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The cognitive work of nurses

In the current Editor’s Pick article titled “Use of the Critical Decision Method in Nursing Research: An Integrative Review,”  author Priscilla K. Gazarian, PhD, RN reports on her synthesis of  7 studies that explored nurses’ cognitive processes in today’s work environment.  She describes her work as follows:

I have been curious about how nurses make decisions for some time. How  do nurses “know” what the right action is in any given situation? Intuition has not been a complete enough explanation for me.

Nursing is unique in many ways, but especially in its decision making. Nurses make decisions under extreme conditions. Often, the nurse has only an instant to decide. The stakes may be very high, maybe even life or death. The decision occurs in an environment that is marked by complexity. In addition, nursing’s commitment to holism requires that the nurse consider each situation within an individual context.

In my role as a Clinical Nurse Specialist and Nurse Educator I have observed nurses act with precision and accuracy in complex situations. I have also seen beginning nurses struggle to learn to “Think like a nurse.” When I watch an experienced nurse, the actions seem well coordinated and fluid, but I am only seeing the tip of the iceberg. Beneath the surface, nurses are continuously perceiving, organizing, interpreting, and deliberating. All the time. In fact, researchers have documented an ICU nurse makes a decision every 30 seconds (Bucknall 2000). How do they do it, and do it so well?

I was first introduced to the critical decision method as published in 1993 here in ANS. The method seemed a good fit for understanding the uniqueness of nurse decision-making. I read more about the method and digested other studies that had used the method. When I looked at the body of studies that had used CDM in nursing, I became aware that when taken together,  these studies corroborated much of what I had observed in practice about nurse decision making.


The Critical Decision Method is certainly useful in describing the cognitive processes of nurses. In addition, the resulting descriptions of situated decision making can provide a framework for instructional materials, to inform the design new information technologies, and to improve and advance nursing practice.

I am grateful for this opportunity to share my work in ANS and in this blog post.  I hope you find my synthesis rings true to what you know about the complexity and uniqueness of nurse decision-making, and I look forward to your comments and dialogue on how this method can be used to influence the development of nursing practice.

Go to the ANS web site now to download your copy of this informative article!

2 Comments Post a comment
  1. chris #

    This is important research! We need to learn more about effective decision-making in the heat of the moment. What direction should this type of research go in?

    June 5, 2013
    • Priscilla Gazarian #

      I believe it is very important to make the situated decision making of nurses explicit through the use of the critical decision method. The results of future studies will be useful in simulated learning experiences or in designing technology that supports the unique work of nursing. Thanks for your comment.

      June 6, 2013

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