Perceptions of clinical decision-making: a matrix model

This chapter defines and discusses clinical decision-making in relation to cultural influences, professional identity, decision theory and a matrix model that cross-references nurses’ perceptions of clinical decision-making with their conceptual understanding of nursing. Although most of the discussion and examples relate to nursing, the issues are relevant to other health professionals. The requirement for all health professionals to be publicly accountable in demonstrating sound clinical judgement and decision-making sets the context against which these skills, together with critical thinking and problem solving, are discussed. Normative, prescriptive and descriptive decision-making models are related to contrasting scientific and experiential processes (and sources of evidence) to support clinical decisions. Benner’s ‘novice to expert’ model of clinical expertise is critiqued and a matrix model, derived from a longitudinal phenomenological study of nurses’ developmental journey, acquiring and applying clinical decision-making skills, is presented. Reflective activities invite readers to relate the matrix model to their experience and perceptions of clinical decision-making. The matrix model is then critiqued with reference to decision theory.