Haemodynamic instability after cardiac surgery: nurses` perceptions of clinical decision-making

Currey, Judy, Browne, J. and Botti, Mari 2006, Haemodynamic instability after cardiac surgery: nurses` perceptions of clinical decision-making, Journal of clinical nursing, vol. 15, no. 9, pp. 1081-1090.

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Title Haemodynamic instability after cardiac surgery: nurses` perceptions of clinical decision-making
Author(s) Currey, Judy
Browne, J.
Botti, Mari
Journal name Journal of clinical nursing
Volume number 15
Issue number 9
Start page 1081
End page 1090
Publisher Blackwell Publishing
Place of publication Oxford, England
Publication date 2006-07-19
ISSN 0962-1067
1365-2702
Keyword(s) cardiac surgery
clinical supervision
critical care nurses
decision-making
experience
perceptions of practice
Summary Background. Cardiac surgical patients are distinguished by their potential for instability in the early postoperative period, highly invasive haemodynamic monitoring technologies and unique clinical presentations as a result of undergoing cardiopulmonary bypass. Little is known about nurses’ perceptions of assuming responsibility for such patients. An nderstanding of nurses’ perceptions may identify areas of practice that can be improved and assist in determining the adequacy of current decision supports.

Aim. The aim of this study was to describe critical care nurses’ perceptions of assuming responsibility for the nursing management of cardiac patients in the initial two-hour postoperative period. Design. An exploratory descriptive study based on naturalistic decision-making.

Methods.
Thirty-eight nurses were interviewed immediately following a two-hour observation of their clinical practice. Content analysis and a systematic thematic analysis process called ‘Framework’ were used to analyse the interview transcripts.

Results. Nurses described their perceptions of managing patients in terms of how they felt about making decisions for complex cardiac surgical patients and in terms of how clinical processes unique to the admission phase impacted their decision-making. Nurses felt either daunted or stimulated and challenged when making decisions. Nurses identified handover from anaesthetists, settling in procedures and forms of
collegial assistance as important processes that impacted their decision-making.

Conclusion.
Nurses’ previous experiences with similar patients influenced how they felt about making decisions during the initial two-hour postoperative period, but did not alter their views about processes important for patient safety during this time. Relevance to clinical practice. Feelings expressed by nurses in this study highlight the need for clinical supervision and appropriate allocation of resources during the immediate recovery period after cardiac surgery. Nurses identified ways to improve clinical processes that impacted their decision-making during the immediate recovery of cardiac surgical patients.
Language eng
Field of Research 111003 Clinical Nursing: Secondary (Acute Care)
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2006, Blackwell Publishing
Persistent URL http://hdl.handle.net/10536/DRO/DU:30003960

Document type: Journal Article
Collections: School of Nursing and Midwifery
Higher Education Research Group
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