Effective Clinical Decision-Making and Action for Patient Safety in Acute Care Settings

Error in acute care settings continues to be a serious threat to patient safety. Nurses, at the patient’s bedside, provide a unique role in the identification of significant changes in patient status, communication with the healthcare team, and in patient care. Frequently, nurses must make rapid decisions for patients experiencing serious decline in status. The rapid decline in patient status requires nurse decision-making under time limitations leading many nurses to rely on heuristics rather than evidence to support their decision-making. Contextual factors, including leadership style and organizational structure also may influence communication and collaboration within the healthcare team. This chapter describes theories and models that support decision-making, leadership, and organizational structure toward improvement of patient safety in acute care settings. To enhance understanding of how these theories and models may be integrated into clinical environments, clinical examples are provided. Supporting nurse decision-making for patients in acute care settings is essential for patient safety. Nurse leaders are in an important role to support understanding of contextual factors within their nursing units and facilitate effective nurse decision-making.