Changes in decision-making among Italian nurses and nursing students over the last 15 years

Aims and objectives: The study aimed at identifying the cognitive strategies used by nurses and nursing students in using information for clinical decision-making and comparing such abilities retrospectively, over the past 15 years.

Background: Within the context of Italian healthcare professions, a process of cultural role development has been ongoing for several years, in the wake of normative and institutional changes. However, the ability to use information for clinical nursing decision-making has been little studied.

Design: Three independent observational studies, with convenience samples of Italian clinical nurses and nursing students recruited at three time-points (1997, 2007, 2012).

Methods: The total sample consisted of 2855 subjects (1406 Nurses and 1449 Nursing Students). Nurses from various clinical realities were subdivided into two classes (less or more than 10 years of experience). Data were collected according to Jenkins' 'Clinical Decision Making in Nursing Scale'.

Results: A trend of decreasing skills in information strategies emerged in both nurses and nursing students from 1997-2012. All subjects totalled values in the lowest class (0-130) of the Clinical Decision Making in Nursing Scale of final scoring. Particularly evident were the decreased scores for nursing students from 1997 to 2007-2012. Comparing nurses with nursing students, the former had significantly higher scores. Comparing experienced nurses with novices, the former again had significantly higher scores. Interestingly, in 1997, nursing students had higher scores than nurses, although this result was not confirmed for the other 2 years.

Conclusions: Results showed consistently decreased competence in the use of information skills, particularly among nursing students.

Relevance to clinical practice: All transformations in training in university-level teaching of nursing show that decision-making skills are continually and significantly worsening. These results are of special interest in view of changes in professional and educational systems.