The Effects of Time Pressure and Experience on Nurses' Risk Assessment Decisions
- 1 September 2008
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Nursing Research
- Vol. 57 (5), 302-311
- https://doi.org/10.1097/01.nnr.0000313504.37970.f9
Abstract
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 (β), 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.Keywords
This publication has 28 references indexed in Scilit:
- Making the diagnosis of labour: midwives’ diagnostic judgement and management decisionsJournal of Advanced Nursing, 2006
- Barriers to evidence‐based practice in primary care nursing – why viewing decision‐making as context is helpfulJournal of Advanced Nursing, 2005
- Hindsight != foresight: the effect of outcome knowledge on judgment under uncertaintyQuality and Safety in Health Care, 2003
- Failure to RescueThe American Journal of Nursing, 2003
- Research information in nurses’ clinical decision‐making: what is useful?Journal of Advanced Nursing, 2001
- Comparing Methods of Learning Clinical Prediction from Case SimulationsMedical Decision Making, 1992
- Controlled trial using computerized feedback to improve physiciansʼ diagnostic judgmentsAcademic Medicine, 1992
- Variations in Physician Practice: The Role of UncertaintyHealth Affairs, 1984
- Social learning of moral judgments.Journal of Personality and Social Psychology, 1969
- CLINICAL INFERENCE IN NURSINGNursing Research, 1967