Background and aims: Pain management is closely related to decision-making process, which includes assessment, and intervention´s evaluation. It´s generally assumed that education and practical experience increases accuracy in decision-making. Benner´s theory xplains acquisition and development of skills from novice to expert, but doesn't examine decision-making strategies.
The purposes of the study:
(1) Research of cognitive processes used by nurses during pain management decisions and the factors which may influence on these processes.
(2) Examination of differences in pain management decision-making between novice, intermediate and expert nurses.
Methods: The subjects constitute a non-random sample of 65 registered nurses working in surgical wards in two Israeli medical centers. The study is based on vignettes describing common situations which require nurse´s decision-making, questionnaire examining decisions´ basis and script concordance test evaluating nurses´ decision-making. The tools were designed by the researches and validated by expert judgment.
Results: The decision regarding pain management of expert nurses were mostly based on their experience and intuition, while novices and intermediates relied on guidelines or colleagues´ advises. Master degree and participation in pain management educational programs were the factors with significant influence on nurses´ decision-making. No association was found between seniority in a surgical ward and accuracy in decision-making. The findings were consistent with vignettes and script concordance test.
Conclusions: Well-developed guidelines may assist to novice nurses to improve decision-making. The script concordance test seems to be an effective tool in evaluating nurses´ clinical decisions. This study emphasized the benefit of nurses´ higher education and participation in clinical educational programs.