Barriers and facilitators to managing uncertainty in nurses' clinical reasoning in post-anaesthesia care units: a qualitative thematic analysis

• Main Author: Cunha, Lara Daniela Matos
• Publication Date: 2023
• Other Authors: Santos, Márcia Noélia Pestana dos, Lomba, Maria de Lurdes Lopes de Freitas, Santos, Margarida Reis
• Format: Article
• Language: eng
• Source: Repositórios Científicos de Acesso Aberto de Portugal (RCAAP)
• Download full: https://doi.org/info:doi:https://doi.org/10.37464/2023.404.1120
• topic: Uncertainty; Post-anaesthesia Nursing; patient safety; Postoperative Period; Clinical Reasoning; Clinical Decision-Making

Objective: To describe and analyse barriers and facilitators to managing uncertainty in nurses' clinical reasoning in post-anaesthesia care units. Background: The diagnostic process in complex clinical settings often involves uncertainty. This can bias clinical reasoning and compromise the safety of healthcare. Still, little is known about how nurses deal with uncertainty in their clinical practice. Study design and methods: This study employs a qualitative descriptive design. Fourteen nurses working at a post-anaesthesia care unit were selected through convenience sampling. Data was collected through semi-structured interviews and analysed using thematic analysis. The deductive analysis was undertaken based on the Theory of Reasoned Action. This study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results: Two major themes emerged from the analysis: 'barriers' and 'facilitators'. Each major theme aggregated four themes: intention to perform the behaviour, attitudes, subjective norms, and external variables. Discussion: The perceptions of barriers and facilitators provide valuable insights into current and desired practices that can help minimise uncertainty in nurses' clinical reasoning in post-anaesthesia care units. They provide knowledge and future direction for clinical practice improvements by addressing motivations for reasoning behaviour. The need to create more nurse-friendly working conditions and reduce the cognitive and emotional impact of uncertainty was also identified. Conclusion: This study provides a comprehensive list of barriers and facilitators of uncertainty management in clinical reasoning based on nurses' perceptions. Recognising behaviours based on reasoned action is essential to manage uncertainty in nurses' clinical reasoning.