The development of nurse decision making: A case study of a four year baccalaureate in nursing programme

Abstract

<p>This project, which used a qualitative case-studying design, explored the development of decision making as nurses progressed through a baccalaureate education. More specifically, the study focussed on the types of decisions students made and the factors that influenced their decision making. Students from all four years, enrolled in problem based learning (PBL) and clinical courses were recruited for this study. In addition, Tutors from both the clinical and PBL courses were involved. In total, 76 students and Tutors participated. Data were collected through Key Informants (students, Tutors) and Key Documents (curricular material). Students in the PBL setting were asked to participate in either an individual semi-structured interview or in a focus group conducted by the principal investigator. For both settings, students were asked to complete reflective journals, which served as a stimulus for the interview. Tutors in the PBL setting were asked to participate in an individual and semi-structured interview or a focus group, while Tutors in the clinical setting were asked to articipate in an interview. Data were also collected from curricular materials provided by McMaster University, School of Nursing. Results of this study indicated that students engaged in decision making, and that they made five different types of decisions; assessment, communication, intervention, resource, and action. Results also showed that the types of decisions they made changed over the four years as did their approach to decision making. Students also described a shift in their focus over the four years and this was reflected in the types of decisions they made. Students described the influence of many internal and external factors and the collaborative nature of student decision making. One additional finding was the students' appraisal of the situation within which they made decisions. Students appraised the risk to them physically, scholastically, and professionally.</p>