Original Articles
Developing an instrument to measure and describe clinical decision making in different nursing fields*

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Abstract

The purpose of this study was to develop and test a decision-making instrument for nursing, to consider the nursing decision-making models in different nursing fields, and to create a scoring system for the instrument. A 56-item instrument was developed on the basis of different decision-making theories and earlier studies about nursing decision making. The instrument was evaluated by using several different convenience samples of nurses from seven different countries (N = 1,460). Statistical analysis used were correlation coefficients, factor analysis, factor scores, and factor reliability coefficients. The results indicated that nurses from different countries and working in different fields of nursing respond similarly. The results of the studies using the 56-item instrument showed that nurses use four kinds of decision-making models (analytical, analytical-intuitive, intuitive-analytical, and intuitive). The factor reliability scores were high (α = 0.85–0.91). According to the results, 60 per cent of the nurses used the analytical-intuitive and intuitive-analytical decision-making models, 14 per cent used the analytical model, and 26 per cent used the intuitive model. However, these models vary both between and within different fields of nursing. J Prof Nurs 18:93-100, 2002. Copyright 2002, Elsevier Science (USA). All rights reserved.

Section snippets

Decision-making theories

Most of the research in nursing science is based on either analytical decision-making theory (Aspinall, 1979; Baumann & Bourbonnais, 1982; Grier, 1976; Lauri, 1981) or information-processing theory (Corcoran, 1986; Hannah, Reimer, Mill, & Letourneau, 1987; Holzemer, 1986; Lauri, 1992; Tanner et al., 1987). In analytic decision-making theory, human decision-making proceeds in accordance with a certain systematic process, and the decision can be reached by analysis of the situation.

Instrument

The instrument of this study was developed on the basis of analytical, information-processing, and intuitive decision-making theories as well as Hammond's Cognitive Continuum Theory (1996a), the Dreyfus' theory about the change of cognition from analysis to intuition (1986), and earlier studies on nursing decision-making (Lauri & Salanterä, 1994a, Lauri & Salanterä, 1994b, Lauri & Salanterä, 1995, Lauri & Salanterä, 1998). Based on an extensive research literature, the structure of the

Validity of the instrument

The psychometric properties of the instrument were assessed in the pilot study by a convenience sample (n = 200) consisting of 100 nurses from one Finnish central university hospital, and 100 nurses who worked in preventive health care in three Finnish community health centers. The rotated factor analysis was calculated for all 56 items to evaluate the content of the items. It was conducted with a maximum likelihood solution, and the factors were orthogonally rotated with Varimax rotation

Discussion

The instrument development reported in this study is based on extensive analyses of the literature on human decision making as well as earlier nursing research into decision-making processes. The content validity of the instrument may be described as good because the factor analyses yielded similar factors for different data sets. This indicates that nurses from different countries and working in different areas of nursing respond similarly to the instrument items. The instrument's

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    *

    Address correspondence and reprint requests to Dr. Sirkka Lauri: Department of Nursing Science, 20014 University of Turku, Finland. E-mail: [email protected]

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    Copyright © 2002 Published by Elsevier Inc.