The experience of decision-making among telephone advice/triage nurses

Abstract

<p>The role of the telephone advice/triage nurse is both complex and demanding. All decisions are made while assessing patients without seeing or touching patients. In addition, the role is often developed to decrease health care costs which can be perceived by nurses as being in conflict with their nursing beliefs. The ambiguous nature of the role makes these nurses' daily experiences with decision-making a challenge. Using a phenomenological method, the lived experience of decision-making among telephone advice/triage nurses was explored by conducting multiple interviews with ten nurses. The internal structure of the lived experience was identified through the philosophical perspective of Merleau-Ponty's phenomenology of perception and the process of Van Manen's researching lived experience. Eight essential themes emerged to explain the lived experience. Connecting relationships between nurses and patients were critical to the process of decision-making as well as to what it meant for the nurses to be decision-makers. Nurses involved patients in decision-making, utilized decision-making support protocols, considered deviating from protocols, and sought validation for certain decisions. The nurses' perceptions of what it was like to assume responsibility for decision-making reflected feelings of self-accountability to job responsibility. All nurses realized that they needed to know clinical information about their patients, but some shared that they needed to maintain an awareness of their personal knowing to support their decision-making. Different ways of coming to decisions included making justifiable decisions based upon what was best for the patient, validating the right call based upon nurse comfort, and striking a balance based upon maintaining system equilibrium between patient satisfaction and the health care organization's resources. All nurses spoke of themselves as decision-makers and sensed feelings of confidence, certainty, and uncertainty in being decision-makers. All study themes were conjoined, occurring simultaneously among the descriptions of the decision-making experience. The study's findings support theoretical work in decision-making as well as cognitive development. Focusing upon the experience and meaning of decision-making, bringing to light the everyday experience of nurse decision-making has important implications for the science of nursing and clinical practice.</p>