Ms Tricia O'Connor1,2, Professor Catherine Paterson1, Professor Karen Strickland3, Associate Professor Joanne Lewis4, Dr Jo Gibson5
1Flinders University, Bedford Park, Australia, 2Clare Holland House, Canberra, Australia, 3Edith Cowan University, Perth, Australia, 4Avondale University, Sydney, Australia, 5University of Canberra, Canberra, Australia
Biography:
Tricia is a PhD candidate at Flinders University with a particular interest in the care needs of the unresponsive dying patient and how nurses make decisions. She is the 2022 recipient of the ANMC Vivian Bullwinkel Award. Tricia has worked as a registered nurse and midwife in various roles across Australia and overseas, as well as in the tertiary education sector. Tricia currently works as a specialist palliative care nurse at Clare Holland House hospice, Canberra, and has done so for over 15 years.
Abstract:
Background: Decision-making is an everyday human experience, and despite all its complexities in multiple different clinical contexts, clinical decision-making to optimise palliative care is an art, and yet an everyday nursing experience. Nurses provide the most direct patient care across all healthcare professional groups, and the decision-making of the nurse has a significant influence on palliative care outcomes. While clinical decision-making in nursing has been explored in the literature and research, a practical graphic model is required for busy nurses to aid clinical decision-making and thus optimise palliative care provision.
Aims: To regenerate interest and highlight the importance of intentional thought and reflection in clinical decision-making in palliative care, and to develop a new model to aid nurse decision-making.
Methods: Systematic review and critique.
Five databases were searched from inception until May 2022 for qualitative peer-reviewed primary research published in English using the ‘Cognitive Continuum Theory’ and ‘nurs*’ as search strategy.
Seven studies were included. Utilising the results of the meta-aggregative synthesis conducted using Joanna Briggs methodology, decision-making literature, together with the Cognitive Continuum Theory reimaged as a guide, a new model for nurse decision-making was developed.
Results: The review produced five synthesised findings: decision-making varied depending on 1. the decision-making capacity of the individual nurse, 2. their level of experience, 3. availability of decision support tools, 4. access to senior staff and peers, and 5. the availability of resources. A gap in the provision of a patient-centric approach to decision-making was identified.
Conclusion: Nurses need to continuously evaluate their decision-making processes to strengthen their status as a profession and to reclaim their position as major decision-makers in the provision palliative care. This presentation will present a Person-Centred Nursing Model for decision-making to better accommodate the multifactorial issues that impact the numerous simple and complex decisions nurses make every day.