An exploratory study on baccalaureate-prepared nurses' perceptions regarding clinical decision-making in mainland China

Aims. To explore Chinese baccalaureate-prepared nurses' perceptions of the concept and practices of clinical decision-making. Background. Clinical decision-making is an integral part of nursing practice. Several studies have explored the experiences and factors which influence nurses' clinical decisions and these have recognised the cultural impact. However, little is known about the experience of clinical decision-making from the perspective of Chinese baccalaureate-prepared nurses. Design. A qualitative, exploratory study. Method. Data were obtained through in-depth, semi-structured interview with a convenience sample of 12 baccalaureate-prepared registered nurses. Interviews focused on registered nurses' understanding and perceptions of clinical decision-making in clinical practice. They were tape-recorded, transcribed verbatim and content analysed. Results. Two major themes were identified, namely, functional perspectives of clinical decision-making and perceived autonomy in clinical decision-making. There were two sub-themes for the first theme: emphasising a full understanding of the patient's health status and undertaking appropriate nursing judgements and problem-solving. Three sub-themes emerged for perceived autonomy in clinical decision-making: relying on a doctor's instructions, making judgements on a doctor's orders and making decisions independently in emergency care. Conclusions. The findings indicate that Chinese nurses understand the essence of clinical decision-making, but they have low autonomy in such decisions in their daily practice. More importantly, the results also reveal the importance of social and cultural factors in nurses' perceptions of this topic. Relevance to clinical practice. A better understanding of the perceptions and concepts of clinical decision-making among nurses in mainland China and other countries as well, can help in establishing nurses' roles and responsibilities in participating in making effective decisions for patient care. The findings can also inform us of potential strategies which may be adopted to develop the knowledge and skills of Chinese baccalaureate-prepared nursing students and graduates in making autonomous and accurate clinical decisions.