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

Full 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 ([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.

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Author information

Author/s: Thompson, Carl (C); Dalgleish, Len (L); Bucknall, Tracey (T); Estabrooks, Carole (C); Hutchinson, Alison M (AM); Fraser, Kim (K); de Vos, Rien (R); Binnekade, Jan (J); Barrett, Gez (G); Saunders, Jane (J);

Affiliation: Department of Health Sciences, University of York, UK. cat4(-atsign-)york.ac.uk

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't

Journal: Nursing research (Nurs Res), published in United States. (Language: eng)

Reference: -2008 Sep-Oct; vol 57 (issue 5) : pp 302-11

Dates: Created 2008/09/16; Completed 2008/10/02;

PMID: 18794714, status: MEDLINE (last retrieval date: 11/6/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adult
Attitude of Health Personnel
Australia
Canada
Clinical Competence - standards
Critical Care - organization & administration
Decision Making
Decision Support Techniques
Great Britain
Health Knowledge, Attitudes, Practice
Humans
Judgment
Middle Aged

Middle Aged
Models, Nursing
Models, Psychological
Needs Assessment
Netherlands
Nursing Assessment - organization & administration
Nursing Evaluation Research
Nursing Staff, Hospital - education; organization & administration; psychology
Risk Assessment - organization & administration
Signal Detection (Psychology)
Time Factors
Time Management - organization & administration
Uncertainty

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