A review of clinical decision making: models and current research

J Clin Nurs. 2008 Jan;17(2):187-95. doi: 10.1111/j.1365-2702.2006.01791.x. Epub 2007 Mar 1.

Abstract

Aims and objectives: The aim of this paper was to review the current literature clinical decision-making models and the educational application of models to clinical practice. This was achieved by exploring the function and related research of the three available models of clinical decision making: information-processing model, the intuitive-humanist model and the clinical decision-making model.

Background: Clinical decision making is a unique process that involves the interplay between knowledge of pre-existing pathological conditions, explicit patient information, nursing care and experiential learning. Historically, two models of clinical decision making are recognized from the literature; the information-processing model and the intuitive-humanist model. The usefulness and application of both models has been examined in relation the provision of nursing care and care related outcomes. More recently a third model of clinical decision making has been proposed. This new multidimensional model contains elements of the information-processing model but also examines patient specific elements that are necessary for cue and pattern recognition.

Design: Literature review.

Methods: Evaluation of the literature generated from MEDLINE, CINAHL, OVID, PUBMED and EBESCO systems and the Internet from 1980 to November 2005.

Results: The characteristics of the three models of decision making were identified and the related research discussed.

Conclusions: Three approaches to clinical decision making were identified, each having its own attributes and uses. The most recent addition to the clinical decision making is a theoretical, multidimensional model which was developed through an evaluation of current literature and the assessment of a limited number of research studies that focused on the clinical decision-making skills of inexperienced nurses in pseudoclinical settings. The components of this model and the relative merits to clinical practice are discussed.

Relevance to clinical practice: It is proposed that clinical decision making improves as the nurse gains experience of nursing patients within a specific speciality and with experience, nurses gain a sense of saliency in relation to decision making. Experienced nurses may use all three forms of clinical decision making both independently and concurrently to solve nursing-related problems. It is suggested that O'Neill's clinical decision-making model could be tested by educators and experienced nurses to assess the efficacy of this hybrid approach to decision making.

Publication types

  • Review

MeSH terms

  • Clinical Competence*
  • Cues
  • Decision Making
  • Decision Support Systems, Clinical
  • Decision Support Techniques*
  • Evidence-Based Medicine
  • Humanism
  • Humans
  • Intuition
  • Mental Processes
  • Models, Nursing*
  • Nurse's Role / psychology
  • Nursing Process / organization & administration*
  • Nursing Research / organization & administration*
  • Outcome Assessment, Health Care
  • Pattern Recognition, Physiological
  • Philosophy, Nursing
  • Research Design