Factors affecting clinical decision making by nurses at the Critical Care Unit in Kenyatta National Hospital

Abstract

Introduction: There is an established association between quality of patient outcomes and nurses" decision-making. Decisions made by Critical Care Nurses have a direct and immediate impact upon the well being and indeed, the survival of the patients under their care. A public outcry over deteriorating health care services in KNH acute care areas has been blamed on nurses. However, nurses' views and experiences on factors influencing their clinical functioning and clinical decision making have not been studied in KNH. Objectives: The study was done to investigate the factors that affect clinical decisionmaking among the nurses at the Critical Care Unit in Kenyatta National Hospital. Specifically, it aimed at establishing the socio-demographic factors that influenced clinical decision-making of the nurses and the nature of the influence. Materials and Methods: This was a cross-sectional descriptive study that utilized a correlational methodology to examine the relationship between Critical Care Nurses' decision-making about some technical aspects of care. A clinical decision-making questionnaire (CDMQ) with a scale of 27 items was developed through extensive review of literature and modified previous scales and distributed to a random sample of 80 CCNs. The scale had a 4-point likert (Range 27-108). It was carried out between January and June 2008. Comparisons, correlations and stepwise regressions were used for analysis that employed SPSS version 12.0. Results: The CDMQ scale exhibited appropriate reliability (cronbach's alpha 0.91). Decision-making scores were moderate (Mean: 72.40 ± 12.94). The factor that accounted for the greatest variability to clinical decision-making was other performance improvement courses done (P=0.001) followed by gender (P=0.013) and professional education (P=0.042) in that order. Level of appointment, age and experience were not significantly related to decision-making.

Conclusions: The results revealed moderate decision performance among KNH CCNs. Other performance improvement courses done, besides the basic training was the most significant predictor. The model developed, however, only accounted for (21%): a low variability in decision-making meaning that, other factors may be affecting decisionmaking by nurses. Recommendations: There is need to consider knowledge and skills obtained through acute and critical care specializations or life support courses when positing nursing staff to the critical care areas. More research (using both quantitative and qualitative approaches) need to be done to identify what other aspects of the clinical environment affect decision performance by nurses.