INVESTIGATING THE RELATIONSHIP BETWEEN CLINICAL DECISION MAKING AND MORAL DISTRESS OF NURSES WORKING IN PEDIATRIC INTENSIVE CARE UNIT

Timely and rational clinical decision making is one of the most important characteristics of nurses working in intensive care units. The decision-making process while caring the children can lead to moral distress in the nurses. Due to the importance of complications resulted from the lack of proper decision making and from creating moral distress in the nurses and its direct effect on their professional performance, the present study was conducted to determine the relationship between clinical decision making and moral distress of nurses working in pediatric intensive care units.

This research is a cross-sectional correlational study. The research sample consisted of 200 nurses working in PICU Educational and Medical Centers of Tehran University of Medical Sciences who were included in the study by continuous sampling method. Data were collected using demographic questionnaire, Corelli Demographic and Moral Distress questionnaire (2002), and Laurie's Clinical Decision questionnaire (2001). Research data were analyzed by SPSS16 software using descriptive statistics (frequency, mean and standard deviation) as well as one-way analysis of variance, Kruskal Wallis, and t-test.

Clinical decision-making in 43% of the researched nurses was of systematic analytical type and in 57% of them was of intuitive analytical type. The mean score of clinical decision making in the nurses was 68.71±4.01. None of the studied nurses had interpretive/intuitive clinical decision-making. The mean value for moral distress was at a medium level of 109.36±22.41. In this study, no statistically significant relationship was found between clinical decision making and moral distress. Clinical decision making had a statistically significant relationship with work shift (p=0.05) and with work experience (p=0.045) in the researched nurses. There was a statistically significant relationship between moral distress and marital status (p=0.032) and number of children (p=0.04).

Clinical decision making in more than half of the nurses of the PICU. Considering the importance of systematic and interpretive clinical decision making in the PICU, it is necessary to take efficient steps to improve clinical decision making in the nurses. Also, the moral distress in the studied nurses was at an average level, and due to its effect on the care behaviors of the nurses in the PICU, it is necessary to design and compile training programs and workshops to help reduce the level of moral distress in the nurses.