Clinical Decision Making: Context for Advanced Practice Nursing

The National Organization of Nurse Practitioner Faculties (NONPF), the American Academy of Nurse Practitioners (AANP), and the American Association of Colleges of Nursing (AACN) support decision making as an essential competency in the education of nurse practitioners. Nurse practitioners must be able to effectively collect and interpret data and formulate a judgment, yet little is known about this process and what factors may influence the process. In the nursing literature, there is ambiguity in how decision making is defined and distinct from other similar terms like clinical reasoning or diagnostic reasoning. The purpose of this literature review was to explore the conceptual definition of clinical decision making and to apply that knowledge to nurse practitioners. A comprehensive literature search was conducted using PubMed, CINAHL, ERIC, and Embase. The final keywords included “clinical decision making,” “nursing,” and “physician.” Articles were included if clinical decision making was a primary study aim, measure or outcome and only non-English and non-research based articles were excluded. Among the sixty-four studies that were reviewed, clinical decision making was clearly defined in only 16% of the studies and was rarely defined within the context of a theoretical framework. Clinical decision making was most commonly described as a complex, non-linear process where data is gathered, evaluated and then a decision is formulated. Many influences of clinical decision making were described in the literature, including practitioner factors (education and experience of the decision maker) and situation factors (setting, resources available); however, these were not consistently shown to influence the decision making process. Only 7 studies were conducted using samples of advanced practice nurses (references will be provided at presentation). There is a need for a clear and distinct definition of clinical decision making, fit within a theoretical framework, that encompasses the process and outcome of decision making. In addition, educators need to examine how they can best foster clinical decision making in students.