Hindawi Publishing Corporation

Nursing Research and Practice

Volume 2011, Article ID 524918, 8 pages
doi:10.1155/2011/524918

Research Article
Clinical Decision Making of Nurses Working in Hospital Settings

Ida Torunn Bjørk1 and Glenys A. Hamilton2

1
Department of Nursing Science, University of Oslo, Postboks 1153, Blindern, 0318 Oslo, Norway
2 Research Department, GAH Consulting, 601 George Hill Road, Lancaster, MA 01523, USA

Correspondence should be addressed to Ida Torunn Bjørk, [email protected]

Received 15 March 2011; Accepted 28 July 2011

Academic Editor: Karyn Holm

Copyright © 2011 I. T. Bjørk and G. A. Hamilton. This is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.

This study analyzed nurses’ perceptions of clinical decision making (CDM) in their clinical practice and compared differences in
decision making related to nurse demographic and contextual variables. A cross-sectional survey was carried out with 2095 nurses
in four hospitals in Norway. A 24-item Nursing Decision Making Instrument based on cognitive continuum theory was used to
explore how nurses perceived their CDM when meeting an elective patient for the first time. Data were analyzed with descriptive
frequencies, t-tests, Chi-Square test, and linear regression. Nurses’ decision making was categorized into analytic-systematic,
intuitive-interpretive, and quasi-rational models of CDM. Most nurses reported the use of quasi-rational models during CDM
thereby supporting the tenet that cognition most often includes properties of both analysis and intuition. Increased use of intuitive-
interpretive models of CDM was associated with years in present job, further education, male gender, higher age, and working in
predominantly surgical units.

1. Introduction model [4]. Two approaches dominate in nursing research

within the systematic-positivist stance, analytical decision
In the clinical setting, nurses are continually faced with de- making theory, and information-processing theory. Analyt-
mands to make decisions of care. The process of coming ical decision making theory assumes that rational analytical
to a choice is the essence of decision making. This process thinking precedes action. The analysis is a systematic step-
is viewed as complex [1, 2]. O’Neill et al. [3] suggest that by-step procedure with the use of logical rules that can be
the complexity of clinical decision making (CDM) requires followed until a decision is made [5]. The information-
a broad knowledge base and access to reliable sources of processing model is a psychological theory much used in
information, as well as working in a supportive environment. research in medical decision making and characterized by
The decisions nurses make while performing nursing care a scientific approach to making decisions [6]. It is also
will influence their effectiveness in clinical practice and make termed the hypothetico-deductive approach [1, 4]. Hamers
an impact on patients’ lives and experiences with health care et al. [7] described four major stages of this process
regardless of which setting or country the nurse is practicing in nursing as, gathering preliminary clinical information
in. Knowledge about nurses’ decision making is therefore about the patient, generating tentative hypotheses about
of utmost importance. Understanding how nurses make the patients’ condition, interpreting the initially registered
decisions is also a prerequisite to facilitating learning and cues in light of the tentative hypotheses, and weighing
development of decision making skills in nursing education the decision alternatives before choosing the one that fits
[1]. best in light of the evidence collected. Earlier knowledge
acquired about the situation at hand is included in this
2. Background process [8]. The intuitive-humanist model is best known
in nursing through Benner’s work [9]. Intuition has been
Historically, CDM in nursing has been discussed in light defined in several ways, for example, “understanding with-
of systematic-positivist models and the intuitive-humanist out a rationale” [10, p.23] or “a perception of possibilities,
2 Nursing Research and Practice

meanings and relationships by way of insight” [11, p.63]. the way in which nurses perceived to arrive at their decisions
According to Benner [9], intuition is rooted in the ability to in practical nursing situations. The main purpose was to
recognize patterns of cues. This is an ability that develops examine cognitive processes nurses thought they used in
with experience in managing patients in the nursing field. their decision making and correlate them with demographic
According to Thompson [4, p.1224], the basic idea of and contextual factors. Based on both CCT and information
the intuitive-humanist model is that, “intuitive judgment processing theory, an extensive literature review, interviews
distinguishes the expert from the novice, with the expert with nurses, and former studies of decision making, a 56-
no longer relying on analytical principles to connect their item instrument was developed. According to the their
understanding of the situation to appropriate action.” The content, the items in the questionnaire were organized to
analytical and intuitive stance towards decision making have reflect four stages of CDM: (a) data collection, (b) data
ardent followers and have often been viewed as two distinct processing and identification of problems, (c) plans of action,
types of cognitive activity sharply separated. However, since and (d) implementation of plan, monitoring, and evaluation
the late 1990s, a third approach to decision making has been [2]. The instrument was used in a study with 1460 nurses
discussed in the nursing literature, decision making based from seven countries after testing.
on the cognitive continuum theory (CCT) by Hammond Their study showed that nurses’ use of CDM differed
[5]. according to field of practice and country [20–23]. In relation
Hammond [5] does not view analysis and intuition as to different stages of the decision making process, Lauri and
distinct cognitive systems. He offers instead the idea of a Salanterä [2] claimed that pure intuitive decision making
cognitive continuum where analysis and intuition are located did not weight on any of the 4 stages. Analytical decision
at each end point. Cognition often falls between the end making did weight in stage 2, that is, data processing and
points and thereby includes properties of both analysis and identification of problems. The other stages of decision
intuition, referred to as quasi-rational cognition, meaning making were more or less quasi-rational. The authors were
that many judgment tasks present cues that induce an cautious in drawing any general conclusions about factors
oscillation between analytical and intuitive cognition [5]. A underlying the differences in nurses’ perception of their
major tenet of the theory is that “judgment is a joint function decision making but suggested that it was fair to assume
of task properties and cognitive properties” [5, p.83], that is, that “the instrument allows us to determine in general terms
different judgment tasks should be solved through different how nurses’ decision making occurs on the continuum from
cognitive processes. In his theory, he therefore describes dif- analytical to intuitive” [2, p.98].
ferences among judgment tasks and locates them in relation The present study was part of a larger study that had
to cognitive properties along the cognitive continuum. A an overall purpose of exploring learning and professional
judgment task that involves uncertainty is difficult to break development in hospital nurses. Inspired by the work of
down into distinct components and may benefit from a more Lauri and Salanterä [2], the study aimed at exploring nurses’
intuitive approach than a judgment task that is well struc- perception of their clinical decision making (CDM) in a
tured with few and recognizable cues. The latter judgment specified patient situation. The following research questions
task would favor a more analytical approach. Dowding [12] were formulated.
in a commentary on Banning’s article [1] seems to support
Hammond’s [5] idea of viewing decision making within one (1) What CDM models characterize the total sample of
theoretical system. She suggests that hypothetico-deductive nurses?
reasoning, intuition, pattern matching, heuristics, and so
forth. All lie within the psychological theory of information- (2) What is the association between selected independent
processing theory. variables (background and demographic variables)
The CCT has been tested in nonnursing settings [13–15]. and the dependent variable (CDM)?
Since 1999, several authors have suggested that Hammond’s (3) How much variance in CDM can be explained by
CCT could be a possible alternative way of conceptualizing scores on the independent variables?
decision making in nursing [4, 16, 17]. In two qualitative
studies, CCT was used either as an explicit analytical tool [18] (4) Is there any difference in CDM models across the four
or as a theoretical perspective in the framing and discussion stages of the decision making process?
of the study [19]. Both studies concerned nurses’ decision
making during pharmacological management. Both studies 3. Methods
also report a mismatch between the type of decision making
nurses used and the characteristics of the situation, for 3.1. Design, Sample, and Setting. The study used a descriptive
example, that intuitive approaches were used when more cross-sectional survey design in which nurses completed a
analytic approaches should have been used [18], or that questionnaire on one occasion. A convenience sample of
appropriate decision tools were missing to help nurses during registered nurses in clinical positions at four hospitals in
their analytical approaches [19]. the western and southern part of Norway was recruited.
In collaboration with international colleagues, Lauri and Two of the hospitals were affiliated with universities, the
Salanterä [2] included Hammond’s CCT [5] in a theoretical third was regional, and the fourth a local hospital. The
framework for developing an instrument to explore nurses’ inclusion criteria were nurses employed in clinical positions
perception of their decision making at a general level, that is, working half, or more than a half, of a full-time equivalent.
Nursing Research and Practice 3

Respondents received an envelope at work including a cover “sometimes,” “often,” and “almost always.” These items were
letter explaining the purpose of the study and ensuring con- scored from 1 to 5 so the lowest scores measured analytical
fidentiality, the questionnaire, and a preaddressed envelope decision making and the highest scores intuitive decision
for return of their response. A total of 4,650 nurses were making. On the even numbered items, the response option
invited to participate in the study. A return rate of 45.5% of “almost always” would then indicate a highly intuitive
yielded 2,095 questionnaires. The data were collected in approach. The scores for responses to odd items were re-
2004-5. versed; thereby, the response option of “almost never” would
be scored as 5 and also indicate a highly intuitive approach.
A low total score described analytical decision making and a
3.2. Instrumentation. The questionnaire included (1) demo- high-score intuitive decision making. The scores were added
graphic and background variables, (2) the 24-item Nursing up, and the sum total was interpreted following instruc-
Decision Making Instrument (Salanterä, e-mail correspon- tions from Salanterä [E-mail correspondence 2004-5]: 24–
dence 2004-5), (3) the index of work satisfaction [24], and 67 indicate analytical-systematic decision making, 68–77
(4) author-designed evaluative questions for participants in indicate quasi-rational decision making, and 78–120 indicate
long-term in-house educational programs (clinical ladder intuitive-interpretive decision making.
programs). Results from the two latter sections are reported
The respondents were instructed to answer the question-
elsewhere [25, 26].
naire with an elective patient in mind. An elective patient
The 24-item Nursing Decision Making Instrument is a situation implies certain judgment tasks that differ from
shortened version of the original 56-item instrument pre- acute situations, that is, the difference in time at hand
sented in the background of this article. Figure 1 shows how for colleting data about the patient, or discussing with
Lauri and Salenterä related four decision making models to colleagues the appropriateness of interventions. The idea was
Hammond’s CCT [5]. to set a scene that would prompt nurses to think of their
These four models are inserted in a continuum from decision making with the same type of judgment tasks in
analysis to intuition and defined by aspects of the patient’s mind and thereby allow for comparison across hospitals and
health problem, knowledge structure, nursing task, and units.
available time, corresponding to Hammond’s [5, p.235]
concepts of task features and cognitive structures. Based
on the international sample, Lauri and Salenterä [2] devel- 3.3. Ethical Considerations. According to Norwegian law,
oped a scoring system to allow for assessment of nurses’ permission was not needed from the regional Committees
decision making style. The scores were related to the for Medical and Health Research Ethics. Permission to use
decision making models presented in Figure 1: the intuitive- name lists in order to supply enough questionnaires to each
interpretive model, the intuitive-analytical model and the unit was granted by the Director of Nursing or Director of
analytical-intuitive model constituting quasi-rational models Research according to local regulations, and such lists were
of cognition, and the analytical-systematic model. obtained from the personnel department of each hospital.
In E-mail correspondence with Salanterä (2004-2005), Permission to distribute questionnaires was obtained from
we were offered to use the 24-item Nursing Decision department directors. Questionnaires could be related to
Making Instrument (Sanna Salanterä, Professor of Clinical each hospital but were otherwise anonymous. Informed
Nursing Science, Department of Nursing Science, Univer- consent to participate was indicated by return of the ques-
sity of Turku, 20014 Turun Yliopisto, Finland, E-mail: tionnaire.
[email protected]). For the shortened version of the instrument,
cut-off points in the scores relating to the four decision 3.4. Data Analysis. The questionnaires were optically scan-
making models were defined on the basis of quartiles: ned. In the original research, there was a lack of information
25% of the responses were intuitive-interpretive, 25% were on how the authors addressed missing data. In accordance
analytical-systematic, and 50% in the two middle quartiles with general statistical procedures, we addressed missing
were analytical-intuitive or intuitive-analytical, that is, quasi- data in the present study in the following way. In relation
rational [Salanterä, E-mail correspondence]. Equivalent to to research questions 1–3, the analysis aimed at matching
the original instrument, the 24-item instrument had four each nurse’s total sum with cut-off points for different
subscales, each with six items, corresponding to the four decision making models. Respondents with more than 40%
stages of the decision making process. Even numbered items of the items missing were therefore taken out of the data
reflected decision making in unstable tasks or situations with set (n = 75, 3.6% of the total sample). An inspection of
short available time, for example, “I make assumptions about the data revealed that missing responses were often due to
forthcoming nursing problems during the first contact with missing responses to all questions on the last page of the
the patient.” Odd numbered items reflected decision making questionnaire. Any missing items in other respondents data
in structured tasks or situations with enough time to seek sets were substituted with the respondents own mean score.
or handle information or plan actions, for example, “On the For question 4, the purpose was to look more closely at
basis of my advance iformation, I specify all the items I intend decision making models within each stage of the decision
to monitor and ask the patient about.” making process. Each stage has six items. Any stage with
Respondents answered each question on a 5-point Likert- more than two out of six items missing was taken out of
type scale with response options of “almost never,” “rarely,” the analysis. Where respondents had one or two missing
4 Nursing Research and Practice

Unstructured Knowledge structure Structured

Analytical- Information seeking

Long-term systematic Information handling
stable model Problem definition
Plans of action

Analytical-
intuitive
model
Health Nursing
problem
Intuitive- task
analytical
model

Intuitive-
interpretive
Acute Action
model
unstable evaluation

Short Available time Long

Figure 1: Nursing decision making theory based on Hammond’s model of cognitive continuum theory (1996, p.235) (Salanterä, e-mail cor-
respondence 2004-5).

items, these were substituted with the mean score within that 4. Findings
stage of decision making. These procedures resulted in a final
N = 2020 for total score analysis and a variation in N of The study participants ranged in age from 21 to 68 (mean
2061, 2054, 1974, and 2009 for analysis within the four stages 37.5 years), 7.9% were men, 8.3% of the nurses had worked
of CDM, respectively. Data were analyzed with frequency more than 5 years in their unit, 66% had graduated before
distributions, and inferential statistics. When studying the 1999, and average work experience in their present setting
association between potentially predictive variables and a was 4.9 years. Approximately 40% of the participants had
dependent variable, linear regression analysis can be used. formal continuing education between 1/2 and 1.5 years, and
Multicollinearity was controlled by the coefficients tolerance 25.8% of the nurses had completed or were enrolled in a 5-
(>0.5), and variance inflation factor (VIF, close to 1 < 2) year in-house clinical ladder program.
Cook’s D and Mahalanobis D, and standard residuals were
used to identify possible outliers that might distort the statis- 4.1. What CDM Models Characterize the Total Sample of
tics [27, p.128]. Adjusted R square evaluated the variance Nurses? The possible range of scores in the CDM instrument
that the independent variables contributed to explaining was 24–120. In the whole sample, the range in scores was 45–
the association with the dependent variable, CDM. The 88 (mean 70.65, SD 4.35). The distribution of CDM models
statistical package for social sciences version 15.0 was used as reported by the total sample of nurses is shown in the chart
for statistical analysis. in Figure 2.
Figure 2 indicates that most nurses reported the use of
3.5. Reliability and Validity. Authors of the original 56- quasi-rational models during CDM. Few nurses fell within
item instrument [2] developed the shortened version thru a the score boundaries indicating the use of intuitive-interpre-
factor analysis on the original instrument to ensure construct tive models.
validity, reduction of items by keeping items that had a high
impact in the factor analysis, and reformulation of items
4.2. What is the Association between Selected Independent
according to responses in the previous measurements. The
Variables (Background and Demographic Variables) and the
shortened version of the instrument has not been formally
Dependent Variable (CDM)? Background and demographic
validated. The questionnaire was translated back-and-forth
variables were computed with t-tests for nominal data and
from English to Norwegian. A Norwegian person fluent in
Pearson’s r for interval level data. The variables that were
English translated from English to Norwegian, an English
statistically associated with CDM are reported in Table 1.
person translated the Norwegian version back to English,
and finally this version was compared with the original. Only
a few small corrections were necessary. Cronbachs alpha in 4.3. How Much Variance in CDM Can Be Explained by
the present study was 0.863. A manual check was performed Scores on the Independent Variables? Variables statistically
of questionnaires where data cleaning procedures uncovered associated with CDM were entered into the final regression.
abnormal values. ANOVA statistics are reported in Table 2.
Nursing Research and Practice 5

Distribution of CDM models (N = 2020) or intuitive-interpretive models. However, the largest vari-
ations across the stages of decision making occurred in
Scores 78–88 relation to reported use of the two latter models.
6% Scores 45–67 Figure 3 shows that the percentage of nurses reporting
22% the use of analytical-systematic models was highest during
data collection and implementation and evaluation. Cor-
respondingly, interpretive-intuitive models were low in use
during these stages, higher in use during data processing
and used approximately as much as the analytical-systematic
model during the stage of planning action.
There were variations in the pattern illustrated in
72%
Scores 68–77 Figure 3 when demographic and contextual variables were
taken into account. These variations are illustrated in Table 3.
Analytical-systematic It is clear that participation in clinical ladders had no
Quasi-rational significant impact on nurses’ reported use of CDM models
Intuitive-interpretive across any of the stages of the decision making process. Age
Figure 2: Distribution of CDM models among the total sample of and nurses’ field of practice was also variables that had little
nurses. impact across the four subscales.

Table 1: The association between background and demographic

variables, and CDM. 5. Discussion
Pearsons r t-test Mean P The purpose of this study was to explore the cognitive pro-
Age 0.059 0.01 cesses used during CDM as reported by a large sample of
Years in present job 0.132 0.01 Norwegian nurses and to identify how demographic and
contextual variables were associated with decision making.
Field of practice
Since no studies with the shortened CDM instrument have
Predominantly surgical 71.04
yet been reported, direct comparisons are not possible
Predominantly medical 70.40 0.002 although results from the present study may be compared
Further education with trends in Lauri and Salanterä’s research [20, 22, 28].
Further education 71.22 Based on the scoring system developed for the shortened
No further education 70.13 <0.000 instrument, results from the present study show that in the
Gender whole sample of nurses the “window” for perceived quasi-
Male 71.62 rational approaches in CDM is large. This is similar to
Female 70.56 0.003 nurses in Dowding et al.’s study [19] and with Hammond’s
[5] suggestion that it is most common to oscillate between
analytical and intuitive modes of cognition during decision
Table 2: Amount of variance in CDM explained by independent making. Also, the analytical-systematic model is perceived to
variables.
be much more in use than the intuitive-interpretive model.
Independent variables Beta t P One interpretation of this may relate to the character of
Years in present job 0.142 5.33 <0.0001 the task outlined in the questionnaire. An elective patient
Further education 0.126 4.97 <0.0001 situation affords a reasonable amount of time for decision
Male gender 0.069 3.13 0.002 making and is relatively well-structured. This situation
therefore has properties that may induce analysis [16, 29].
Higher age 0.081 2.77 0.006
Since the CDM instrument has a lower number for anal-
Surgical field of practice 0.05 2.23 0.026
ytical-systematic CDM and a higher for intuitive- interpre-
F = 15.698, P < 0.0001, R2 0.38. tive, with quasi-rational decision making modes in between,
one can conclude that years in present job is significantly
associated with intuitive-interpretive CDM, followed by
Table 2 shows that nurses’ number of years in present further education, male gender, higher age, and surgical
job and further education had the largest associations with field of practice. In line with findings in Benner and
CDM. colleagues’ research [9, 30, 31], there is a significant increase
in the nurses’ reported use of intuitive-interpretive CDM
4.4. Is There Any Difference in CDM Models within the Four models with increasing experience in their unit. This is
Subscales of the CDM Instrument? Differences in nurses’ re- also similar to Lauri et al.’s [20] report on CDM among
ported use of CDM models across the four subscales of the nurses in geriatric and acute care settings in Finland, Sweden,
CDM instrument are illustrated in Figure 3. Switzerland, Canada, and the USA. In other studies, however,
In general, nurses reported the use of quasi-rational experience does not significantly influence CDM [22, 28].
models of CDM more often than either analytical-systematic Further education was also associated with perceptions of
6 Nursing Research and Practice

70
63.6% Quasi-rational
66.1%

Distribution of CDM models (%)

60
53%
55.9%
50

40
35.7%
31.1% Analytical-systematic
30
24.5%
22.8%
20 22.5%

10
8.4% 11.1% Intuitive-interpretive
5.8%
0
Data collection Data processing Planning action Implementation
and evaluation
Subscales of CDM instrument

Figure 3: Pattern of reported CDM models within the subscales of the CDM Instrument.

Table 3: The influence of demographic and contextual variables on the use of analytical-systematic (A-S) and intuitive-interpretive (I-I)
models within stages of the decision making process (Chi-Square, significance level P < 0.05).

Implemen tation and

Demographic and Data collection Data processing Planning action
evaluation
contextual variables P P P
P
Less A-S and more I-I as Less A-S and more I-I as Less A-S and more I-I as
Work in ward in years: experience in ward experience in ward experience in ward
Ns
<2, 2–4, 5–9, ≥10 increases increases increases
0.001 0.007 0.003
Less A-S and more I-I if Less A-S and more I-I if Less A-S and more I-I if
More A-S if nurse has
Further education: nurse has further nurse has further nurse has further
further education
yes or no education education education
0.039
0.002 <0.001 <0.001
Less A-S and more I-I if More A-S and less I-I if Less A-S and more I-I if
Gender of nurse:
nurse is male nurse is male nurse is male Ns
male or female
.032 .024 .001
Less A-S and more I-I if
Age in years:
age over mean Ns Ns Ns
<37 or >37
0.015
Participation in
Clinical ladder: Ns Ns Ns Ns
yes or no
Type of hospital where
nurses worked: No clear pattern No clear pattern
Ns Ns
local or regional, or 0.018 <0.001
university
Nurses’ field of Less A-S and more I-I if
practice: nurses field of practice is
Ns Ns Ns
predominantly surgical predominantly surgical
or medical <0.001

more intuitive decision making among Norwegian nurses. associated with CDM models in the present study, and both
Although earlier research into the association between edu- further education and years of work experience often parallel
cational level and decision making is inconclusive [32], Lauri increasing age, it is difficult to gauge the contributions of
et al., [20] found that nurses with professional education these demographic variables.
used significantly more intuitive CDM than nurses with only An interesting finding is the association between male
2.5–3 years of education. As age is also a significant factor gender and CDM. Male nurses’ CDM scores are similar to
Nursing Research and Practice 7

that of nurses who had more than 10 years experience in their There is a potential for nonresponse bias with a response rate
unit. However, male nurses had fewer years of experience of 45.5%. Personnel departments at Norwegian hospitals do
less further education and were younger. This indicates not make lists of their employees that automatically include,
that being male in itself may influence perceived models of for example, gender and age, so it is difficult to access such
CDM. Studies reporting on the association between gender data to verify the demographic similarity between responders
and decision making are scarce. In the field of human and nonresponders. However, all Norwegian RN’s have the
relationships and management, Burke and Miller [33] found same undergraduate nursing education as there is only one
minimal support for a gender-based stereotype of women’s form of educational program in the country. The limitation
intuition. From 51 interviews with seasoned professionals, of mean imputation methods is discussed in the literature
they found that men were believed to use intuitive skills although mean substitution for items in multiple-item scales
at work as much or more than women. In contrast, in a is often used [35] in order not to waste information by
study of 520 physicians, nurses and health managers, men scoring the entire scale as missing. When data were inspected,
preferred rational reasoning while women preferred intuitive the magnitude of missing was rather small and evenly
reasoning [34]. distributed among the items (between 27–40 responses to
Nurses’ perception of their CDM in this study is asso- the first 12 items, and between 61–65 responses to the last
ciated with field of practice, as nurses in predominantly 12 items).
surgical units are more intuitive interpretive than nurses
in predominantly medical units. Patients in surgical units
6. Conclusion
may experience more sudden shifts in their health condition
than patients in medical units. Nurses in a surgical field of The research presented in this paper extends our ways of
practice may therefore be faced with tasks characterized by looking at CDM based on Hammond’s [5] new insights into
uncertainty and many cues at the same time. Such situations possible models of CDM. Our findings support the preva-
favor an intuitive approach in CDM [5]. lence of nurses’ oscillation between analysis and intuition, at
In the whole sample, variations in CDM models are also least when nurses were confronted with the kind of decision
apparent across the different stages of the decision making situation introduced in this study. The exploratory nature of
process. As mentioned before, nurses in general use quasi- this work does not invite definitive conclusions about nurses’
rational models of CDM the most. Analytical-systematic decision making. However, we believe it can stimulate ideas
models of CDM are perceived to be more in use than in- and discussions about additional ways of understanding the
tuitive-interpretive models during stages of data collection thinking processes nurses use in practice. This is the first time
and implementation and evaluation. Intuitive-interpretive the shortened version of Lauri and Salanterä’s [2] Nursing
models are reported in use more during data processing, Decision Making Instrument is reported. More extensive
while during planning both models are perceived to be equal- evaluation of the CDM model in other countries and in dif-
ly in use. This does not match the findings of Lauri and ferent practice settings is therefore needed in order to explore
Salanterä [2], where one of their major findings was that the merit of this way of conceptualizing nurses’ CDM.
analytical decision making models were weighted for the
stage of data processing in all nursing fields. The nurses in
the present study were prompted to relate their answers to Conflict of Interests
how they viewed their CDM with an unknown but elective
The authors declare that they have no competing interests.
patient. To our knowledge, this was not done in the study
by Lauri and Salanterä [2] and may be one reason for the
difference in these findings. However, when CDM across Acknowledgments
stages of the decision making process is analyzed according
to demographic variables, some groups of nurses do report We would like to thank Britt Sætre Hansen, Gro Beate Sam-
more analytical-systematic models during data processing dal, and Solveig Tørstad for their help in collecting data for
than other groups. this study. The study was funded by the Norwegian Direc-
torate of Health and Social Affairs.
5.1. Limitations. Although the sample in this study was large,
a survey method has limitations as answers to a questionnaire References
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analysis was also limited to an elective patient situation. 2005.
8 Nursing Research and Practice

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