Nurses' reflections on problems associated with decision‐making in critical care settings

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Abstract
The present study investigated nurses' perceptions of the problems associated with their decision‐making in critical care settings. This paper reports a survey of 230 Australian practicing critical care nurses. In responses to a set of structured questions concerning various difficulties in making decisions, it was found that between 22 and 56% of nurses reported to be experiencing difficulties on a weekly or more frequent basis ‘due to knowledge base’, and ‘personal values conflicts with other staff’, Nearly one‐third (30.3%) of the respondents indicated that they disagreed with other staff who were responsible for making decisions in their units on at least a weekly basis. The nurses were also invited to comment in writing on their concerns in a variety of areas. Major sources of nurse dissatisfaction included: treatment decisions for patients with poor prognoses; disharmony with medical staff concerning decision autonomy issues, especially with junior doctors; time constraints on nursing care; the demands of new intensive care technology upon the nurses' knowledge bases; and the need for in‐service education to address this problem. The paper concludes with arguments for the use of in‐depth interviews to further study these issues.

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