Douglas 1973, Wren 1977). Nursing authors rapid decisions under crisis situations resulting have recognised that decision making is an import- from a sudden change in patient status. This crisis ant function ofnursing practice (Bailey 1975, Ford situation calls for an immediacy of action (Kelly et al. 1979, Gill 1979). However, there is a paucity 1966), which may or may not produce the resol- of literature about the rapid decision making that ution ofthe crisis. is required in critical care areas. Although the critical care nurse has assumed Nurses are accountable and responsible for their many responsibilities that once were those of the decision making. An analysis of decision making in physician, these added responsibilities only serve to critical care areas is imperative in order to facilitate increase the complexity ofthe decisions the nurse the decision making skills of critical care nurses, must make. It is often imperative that a decision take place within a span ofa few minutes or less. statement ofthe problem There are times when a nurse cannot postpone de- cisions, await consultation with her colleagues, or The authors have observed that decision making is await physician's orders. (Kelly 1966). an important function of nurses in critical care 0309-2402/82/0900-0435 S02.00 © 1982 Blackwell Scictitific Publication 435