Clinical decision-making in the intensive care unit: A concept analysis

The intensive care unit (ICU) can be a place of considerable stress for frontline nurses. They are frequently exposed to demanding work situations, such as managing cardiac and respiratory arrest circumstances, providing emergent care to rapidly decompensating patients, transitioning patients to end-of-life care, deescalating family distress, and observing the prolonged suffering of patients (Van Mol et al., 2015). In addition, with the current nursing shortage, there is a chance ICU nurses are providing this high-level care under increased workload and understaffed conditions (American Association of Colleges of Nursing, 2020). Also, the ICU has become an increasingly technical environment, requiring nurses to undergo frequent training in advanced medical therapies to keep up with new technology (Van Mol et al., 2015). Overtime, these occupational hardships can take an emotional and physical toll on ICU nurses, which could compromise their ability to make sound clinical decisions (Prapanjaroensin et al., 2017).

Clinical decision-making is a vital skill ICU nurses must possess to competently care for their high acuity patients. However, there is no established definition of this concept specifically for ICU nursing. This gap in knowledge merits attention because ICU clinical decision-making entails different attributes than traditional decision-making for nurses due to the unique aspects of the critical care setting. To illustrate, patients in the ICU are prone to sudden changes in vital signs and laboratory values, which warrant prompt nursing judgment. They also have severe medical illnesses that require continuous monitoring and frequent nursing care. ICU nurses provide this care while simultaneously attending to a multitude of medical equipment (e.g., intravenous [IV] pumps, mechanical ventilators, telemetry monitors, continuous renal replacement therapy machines, crash cart, therapeutic cooling devices). Furthermore, many of the clinical decisions these nurses make are done under time pressure situations (e.g., titrating vasoactive medications, deciding which IV access is the best site to safely administer a high-alert drug) due to the life-threatening health status of their patients. Lastly, ICUs have high patient mortality, so nurses are oftentimes making decisions under emotionally and ethically challenging situations (Kompanje, 2018). For these reasons, ICU clinical decision-making is a distinct concept essential to critical care nursing practice that is deserving of its own definition and formal analysis.

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