Concepts and factors in naturalistic decision-making

Decision-Making in Nursing Practice
Decision-making in nursing practice is a vital component of patient care. Errors made in the decision-making process contribute to poor patient outcomes. Nurses in acute care employ several processes and factors in making a decision. This paper aims to identify factors and processes that influence a nurse’s decision related to patient care in a medical-surgical environment and determine whether decision-making literature in the medical-surgical environment includes factors similar to concepts and factors in naturalistic decision-making.
The research included a review of nine qualitative studies, three quantitative studies, and five systematic reviews; the number of participants included in the study ranged from twelve to one hundred and fifty and eight countries were involved in the literature review.
Previous experiences in clinical practice influenced most nurses’ decision-making processes. Better decision-making by experienced nurses was based on their intuition, increased confidence, and frequent use of protocol and colleague collaboration. Education improved the awareness of a nurse in the medical-surgical environment, and the decisions made were better informed by scientific facts. A nurse who has spent more time with a patient better understands a patient’s clinical situation, physiologic status and social status; hence, the decisions made are wholesome based on the patient’s responses and involve patient participation. Autonomy in nursing practice and organizational cultures also influences the decision-making process
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The naturalistic decision-making approach in nursing care is made in ill-structured, urgent situations and an uncertain and dynamic environment. It incorporates the practice of nurses in acute care, and the nurses’ experience is a central focus of this approach.
Decision-making is multi-faceted and occurs in a dynamic environment. There are similarities in the decision-making process in a medical-surgical environment and the naturalistic decision-making approach.

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