A study of the use of past experiences in clinical decision making in emergency situations

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Abstract

Making decisions to call emergency assistance to patients is an important dimension of nursing practice. Most usually these decision making situations are uncertain and it is expected nurses rely on past clinical experiences. This study, approved by the ethics committees of both a university and an area health service, aimed to describe nurses’ reliance on past experiences and identify associated judgement strategies (heuristics). Thirty-two registered nurses with five or more years experience were interviewed. Main findings were: nurses did use their past experiences and these experiences were used in the form of the three ‘classic’ heuristics, representativeness, availability and anchoring and adjustment. It can be concluded past experiences are intrinsic to decision making and this has implications for both the clinical components of nursing educational programs and staffing allocations made by administrators. Some nurses, however, did not include referral to past experiences in their decision-making accounts which may be a limitation of the study design.

Introduction

Nurses consistently recognise patients requiring emergency assistance. To accommodate this need for emergency assistance most hospitals have a specific protocol and emergency team that can be called to patients who most usually have ‘arrested’. About 7 years ago a unique initiative, a medical emergency team (MET), that promotes early intervention to prevent the occurrence of cardiac arrest and its associated morbidity and mortality was introduced in a Sydney hospital (Daffurn et al., 1994). Most usually decisions to call the MET are made by nurses in conditions of uncertainty as according to Carnevali et al. (1984) and Tierney (1987) the unknowns and uncertainties usually outnumber the knowns and certainties in patient assessment situations. In uncertain situations of such complexity nurses have been found to rely heavily on heuristics involving past experiences (Cioffi and Markham, 1997; Cioffi, 1998). No study has explored and described how nurses use past experiences when recognising patients who need emergency assistance. Hence, this study describes nurses’ reliance on past experiences and identifies the heuristics associated with these experiences that are employed in making decisions to call emergency assistance.

Section snippets

Decision making in uncertainty

Often in nursing practice, decision making is a complex process (Ellis, 1997) with some situations being more complex than others as they involve more unknowns and uncertainties (Tierney, 1987; Cioffi and Markham, 1997; Cioffi, 1998). Such complexity is considered to be present in the decision-making situation of calling the MET. In decision-making involving complexity, studies have shown decision-making strategies, heuristics, are used that are dependent on experiences (Cioffi and Markham, 1997

Method

This exploratory descriptive study used interviews to investigate the use of past experiences by nurses in their decisions to call the MET. The study sites were four wards/units in a teaching hospital and three wards in a peripheral hospital within an Area Health Service. The clinical specialities of these wards/units were medical, surgical, renal, gynaecological, coronary care and orthopaedics. These areas all had high numbers of MET calls. Institutional Ethics Committees of the Area Health

Discussion

Nurses were found to use past experiences in making decisions to call emergency assistance, the MET. Past experiences were used to construct the assessments that led to judgements. These subjective assessments were heuristic strategies. Not all nurses reported using past experiences in their accounts of calling the MET. However this may be a limitation of the exploratory descriptive study design using unstructured retrospective interviews. The unstructured interview method of data collection

Acknowledgements

To all the nurses who participated in this study. To Ms. S. Eagar and Mr. C. Thebridge for their advise and assistance with the study. To Mr. M. Masso for proposing that the study be undertaken.

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