A Mixed Methods Exploration into Clinical Decision-Making, Moral Distress and Coping-Related Constructs Amongst Nursing Professionals.

Miley, Molly (2025) A Mixed Methods Exploration into Clinical Decision-Making, Moral Distress and Coping-Related Constructs Amongst Nursing Professionals. Doctoral thesis, Birmingham City University.

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Abstract

Clinical decision-making is a core competency of the nursing role, one that is derived from clinical skill, knowledge and experience. However, little is known about how decision-making relates to nurses’ wellbeing. Moral distress is a common challenge throughout the nursing workforce and describes the psychological response that arises when one identifies a correct action to take but is constrained from implementing this in practice. This experience is particularly prevalent across the nursing profession, with nursing professionals demonstrating a heightened susceptibility to this phenomenon due to the nature of the nursing role. It is therefore important to consider potential associations between clinical decision-making and moral distress, with consideration to potential elements of support. The main aim of the current thesis was to examine nurses’ experience of clinical decision-making and any impact on health and wellbeing. Further consideration was given to the role of coping behaviours, health-promoting behaviours and self-compassion and their role in mitigating any potential negative effect. A mixed-methods approach was adopted to explore these areas, with an initial exploratory quantitative phase, followed by a qualitative exploration of key findings. The first phase of data collection consisted of four cross-sectional studies. Findings revealed that clinical decision-making was indeed associated with nurses’ wellbeing, demonstrating significant associations with physical health, psychological wellbeing and moral distress. Interestingly, control decision-latitude, grazing, self-compassion, coping behaviours, personality and philotimo were all seen to influence the observed relationships, offering insight into potential areas of support for nurses’ wellbeing. The second phase of data collection utilised qualitative methods to offer further insight into the relationships observed within the initial quantitative phase and examine findings further. This phase consisted of two studies. Chapter 7 details the first qualitative study, which utilised semi-structured interviews to explore nurses’ experience of clinical decision-making. Three key 3 themes were derived from the data: We’re not doctors handmaidens anymore, the impact of clinical decision-making, we’re not trained to make clinical decisions. Overall findings from this chapter highlight that the nursing role has become increasingly autonomous, and nurses possess high levels of responsibility for clinical decision-making. However, training and support is not yet sufficient which ultimately impedes nurses’ ability to manage the impact of decision-making. The final chapter details a dissemination study whereby participants discussed the research findings and offered practical insight into how findings could be implemented in reality. Discussions centred around the need for greater models of clinical supervision and training opportunities tailored towards nurses’ decision-making specifically. Overall, this research offers insight into the impact of clinical decision-making on nurses’ wellbeing and offers suggestion for both person-centred and organisation-led intervention to mitigate any negative effect.

Item Type:	Thesis (Doctoral)
Dates:	Date Event 23 April 2025 Accepted
Uncontrolled Keywords:	Nursing, Clinical Decision-Making, Moral Distress, Self-Compassion, Coping behaviours, Grazing, Personality, Autonomy
Subjects:	CAH02 - subjects allied to medicine > CAH02-04 - nursing and midwifery > CAH02-04-01 - nursing (non-specific) CAH04 - psychology > CAH04-01 - psychology > CAH04-01-04 - psychology and health
Divisions:	Doctoral Research College > Doctoral Theses Collection Faculty of Business, Law and Social Sciences > College of Psychology
Depositing User:	Louise Muldowney
Date Deposited:	25 Apr 2025 11:22
Last Modified:	25 Apr 2025 11:22
URI:	https://www.open-access.bcu.ac.uk/id/eprint/16314