The Critical Decision Method in Uncovering the Cognitive Work of Nursing

Tuesday, 31 July 2012: 11:35 AM

Priscilla Gazarian, PhD, RN
School of Nursing, Simmons College, Boston, MA

Learning Objective 1: Describe the critical decision method and its use in current nursing research.

Learning Objective 2: Discuss the findings and application of current nursing research using the Critical Decision Method.


This presentation will provide a description of the Critical Decision Method (CDM), a review of nursing studies using CDM and consider future application of this method in understanding the cognitive work of nursing. Analysis of current research reveals how the CDM uncovers the cognitive strategies and demands of nurses’ in the clinical practice environment.


A search for nursing studies using the CDM was conducted using CINHAL, Medline and Web of Knowledge using the search terms “critical decision method” and nursing. This search produced a data set of 11 articles, representing 8 unique studies.


Five studies investigated the cues and factors which nurses use in clinical situations including assessment of critical illness and necrotizing enterocolitis in neonates, predicting and managing aggression in brain injured patients, identifying and interrupting potential cardiopulmonary arrest and midwives decision to suture following childbirth. Two studies used the critical decision method to describe the complexity of work among nurses in acute care. One study described the stress, coping and decision-making among nurse managers.


Studies examing clinical situations revealed that nurses do not use a single cue in isolation; rather they are attentive to patterns of early, ambiguous and subtle perceptual cues over time and constantly compare current state to previous state. The studies examining the cognitive demands of the clinical practice environment revealed the complexity of the clinical situations, which are influenced by multiple factors including resources, people and organizational culture.

The synthesis of these articles demonstrated CDM to be valuable in eliciting practice knowledge held by experienced nurses. Precise use of CDM and other cognitive task analysis methods allows nursing expertise to be made explicit in order for nurses to practice safely in novel situations.