دانلود رایگان مقاله آیا تفکر انتقادی خوب در بین پرستاران مراقبت های ویژه برابر با تصمیم گیری موثر است؟

ABSTRACT

 Background: A critical thinker may not necessarily be a good decision-maker, but critical care nurses are expected to utilise outstanding critical thinking skills in making complex clinical judgements. Studies have shown that critical care nurses’ decisions focus mainly on doing rather than reflecting. To date, the link between critical care nurses’ critical thinking and decision-making has not been examined closely in Malaysia. Aim: Tounderstand whether critical carenurses’ criticalthinkingdispositionaffects their clinicaldecisionmaking skills. Method: This was a cross-sectional study in which Malay and English translations of the Short FormCritical Thinking Disposition Inventory-Chinese Version (SF-CTDI-CV) and the Clinical Decision-making Nursing Scale (CDMNS) were used to collect data from 113 nurses working in seven critical care units of a tertiary hospital on the east coast of Malaysia. Participants were recruited through purposive sampling in October 2015. Results: Critical care nurses perceived both their critical thinking disposition and decision-making skills to be high, with a total score of 71.5 and a mean of 48.55 for the SF-CTDI-CV, and a total score of 161 and a mean of 119.77 for the CDMNS. One-way ANOVA test results showed that while age, gender, ethnicity, education level and working experience factors significantly impacted criticalthinking (p < 0.05), only age and working experience significantly impacted clinical decision-making (p < 0.05). Pearson’s correlation analysis showed a strong and positive relationship between critical care nurses’ critical thinking and clinical decision-making (r = 0.637, p = 0.001). Conclusion: While this small-scale study has shown a relationship exists between critical care nurses’ critical thinking disposition and clinical decision-making in one hospital, further investigation using the same measurement tools is needed into this relationship in diverse clinical contexts and with greater numbers of participants. Critical care nurses’ perceived high level of criticalthinking and decision-making also needs further investigation.

Conclusion

This cross-sectional study demonstrated that critical care nurses perceived both of their critical thinking dispositions had strong impact on decision-making skills. Critical thinking is influence by many factors, in particular the nurses’ age, gender, ethnicity, education level and working experience however, only age and working experience significantly impacted clinical decision-making. The results show a need for critical care nurses especially the junior nurses to continuously improve their decision making in clinical practice by developing higher order thinking abilities. This would assist them to become autonomous decision-makers in the workforce after to solve critical problems. Furthermore, the on-going nurse education is required to place greater emphasis on the promotion and development of critical thinking skills and decision-making among nurses of all ages and working experience levels, rather than relying on nurses simply picking up the skills as they go along. Critical care nurses should be encouraged to participate more in improving and further developing their critical thinking and decision-making skills, and those of their colleagues, and equipping themselves with updated knowledge and clinical skills to meet the expectation that they are independent practitioners delivering the highest quality care to the most vulnerable patients. Further research is needed in different clinical contexts and other parts of Malaysia and globally to provide a comparative evidence base of the association between critical thinking and decision-making among critical care nurses, and the factors contributing to this, using the SF-CCTDI and its subscales. Adaptation of current measurement tools (like those used in this study) to other contexts or the creation of new tools to provide better research options is also needed.