decisions based on their concerns (King & Clark, 2002). This is because nurses have gained experience and expertise to better inform their intuition. Benner and Tanner (1987) examined the thought processing of nurses in the clinical setting and determined that knowledge, skill, and experience come together in their decision making. When experts encounter intuitive feelings about a patient, they pull from similar experiences, seek evidence of their suspicions, and make judgment to act. The confidence in their intuitive awareness and decision making allows them to “use intuition much more skillfully and effectively” (King & Clark, 2002, p. 327). In exploring intuition as part of the surveillance process, research often focuses on the intuitive feelings associated with a complication or downward turn in the patient’s status. Nurses describe a fear or anxiety for the patient’s health and a heightened sense of awareness to understand the patient’s condition to detect changes (Minick & Harvey, 2003). Intuitive feelings and surveillance have the same purpose of identifying threats to the patient and deciding to take action. Nurses identify patterns in collected data, often seeking more information when their intuition seeks to confirm a feeling (Leners, 1992).
59 As a nurse moves from novice to expert level of proficiency, intuitive decision making becomes more developed and the speed in which nurses confirm and make decisions based on their intuitive feelings increase. Nurses more proficient in utilizing their intuitive skills could potentially provider higher levels of surveillance by applying judgment and confidence to their data collection and decision making. Clinical Decision Making Nurses’ decision making has been examined from many different perspectives and determined to be highly contextual (Bucknall, 2003). Nurses use two phases of decision making when addressing patients in the acute care setting: a diagnostic observation phase with data collection and processing, and a management phase of identifying problems and diagnostics and intervening appropriately (Junnola, Eriksson, Salantera, & Lauri, 2002). Based on information processing theory, decision making involves recalling knowledge and previous experiences. In the observation period, signs and cues are picked up to comprise a hypothesis that is then compared to previous knowledge (Junnola et al., 2002). In the management phase, nurses use discriminative thinking to evaluate options, courses of action, and potential outcomes to make judgments on the care they provide (Bakalis & Watson, 2005). Decision making literature focuses on the process of nurses collecting data, comparing options, and making judgments; however, the decision is the outcome of a nurse’s choice to pursue a course of action (Bakalis & Watson, 2005). The decision outcome is influenced by clinical expertise and experience, environmental conditions, and time constraints (Buckingham & Adams, 2000;
60 Thompson, Cullum, McCaughan, Sheldon, & Raynor, 2004). Clinical expertise again becomes useful as nurses gain experience and proficiency in conducting the hypo-
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