Framework: Decision-making theory guided the Nurse Decision Making framework (NNDM). The framework is composed of a clinical decision making model and a second nested model depicting clinical reasoning development of the novice.

Research Question: How do novice nurses develop and refine their ability to make clinical decisions in the acute care environment? How can knowledge of this process be used in the construction of a decision-support system?

Method: The framework is based on an analysis and synthesis of over 100 studies on clinical decision-making. Guided by the framework, the project team is constructing explicit knowledge representations for the computer that fit nurses’ working models.

Results: The paper discusses disciple-specific knowledge including the use of pre-encounter data and working memory in making clinical decisions. The analytical, rule-based thinking of the novice are highlighted. Emphasis is placed on the process by which novices identify patterns and develop a sense of saliency in the clinical environment. The framework highlights key steps in decision making such as identifying risk, generating hypotheses, and determining the importance of a clinical observations.

Implications: The paper will be of interest to informatics nurses, nurse managers, nurse educators, and nurse scientists interested in improving clinical decision-making. Previous attempts to build comprehensive clinical decision support systems have disregarding important theoretical considerations hindering the success of these projects.

Supported by NSF Grant # EIA-0218909

Back to Research Methodology
Back to 15th International Nursing Research Congress
Sigma Theta Tau International
July 22-24, 2004