Nursing studies

Learning how to make the right decision fast

We all make judgements and decisions every day about what to wear, eat or do. The decisions affect us and the people close to us, while the judgements and decisions in our professional nursing lives have implications for patients and service users.

We all make judgements and decisions every day about what to wear, eat or do. The decisions affect us and the people close to us, while the judgements and decisions in our professional nursing lives have implications for patients and service users.

 

It is clear that we should be paying more attention to how nurses learn to make judgements and decisions. Stories in the media and the Nursing and Midwifery Council Fitness to Practice hearings show that patients have been harmed as a result of poor nursing judgements and decisions. Evidence suggests that nurses make widely different decisions with the same information and in the same circumstances (see resources).

 

Recently, we have reconsidered how judgement and decision making can be addressed in the undergraduate nursing curriculum. A systematic review of the literature revealed a large body of evidence to support teaching in this field (see resources).

 

At level 1 in the undergraduate curriculum, we aim to raise awareness that uncertainty and error are an inevitable part of nursing practice. It is impossible to master the constantly expanding repertoire of clinical knowledge and skills – knowledge that in itself is limited and incomplete. Effective communication helps us to understand the situation as fully as possible and good quality research evidence informs our clinical practice.

 

At level 2 in the curriculum, we discuss theories of nursing judgement and decision making. Benner’s theory of intuition and experience proposes that expert nurses appear to internalise decision making at an almost subconscious level of cognition so that their practice appears intuitive and fluid. One of the challenges of nursing practice is that some judgements need to be made rapidly while others benefit from more considered thinking. This latter is associated with higher levels of accuracy. So, it is helpful for nurses to consider how they think when making different types of judgements and decisions.

 

At level 3 as nursing students approach registration, we consider the literature about how to develop expertise.

 

Expertise is a function of knowledge and behaviour, and there is evidence to suggest that its development is linked to certain identifiable factors. These include focusing on a well-defined task, receiving detailed immediate feedback on performance and repetition of the task.

 

Opportunities to think about practice can be sought actively in clinical practice and can help us develop expertise in the important tasks of our chosen area of clinical practice.

 

It is important to optimise the quality of nurses’ judgement and decision making. We do not have a perfect approach to teaching judgement and decision making yet, but introducing more research-informed teaching does feel like a step towards improving outcomes for patients.

 

Find out more

 

Judgement among community nurses

 

Educational interventions and clinical decision making

 

 

 

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