Paediatric nurses' decision-making related to high flow oxygen therapy in infants with bronchiolitis: A cross-sectional survey

Abstract

Aim

To examine nurses’ decision-making skills managing infants with bronchiolitis receiving high flow oxygen therapy in two regional Australian paediatric unit settings.

Method

A descriptive cross-sectional survey design was used to explore decision-making models in a purposive sample of paediatric nurses (target n = 88) caring for infants with bronchiolitis receiving high flow nasal cannula oxygen therapy across two regional hospital sites. Participants completed the two-part questionnaire, consisting of 1) demographic and professional characteristics and 2) the 24-item Nurse Decision-Making Instrument (NDMI). Models of decision-making were analysed overall as well as within the context of the four key phases or subscales of the NDMI.

Results

Of the 69 eligible paediatric nurses who participated in this study, the majority (80 %) used quasi-rational clinical decision-making models; indicating that both analytical and intuitive cognitive processes were employed in the decision-making process within this clinical context. Over the four phases of decision-making the quasi-rational approach continued to be predominant. Analytical decision-making was utilised slightly more in the data collection phase and steadily decreased across the phases in this sample of paediatric nurses. Casual employment status was a significant influence on the nurse decision-making instrument score, with analytical-systematic models most used in this group.

Conclusion

Infants with bronchiolitis constitute a vulnerable paediatric cohort as individuals experiencing this disease may deteriorate quickly. Ascertaining how paediatric nurses make decisions is essential for promoting optimal outcomes for this vulnerable patient cohort. While this study provides a representation of paediatric nurse decision-making models in this clinical context, further research is required to confirm these findings and inform educational opportunities which support nurses to make the best decisions based on evidence.

Implications for practice

In clinical practice paediatric nurses make numerous decisions throughout the course of a shift for this vulnerable patient cohort. Infants receiving HFNC therapy for treatment of bronchiolitis are acutely unwell and sub-optimal decision-making strategies may adversely affect patient outcomes if clinical deteriorations are not detected promptly and acted upon. It is therefore essential to ascertain how paediatric nurses make clinical decisions. This understanding will facilitate the development of quality learning resources to support effective paediatric nurses decision-making skills which will positively impact patient outcomes in a vulnerable patient cohort.

Impact

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  Study findings indicated that the majority of participating paediatric nurses used quasi-rational models in their decision-making, which comprise both analytical and intuitive approaches during cognitive decision-making processes.
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  This research contributes to nurse decision-making literature from a paediatric perspective with implications for future explorations of paediatric nurse decision-making.
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  This is the first reported study to map nurse decision-making models in a regional Australian setting utilising the Nurse Decision Making Instrument.
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  This study is the first known study to validate the Nurse Decision Making Instrument in an Australian paediatric and regional setting.

Reporting method

The checklist for Reporting of Survey Studies (CROSS) was utilised as the appropriate EQUATOR guideline for reporting.

No Patient or Public Contribution.

What does this paper contribute to the wider global clinical community?

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  Validation of the NDMI in an Australian setting.
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  Original contribution to mapping of paediatric nurse decision making models to inform effective learning resources for paediatric nurse health professionals.