Uncertainty management strategies in clinical reasoning: perceptions of nurses in post-anesthesia care units.

Background: While it is acknowledged that effectively managing uncertainty in nursing clinical practice is imperative for ensuring safe healthcare delivery, there remains a scarcity of guidance on enhancing uncertainty management within the clinical reasoning of nurses.

Aims: To describe strategies that nurses in post-anesthesia care units use to manage uncertainty in clinical reasoning; and to map these strategies within the Integrative Framework of Uncertainty Management, and the clinical realities of Wiedenbach's Prescriptive Theory.

Material & methods: A descriptive qualitative study. Fourteen nurses from a post-anesthesia care unit of a third-level hospital at the center region of Portugal were recruited using a convenience sampling method. Data were collected through semi-structured interviews and analyzed using thematic analysis using MAXQDA software. Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used for reporting. Ethical approval was obtained from the relevant Ethics Committee, with informed consent, confidentiality, and data protection measures in place to ensure participant anonymity and compliance with the Declaration of Helsinki.

Results: The major theme 'uncertainty management strategies in clinical reasoning of nurses in Post-anesthesia Care Units' included four themes: ignorance-focused strategies, uncertainty-focused strategies, response-focused strategies, and person-focused strategies. These themes were mapped within key domains of nursing care: recipient, skills, policies, techniques, time sequence, agent, happenings, and supportive relationships. The domains encompassed various approaches such as person-centered care, evidence-based practice, postgraduate training, conflict management, critical thinking, continuous improvement projects, in-service team training, contingency planning, case discussions, simulation, self-reflectiveness, emotion self-regulation, optimizing working conditions, positive cognitive reframing, seeking support, fostering team reflection, and collaborative communication.

Conclusion: Nurses in the Post-anesthesia Care Unit employed a range of uncertainty management strategies, which were effectively categorized within the Integrative Framework of Uncertainty Management (IFUM). Emphasizing nursing as a process, as described in Wiedenbach's Prescriptive Theory, these strategies were aligned with addressing the clinical realities tailored to each strategy. More research is needed to understand how the use of different strategies can promote nurses' wellbeing and enhance the safety of nursing care.

Clinical trial registration: Not applicable.