Effects of reflection on clinical decision-making of intensive care unit nurses

Abstract

Background: Nurses are one of the most influential factors in overcoming the main challenges faced by health systems throughout the world. Every health system should, hence, empower nurses in clinical judgment and decision-making skills. Objective: This study evaluated the effects of implementing Tanner's reflection method on clinical decision making of nurses working in an intensive care unit (ICU). Design: This study used an experimental, pretest, posttest design. Setting The setting was the intensive care unit of Amin Hospital Isfahan, Iran. Participants: The convenience sample included 60 nurses working in the ICU of Amin Hospital (Isfahan, Iran). Methods: This clinical trial was performed on 60 nurses working in the ICU of Amin Hospital (Isfahan, Iran). The nurses were selected by census sampling and randomly allocated to either the case or the control group. Data were collected using a questionnaire containing demographic characteristics and the clinical decision-making scale developed by Laurie and Salantera (NDMI-14). The questionnaire was completed before and one week after the intervention. The data were analyzed using SPSS 21.0. Results: The two groups were not significantly different in terms of the level and mean scores of clinical decision making before the intervention (P = 0.786). Based on the results of independent t-test, the mean score of clinical decision-making one week after the intervention was significantly higher in the case group than in the control group (P = 0.009; t = -2.69). The results of Mann Whitney test showed that one week after the intervention, the nurses' level of clinical decision-making in the case group rose to the next level (P = 0.001). Conclusion: Reflection could improve the clinical decision-making of ICU nurses. It is, thus, recommended to incorporate this method into the nursing curriculum and care practices. Clinical decision-making is a fundamental concept in the field of nursing which affects the course of patient care and recovery The validity of important clinical decisions depends on proper and thoughtful judgment Reflection helps individuals use the critical analysis of their performance and integrate their thoughts and actions when facing different situations The results of this study showed that the implementation of Tanner's reflection could significantly increase the mean score and level of clinical decision-making in ICU nurses