Factors affecting nurse’s clinical decision making in the critical care units: A descriptive study in Dar es Salaam, Tanzania

Abstract

Background Globally, clinical decision-making is regarded as a vital element for nurses’ professional performance. Studies have shown decision made by nurses especially to critically ill patients admitted in intensive care units has led to positive patient’s outcomes. However, institutional and individual factors can hamper a nurse’s clinical decision and lead to negatively nurse’s performance and patient’s outcome. Objective: The general objective of the study was to assess factors affecting nurses’ clinical decision-making to critically ill patients at Muhimbili national hospital (MNH) in Dar es Salaam, Tanzania. Material and Methods: This was a descriptive cross-sectional design employing a quantitative approach, conducted at Muhimbili National Hospital (MNH), Dar es Salaam. A structured self administered questionnaire was given to 142 nurses. The selection of participants was through a simple random method. Data were cleaned and analyzed descriptively by using the computer software IBM SPSS version 21. Univariate and bivariate analyses were conducted to determine the factors affecting nurses’ clinical decision-making. A p-value of < 0.05 was used to ascertain significant relationships between dependent and independent variables. Results: Concerning individual factors which affect nurses clinical decision making more than half of participants pointed out that inadequate training on basic life support, the workload in the clinical setting, and inadequate/poor communication with other health personnel are factors that affect nurses’ clinical decision making by 55.8 %, 62%, and 57.2% respectively. Institutional factors identified as factors affecting nurses' decision making were the absence of authority by nurses, shortage of staff, and lack of motivation in the working area by 52.8%, 66.9%, and 75.3% respectively.Conclusion: The hospital management must address the identified factors which interfere with nurses' clinical decision-making for better outcomes of critically ill patients. Keywords: Nurses clinical decision making, critical care units, critically ill patient.