Clinical Decision-Making Styles of Undergraduate Nursing Students: A Multi-Site Study

Making appropriate clinical decisions regarding the care of patients is one of the crucial aspects of health care delivery. A rather large part of the education received in nursing schools aims at developing analytical and rational thought processes. The analytical thinking process is widely accepted as the most appropriate to follow. However, in many clinical scenarios, intuitive thinking, often used by experts in the field, dominates the rational thinking, and possibly leads to different clinical outcomes. Ultimately, the goal is to help students make the proper clinical decisions in order to secure a safe, efficient, and cost effective care.

The purpose of this study is to explore the different clinical decision making styles in end of life care situations among undergraduate nursing students at various levels of preparation (sophomore, junior, and senior years). This was a multi-site cross sectional survey study that recruited undergraduate nursing students in two universities in the North East region of the United States. Participants completed the Rational and Intuitive Decision Style Scale (DSS), the Tolerance of Ambiguity Scale (TFA), and the risk taking scale. Students completed four clinical vignettes that addressed various end of life care scenarios with the purpose of understanding their support to providing full care versus withdrawing care of patients with poor prognosis.

A total of 595 students participated in this study, of which 469 fully completed the survey study. A Mann-Whitney test was performed to examine the difference in the mean scores of DSS, TFA, and risk scales among students in both universities. There was a significant difference in the mean risk and GPA scores among the students of the two universities (P < 0.001). There were no significant differences in the mean DSS and TFA scores among the students. A Spearman’s Rho correlation was performed to examine the relationship between the study variables. There was a statistically significant positive relationship between risk taking and intuition, with risk takers being more intuitive (r_s = 0.334, p < 0.01). There was weak but statistically significant inverse relationship between risk and GPA scores, indicating that students with higher GPAs tend to be low risk takers (r_s = - 0.157, p < 0.01).

When examining students’ responses to the four different clinical vignettes, there were significant variations in the responses across the enrollment years. In one of the clinical vignettes, sophomore supported a decision to place a feeding tube and tracheostomy much more frequently than junior and senior students (SC Sophomore 49; SC Junior 35; SC Senior 21; p < 0.01). There was no statistically significant correlation between the participants’ traits (DSS, Risk taking, and TFA) and the therapy options at the end of life.

Our study demonstrated that decision making styles differed among nursing students of various clinical experiences. However, choice for aggressive versus withdrawal of care did not correlate with the personality traits examined in this study. The variation in support of end of life therapy options suggests that the clinical experience of nursing students may have a profound effect on the decision making styles in challenging clinical situations with poor prognosis.