Beslutsfattande i klinisk verksamhet : En studie om sjuksköterskans beslutsfattande i praktiken

Sammanfattning: The overall aim of the project was to investigate how decision-making is expressed by experienced nurses in practice. A research questions were to describe how nurses make decisions of measures in practice and another research question were to explore contextual elements related to decision-making in nursing practice.A problem-solving-model could be used by the nurse to systematize tasks in which she is responsible. Specific competence is required when nurses act from such a model, when it comes to ability to manage information and to make clinical assessments, necessary claims for decision-making on measures.The theoretical starting point draws on naturalistic decision theory, which is based within a phenomenological perspective. One of the assumptions herein is that actions from experienced nurses are based in intuition and not in rationalistic and analytical mental models.Participant observations and interviews with six nurses from three differ-ent domains constituted the data. To call on the experience of the nurses, limited decision-making activities, identified from the field notes, served as a spring-board during the interviews. The data were analysed by an inductive content analysis.The results reveal that nurses uses observation of cues, confirmation of information and acting from strategies, developed from experience, as tools in their decision-making process. Observation of cues emerged as a powerful tool, used by the nurses to as soon as possible get to know the patient. When the nurses used confirmation as a tool, they used it to vali-date their interpretation of noticed cues and to choose appropriate meas-ures. From their experience the nurses had developed strategies which they used to be able to act independently when to choose measures. An-other finding highlighted important environmental elements, such as dis-ruption and procedures the nurse has to do as a part of her professional function, affecting the decision-making process.