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The effects of time pressure and experience on nurses' risk assessment decisions : a signal detection analysis

Thompson, Carl, Dalgleish, Len, Bucknall, Tracey, Estabrooks, Carole, Hutchinson, Alison M., Fraser, Kim, de Vos, Rien, Binnekade, Jan, Barrett, Gez and Saunders, Jane 2008, The effects of time pressure and experience on nurses' risk assessment decisions : a signal detection analysis, Nursing research, vol. 57, no. 5, September/October, pp. 302-311, doi: 10.1097/01.NNR.0000313504.37970.f9.

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Title The effects of time pressure and experience on nurses' risk assessment decisions : a signal detection analysis
Author(s) Thompson, Carl
Dalgleish, Len
Bucknall, TraceyORCID iD for Bucknall, Tracey orcid.org/0000-0001-9089-3583
Estabrooks, Carole
Hutchinson, Alison M.ORCID iD for Hutchinson, Alison M. orcid.org/0000-0001-5065-2726
Fraser, Kim
de Vos, Rien
Binnekade, Jan
Barrett, Gez
Saunders, Jane
Journal name Nursing research
Volume number 57
Issue number 5
Season September/October
Start page 302
End page 311
Total pages 10
Publisher Lippincott Williams and Wilkins
Place of publication New York, N. Y.
Publication date 2008-09
ISSN 0029-6562
1538-9847
Keyword(s) critical care
decision making
early warning scores
judgment
signal detection
Summary Background: Time pressure and, occasionally, suboptimal assessment decisions are features of nursing in acute care.

Objectives: To explore the effect of generic and specialist clinical experience on the ability to detect the need to take action in acute care and the impact of time pressure on nurses' decision-making performance.

Methods: Experienced acute care registered nurses (n = 241) were presented with 50 vignettes of real clinical risk assessments. Each vignette contained seven information cues. In response to these vignettes, nurses had to decide whether to intervene or not. The 26 vignettes were time limited and mixed randomly into the 50 cases. Signal detection analysis was used to establish nurses' performance, personal decision thresholds ([beta]), and their abilities (d') to distinguish a signal of clinical risk from the clinical noise of noncontributory information.

Results: Nurses had significantly lower d' and were significantly less likely to indicate intervening under time pressure. For ability-but not threshold-there was a significant interaction of time pressure and years of experience in acute care. With no time pressure, d' increased in line with years of experience. Under time pressure, there was no effect.

Discussion: Time pressure reduced nurses' ability to detect the need and the tendency to report intervening. Thus, there were more failures to report appropriate intervention under time pressure, and the positive effects of clinical experience were negated under time pressure. More and larger scale research on the effect on clinical outcomes of time pressured nursing choices is required.
Language eng
DOI 10.1097/01.NNR.0000313504.37970.f9
Field of Research 111003 Clinical Nursing: Secondary (Acute Care)
Socio Economic Objective 920210 Nursing
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
HERDC collection year 2008
Copyright notice ©2008, Lippincott Williams & Wilkins
Persistent URL http://hdl.handle.net/10536/DRO/DU:30017899

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