THE EFFECT OF LEVEL OF PATIENT ACUITY ON CLINICAL DECISION-MAKING BY CRITICAL CARE NURSES WITH VARYING LEVELS OF KNOWLEDGE AND EXPERIENCE.
Contributors: University of California, San Francisco.
Published: 1989
Number of pages: 200
Subjects: Health Sciences, Nursing.
Description: The purpose of this investigation was to examine the effect of patient acuity on clinical decision making processes and outcomes of critical care nurses with varying levels of knowledge and experience. Secondary purposes were: (a) to examine the relationship between the process and the outcome of clinical decision making and (b) to explore the relationship between clinical decision making on computerized clinical simulations and self-evaluation of clinical expertise.

The sample of critical care nurses (N = 142) completed the Basic Knowledge Assessment Tool for Critical Care (BKAT), Cardiovascular Self-Evaluation Tool, and four computerized clinical simulations. Level of patient acuity was operationalized by two tachydysrhythmias presented by computerized clinical simulation (atrial flutter and ventricular tachycardia). Clinical decision making on the clinical simulations was measured by two outcome variables, proficiency score and patient outcome, and by three process variables, efficiency score, amount of data collected before the first intervention, and time to complete the simulation. Clinical expertise was measured by a 38 item ordinal self-evaluation tool.

Analyses of variance were used to examine the effect of patient acuity, knowledge, and experience on clinical decision making. There was a main effect of patient acuity on clinical decision making outcomes as measured by simulation proficiency score, F(1,66) = 13.87, p =.000. Patient outcome also differed by acuity, Z = 2.91, p =.005. However, there was no main effect of patient acuity on clinical decision making processes. Only limited support was found for a relationship between knowledge and clinical decision making. BKAT score was significantly correlated with atrial, but not ventricular, proficiency score, r =.46, p =.00. The only significant main effect of knowledge on simulation performance was that of ACLS certification on atrial patient outcome, Fisher's exact test, p =.003. There was no main effect of critical care experience on simulation performance. However, nurses with varying levels of knowledge and experience differed on BKAT score and in self-evaluation of clinical expertise. The significant relationships found between the process and outcome of decision making were not consistent across simulations. Simulation performance was not significantly related to self-evaluation of clinical expertise.
Notes: Source: Dissertation Abstracts International, Volume: 51-03, Section: B, page: 1193.

Thesis (D.N.S.)--UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, 1989.

School code: 0034.