Clinical Decision-Making in Nursing in the Emergency Department: Systematic Literature Review Synthesis
DOI:
https://doi.org/10.56294/saludcyt20251705Keywords:
clinical decision-making, nursing, literature review, intuition, evidence-based practiceAbstract
Introduction: Clinical decision-making is vital in nursing and impacts care quality and patient safety. The increasing complexity of healthcare demands nurses to integrate theoretical knowledge, clinical experience, and professional judgment. This review synthesizes literature on clinical decision-making in nursing, focusing on theoretical models and strategies for enhancing nurses' competencies globally.
Methods: A systematic literature review was conducted using Scopus, PubMed, ScienceDirect, and CINAHL. English-language articles published from 2015 to 2024 were included. Data were thematically analyzed to identify consistent models, themes, and influencing factors.
Results: Analysis of 18 articles revealed six core themes in clinical decision-making: recognizing cues, analyzing cues, prioritizing hypotheses, formulating solutions, taking action, and evaluating outcomes. Clinical experience, critical thinking, intuition, team collaboration, technology, cultural context, and professional ethics were key influencing factors. Effective decision-making often combines analytical and intuitive approaches, particularly in complex or emergencies.
Conclusions: Clinical decision-making is a multifaceted process shaped by individual factors, workplace dynamics, and systemic support. These findings highlight the need for tailored, evidence-based education and training programs to strengthen decision-making skills among nurses across diverse healthcare settings.
References
1. Candan Dönmez Y, Sahin Koze B, Durmaz Edeer A, Ciğerci Y, Yilmaz E, Gök F, et al. Evaluation of clinical decision-making perception of nursing students: the Aegean region case. BMC Nurs [Internet]. 2025;24(1). Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-105003966402&doi=10.1186%2fs12912-025-03123-8&partnerID=40&md5=3f9fbc619a4338079ae72d6a267e889f
2. Quach TBY, Nguyen TPL, Huynh TPH. The clinical decision-making of Vietnamese nursing students and related factors: A cross-sectional survey. Belitung Nurs J [Internet]. 2025;11(2):126–32. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-105003131739&doi=10.33546%2fbnj.3686&partnerID=40&md5=1ec6dc94a04ca51b791b4b72b0b12690
3. Marino MA, Andrews K, Ward J. Clinical Decision Making at the Bedside. Nursing Clinics of North America [Internet]. 2020;55(1):29–37. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85076846033&doi=10.1016%2fj.cnur.2019.10.003&partnerID=40&md5=e624645a1008c5548d7fc89690acb4e0
4. ten Ham W, Ricks EJ, van Rooyen D, Jordan PJ. An Integrative Literature Review of the Factors That Contribute to Professional Nurses and Midwives Making Sound Clinical Decisions. Int J Nurs Knowl [Internet]. 2017;28(1):19–29. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-84929440658&doi=10.1111%2f2047-3095.12096&partnerID=40&md5=3da0f048e0b0f8420ab9a9793e000b8c
5. Zhang S, Li Y, Niu L, Wang J, Ma W, Su L, et al. Research on the current situation and influencing factors of nurses’clinical decision-making ability. Chinese Medical Ethics [Internet]. 2024;37(7):798–806. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85200810725&doi=10.12026%2fj.issn.1001-8565.2024.07.08&partnerID=40&md5=d87cb4acc365ed5dfce8a8903bd50000
6. Chen SL, Hsu HY, Chang CF, Lin ECL. An exploration of the correlates of nurse practitioners’ clinical decision-making abilities. J Clin Nurs [Internet]. 2016;25(7–8):1016–24. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-84961153252&doi=10.1111%2fjocn.13136&partnerID=40&md5=84aae545859ec5b6afebd2433654dd30
7. Wang Y, Chien WT, Twinn S. An exploratory study on baccalaureate-prepared nurses’ perceptions regarding clinical decision-making in mainland China. J Clin Nurs [Internet]. 2012;21(11–12):1706–15. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-84861231610&doi=10.1111%2fj.1365-2702.2011.03925.x&partnerID=40&md5=0677e25994b2fe80e389a7f38bdfea4c
8. Kindie Abate H, Birhanu Y, Hailu Gebrie M. Clinical decision-making approaches and associated factors among nurses working in a tertiary teaching hospital. Int J Afr Nurs Sci [Internet]. 2022;17. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85131403231&doi=10.1016%2fj.ijans.2022.100432&partnerID=40&md5=b58d26c774fe8c54d5ac7854e183f6e2
9. Haddaway NR, Page MJ, Pritchard CC, McGuinness LA. PRISMA2020: An R package and Shiny app for producing PRISMA 2020‐compliant flow diagrams, with interactivity for optimized digital transparency and Open Synthesis. Campbell Systematic Reviews. 2022 Jun 27;18(2).
10. Cioffi J. A study of the use of past experiences in clinical decision-making in emergency situations. Int J Nurs Stud. 2001 Oct;38(5):591–9.
11. Pugh D. A phenomenologic study of flight nurses[apos ] clinical decision-making in emergency situations. AirMed. 2002 Apr;21(2):a122906.
12. Wolf L. An Integrated, Ethically Driven Environmental Model of Clinical Decision Making in Emergency Settings. Int J Nurs Knowl. 2013 Feb 16;24(1):49–53.
13. Fry M, MacGregor C. Confidence and impact on clinical decision-making and behavior in the emergency department. Australasian Emergency Nursing Journal. 2014 Aug;17(3):91–7.
14. Ucuzal M, Doğan R. Emergency nurses’ knowledge, attitude and clinical decision making skills about pain. Int Emerg Nurs. 2015 Apr;23(2):75–80.
15. Mizerek E, Wolf L. To Foley or Not To Foley: Emergency Nurses’ Perceptions of Clinical Decision Making in the Use of Urinary Catheters in the Emergency Department. J Emerg Nurs. 2015 Jul;41(4):329–34.
16. Paulina Espinosa-Rivera B. Self-Confidence and Anxiety as Intervening Factors in Clinical Decision-Making in Newly Nursing Bachelor Graduates. American Journal of Nursing Science. 2019;8(2):59.
17. ŞEN CELASİN N, DUR Ş, ERGİN D, KARAARSLAN D. Knowledge, Attitude and Clinical Decision-Making Abilities of Pediatric Nurses Regarding Pain Management. Clinical and Experimental Health Sciences. 2020 Dec 30;10(4):416–22.
18. Rubio-Navarro A, García-Capilla DJ, Torralba-Madrid MJ, Rutty J. Decision-making in an emergency department: A nursing accountability model. Nurs Ethics. 2020 Mar 18;27(2):567–86.
19. Farčić N, Barać I, Lovrić R, Pačarić S, Gvozdanović Z, Ilakovac V. The Influence of Self-Concept on Clinical Decision-Making in Nurses and Nursing Students: A Cross-Sectional Study. Int J Environ Res Public Health. 2020 Apr 28;17(9):3059.
20. Michael D, Nikolaos B, Antigone M, Anastasios T, Panagiotis K, Georgia K, et al. Clinical Decision Making of Greek Nurses Working in Health Centers, Emergency Rooms, Medical-Surgical Clinics and ICUs. Annals of Clinical and Medical Case Reports. 2021;06(19).
21. Yee A. Clinical decision-making in the intensive care unit: A concept analysis. Intensive Crit Care Nurs. 2023 Aug;77:103430.
22. Wolf L, Noblewolf HS, Callihan M, Moon MD. What if It Were Me? A Qualitative Exploratory Study of Emergency Nurses’ Clinical Decision Making Related to Obstetrical Emergencies in the Context of a Post-Roe Environment. J Emerg Nurs. 2023 Sep;49(5):714–23.
23. Novalia A, Rachmi SF, Yetti K. Clinical Decision-Making of Bachelor and Clinical Internship (Professional) Nursing Students in Indonesia. J Public Health Res. 2022 Apr 14;11(2).
24. İlaslan E, Adıbelli D, Teskereci G, Üzen Cura Ş. Development of nursing students’ critical thinking and clinical decision-making skills. Teaching and Learning in Nursing. 2023 Jan;18(1):152–9.
25. Abu Arra AY, Ayed A, Toqan D, Albashtawy M, Salameh B, Sarhan AL, et al. The Factors Influencing Nurses’ Clinical Decision-Making in Emergency Department. INQUIRY: The Journal of Health Care Organization, Provision, and Financing. 2023 Jan 27;60.
26. Chow KM, Ahmat R, Leung AWY, Chan CWH. Is high-fidelity simulation-based training in emergency nursing effective in enhancing clinical decision-making skills? A mixed methods study. Nurse Educ Pract. 2023 May;69:103610.
27. Farzaneh M, Saidkhani V, Ahmadi Angali K, Albooghobeish M. Effectiveness of the SBAR-Based training program in self-efficacy and clinical decision-making of undergraduate anesthesiology nursing students: a quasi-experimental study. BMC Nurs. 2023 Apr 27;22(1):145.
28. Wiggins MW. Cue utilization as an objective metric in naturalistic decision-making. In: Proceedings of the Human Factors and Ergonomics Society [Internet]. 2020. p. 209–13. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85139961691&doi=10.1177%2f1071181320641051&partnerID=40&md5=ec6e4e708c840019079805d887bdfcdc
29. Watkinson J, Bristow G, Auton J, McMahon CM, Wiggins MW. Postgraduate training in audiology improves clinicians’ audiology-related cue utilization. Int J Audiol [Internet]. 2018;57(9):681–7. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85047434209&doi=10.1080%2f14992027.2018.1476782&partnerID=40&md5=ef903e3076877a7f406cbbbf29b6e50a
30. Price A, Zulkosky K, White K, Pretz J. Accuracy of intuition in clinical decision-making among novice clinicians. J Adv Nurs [Internet]. 2017;73(5):1147–57. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85006356490&doi=10.1111%2fjan.13202&partnerID=40&md5=18c82988e69fce02fea4d93a55c3ed32
31. Plener J, Assimakopoulos D, Chung C, Hains F, Mior S. Exploring strategies to improve clinical decision making in a chiropractic office: a case series. Journal of the Canadian Chiropractic Association [Internet]. 2024;68(2):113–21. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85204492639&partnerID=40&md5=31383af50f2078404216510ec300b157
32. Daniel M, Carney M, Khandelwal S, Merritt C, Cole M, Malone M, et al. Cognitive Debiasing Strategies: A Faculty Development Workshop for Clinical Teachers in Emergency Medicine. MedEdPORTAL [Internet]. 2017;13:10646. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85069982872&doi=10.15766%2fmep_2374-8265.10646&partnerID=40&md5=275756a48b3b3b4027e4cf0c4317506a
33. Hendry C, Walker A. Priority setting in clinical nursing practice: A literature review. J Adv Nurs [Internet]. 2004;47(4):427–36. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-4243188079&doi=10.1111%2fj.1365-2648.2004.03120.x&partnerID=40&md5=1820eca9bc2e9873c05d335cd3d5dfe3
34. Jones TL. What nurses do during time scarcity and why. Journal of Nursing Administration [Internet]. 2016;46(9):449–54. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-84988515804&doi=10.1097%2fNNA.0000000000000374&partnerID=40&md5=1e4d5069bda92993cb4492c6e0292626
35. Lake S, Moss C, Duke J. Nursing prioritization of the patient need for care: A tacit knowledge embedded in the clinical decision-making literature. Int J Nurs Pract [Internet]. 2009;15(5):376–88. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-77958112745&doi=10.1111%2fj.1440-172X.2009.01778.x&partnerID=40&md5=727cda4cb44a71db3f1100eee2fefd67
36. Patterson ES, Ebright PR, Saleem JJ. Investigating stacking: How do registered nurses prioritize their activities in real time? Int J Ind Ergon [Internet]. 2011;41(4):389–93. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-79958228237&doi=10.1016%2fj.ergon.2011.01.012&partnerID=40&md5=b00cbbe18005bf763cd2098edda0f84a
37. Van Meijel B, Gamel C, Van Swieten-Duijfjes B, Grypdonck MHF. The development of evidence-based nursing interventions: Methodological considerations. J Adv Nurs [Internet]. 2004;48(1):84–92. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-4844224159&doi=10.1111%2fj.1365-2648.2004.03171.x&partnerID=40&md5=4f1261f59895978c80dc44e497b49e35
38. Aranda S. Designing nursing interventions. Collegian [Internet]. 2008;15(1):19–25. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-41249102290&doi=10.1016%2fj.colegn.2007.11.002&partnerID=40&md5=ef2e1099c319021c970b53f25dc10afe
39. Sidani S, Braden CJ. Nursing and Health Interventions: Design, Evaluation, and Implementation, SECOND EDITION [Internet]. Nursing and Health Interventions: Design, Evaluation, and Implementation, SECOND EDITION. 2021. 1–426 p. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85119448322&doi=10.1002%2f9781119610113&partnerID=40&md5=abd56e45c4bbba8ddc0497def561c5fa
40. Hickman SE, Miech EJ, Stump TE, Fowler NR, Unroe KT. Identifying the Implementation Conditions Associated With Positive Outcomes in a Successful Nursing Facility Demonstration Project. Gerontologist. 2020 Nov 23;60(8):1566–74.
41. Geltmeyer K, De Meester E, Malfait S, Eeckloo K, Duprez V. Building the Ship While Sailing: A Qualitative Evidence Synthesis of the Implementation of Nursing Care Delivery Models in a Hospital Setting. J Adv Nurs. 2025 Apr 29;
42. Giardino ER. Evaluation and Outcomes. In: Evaluation of Quality in Health Care for DNPs. New York, NY: Springer Publishing Company; 2021.
43. Easter K, Tamburri LM. Understanding Patient Safety and Quality Outcome Data. Crit Care Nurse. 2018 Dec 1;38(6):58–66.
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Copyright (c) 2025 Saharuddin, Elly Nurachmah, Masfuri, Dewi Gayatri, Sri Yona (Author)
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