Decision-making in nursing practice: An integrative literature review

Christine W. Nibbelink, Barbara B. Brewer

Research output: Contribution to journalReview articlepeer-review

163 Scopus citations


Aims and objectives: To identify and summarise factors and processes related to registered nurses’ patient care decision-making in medical–surgical environments. A secondary goal of this literature review was to determine whether medical–surgical decision-making literature included factors that appeared to be similar to concepts and factors in naturalistic decision making (NDM). Background: Decision-making in acute care nursing requires an evaluation of many complex factors. While decision-making research in acute care nursing is prevalent, errors in decision-making continue to lead to poor patient outcomes. Naturalistic decision making may provide a framework for further exploring decision-making in acute care nursing practice. A better understanding of the literature is needed to guide future research to more effectively support acute care nurse decision-making. Design: PubMed and CINAHL databases were searched, and research meeting criteria was included. Data were identified from all included articles, and themes were developed based on these data. Results: Key findings in this review include nursing experience and associated factors; organisation and unit culture influences on decision-making; education; understanding patient status; situation awareness; and autonomy. Conclusions: Acute care nurses employ a variety of decision-making factors and processes and informally identify experienced nurses to be important resources for decision-making. Incorporation of evidence into acute care nursing practice continues to be a struggle for acute care nurses. This review indicates that naturalistic decision making may be applicable to decision-making nursing research. Relevance to clinical practice: Experienced nurses bring a broad range of previous patient encounters to their practice influencing their intuitive, unconscious processes which facilitates decision-making. Using naturalistic decision making as a conceptual framework to guide research may help with understanding how to better support less experienced nurses’ decision-making for enhanced patient outcomes.

Original languageEnglish (US)
Pages (from-to)917-928
Number of pages12
JournalJournal of Clinical Nursing
Issue number5-6
StatePublished - Mar 2018


  • acute care
  • clinical decision-making
  • decision-making
  • education
  • evidence-based practice
  • literature review
  • naturalistic decision making
  • nursing practice
  • nursing research

ASJC Scopus subject areas

  • General Nursing


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