Clinical decision-making competencies of undergraduate nursing students: A qualitative approach

  • Fátima Mendes Marques
  • Maria José Pinheiro
  • M. Teresa Leal


Professional nursing practice is a result of constant decision-making concerning the health-disease process of the person being cared for. The nursing decision-making process requires the ability of nurses to make decisions and prescribe nursing actions, through which specific responses occur in the client (Tanner, 2006). Clinical decision-making competence emerges as one of the fundamental competences in nursing practice (Arzani, Lotfi & Abedi, 2016; Espinosa-Rivera, Morán-Peña, García-Piña, González-Ramírez & López-Ruíz, 2019; Nibbelink & Brewer, 2018).

Preparing nurses for professional practice involves learning decision-making in the undergraduate program (Johansen & O'Brien, 2016). Higher education in nursing is increasingly using problem based learning (PBL) and simulation as the most effective pedagogical strategies (Lee, Lee, Gong, Bae & Choi, 2016; Nibbelink & Brewer, 2018).

Following the national guidelines, which pronounces nursing decision-making as what guides nursing professional practice (Regulamento No. 190/2015), the Lisbon School of Nursing (ESEL) has created a second year course, called Nursing Decision-making Process (NDMP) (ESEL, 2012). In its operationalization, the pedagogical team elected PBL as the teaching methods to promote nursing student decision making. Reflecting on NDMP's contributions to student competencies acquisition, and since it is a relatively unexplored area in Portugal (Marques, 2019), the following research questions emerged:

  • What are the clinical decision-making competencies perceived by second year students of ESEL's undergraduate nursing program when they complete the NDMP course and the theoretical section of the graduation program?
  • What are the clinical decision-making competencies perceived by the fourth year students of ESEL's undergraduate nursing program when they complete one year of decision-making training in clinics?[1]

For this reason, we designed a study to identify the perceptions of the second and fourth year students about the competences acquired in NDMP course, to understand which competences they considered to have the greatest impact on their clinical decision-making and to highlight similarities and differences among them.

[1] One year corresponds to the time required to complete, in clinical context, the first experience of process of decision making, as demonstrated through the learning outcomes of the two semesters.