Relationship Between Nurses' Decision-Making Styles and Stage-Specific Missed Care in Oncology: A Nursing Process Perspective.

Abstract

Objective: To explore the relationship between nurses' decision-making styles and missed care across different stages of the nursing process (assessment and evaluation, planning, implementation) in oncology care settings.

Methods: A cross-sectional study was conducted among oncology nurses from three hospitals using convenience sampling. Data were collected through a sociodemographic questionnaire, the Oncology Missed Nursing Care Self-Rating Scale (OMNCS) and the General Decision-Making Style Scale (GDMS). Mann-Whitney U tests and binary logistic regression were employed to analyse the associations between different decision-making styles and missed care.

Results: Missed care was commonly reported across all dimensions, with the highest prevalence observed in the planning stage. The rational decision-making style was dominant, with significantly higher scores in the non-omission group. It was negatively associated with missed care during the implementation stage (OR = 0.460, 95% CI 0.251-0.844; p = 0.012). The intuitive-impulsive decision-making style showed a protective effect in all dimensions (OR = 0.254-0.337, 95% CI 0.128-0.501, 0.172-0.661; p < 0.01). In contrast, the dependent and avoidant styles both significantly increased the risk of missed care during the assessment and evaluation stage.

Conclusion: Nurses' decision-making styles play a crucial role in the occurrence of missed care, with different styles exerting varying influences across stages of the nursing process. Therefore, nursing managers should recognise the role of these styles in nursing quality and tailor interventions to support nurses with dependent or avoidant decision-making styles. Moreover, using simulated training or decision support systems to transition between rational and intuitive approaches offers a promising strategy to reduce stage-specific missed care, enhance oncology nursing quality and improve patient safety.

Implications for the profession and/or patient care: Identifying high-risk stages for missed care, incorporating assessments of nurses' decision-making styles and implementing personalised interventions provide a new management pathway to reduce missed care and enhance patient safety.

Impact: What problem did the study address?: This study provides new evidence that nurses' decision-making styles are significantly associated with missed care, with this relationship varying across different stages of the nursing process. What were the main findings?: The rational style was the most common decision-making style among oncology nurses, with the non-omission group scoring significantly higher than the omission group. The intuitive-impulsive style consistently showed a protective effect across all stages. In contrast, both dependent and avoidant styles increased the risk of missed care during the assessment and evaluation stage. Where and on whom will the research have an impact?: This study informs the development of targeted interventions for nursing management. Immediate priorities include implementing structured tools and training during high-risk care stages, while long-term strategies should focus on simulation-based training and fostering a supportive culture to enhance decision-making skills and reduce missed care.

Reporting method: The STROBE checklist.

Patient or public contribution: This is a cross-sectional study to investigate the relationship between nurses' decision-making styles and missed care at specific stages of the nursing process. In the design phase, the research team collected data on oncology nurses' general information, missed care status and decision-making styles by reviewing relevant literature. During the research process, the nurses participated in data collection, providing key primary data for the study. This cooperation ensured the smooth execution of the research and contributed to obtaining effective results.