Iranian Journal of Medical Education

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Background. The dynamic and uncertain nature of health care environment requires nurses to be competent decision makers and to respond to the clients needs. Recently, the public and the government have criticized Iranian nurses because of a low quality patient care. However, the nurses’ views and experiences concern- ing the factors affecting their clinical practice and clinical decision making have rarely been investigated. Therefore, this research tried to study the viewpoints, perceptions and experiences of Iranian nurses concerning the factors affecting their clinical decision making. Methods. A qualitative research with Grounded theory methodology was used to study the participants’ lived experiences and their viewpoints regarding the factors affecting their clinical practice and clinical decision making. Un-structured interviews and participant observation methods were used to gather the data. Thirty eight participants were interviewed and twelve sessions of observation by taking field notes were carried out. Constant comparative analysis method was used to analyze the data. Results. Five main categories emerged from the data, indicating the participants’ points of view. “Being competent” and “feeling self-confident” were the most important internal factors, and “organizational culture”, “nursing education”, and “supporting structures” were considered as the most important external factors affecting their clinical decision -making. Conclusion. As participants in this research implied, although being competent and self-confident were important factors in nurses’ clinical decision making, organizational culture and structure were the core variables affecting other variables. Nurse managers and nurse educators are responsible for identifying barriers and enhancing factors within the organizational structure that facilitate nurses’ clinical decision-making.

Keywords: Clinical decision making, Grounded theory, Nursing education, Nursing profession, Selfconfidence, Professional empowerment, Organizational culture

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