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critical care, decision making, early warning scores, judgment, signal detection



  1. Thompson, Carl
  2. Dalgleish, Len
  3. Bucknall, Tracey
  4. Estabrooks, Carole
  5. Hutchinson, Alison M.
  6. Fraser, Kim
  7. de Vos, Rien
  8. Binnekade, Jan
  9. Barrett, Gez
  10. Saunders, Jane


Background: Time pressure and, occasionally, suboptimal assessment decisions are features of nursing in acute care.


Objectives: To explore the effect of generic and specialist clinical experience on the ability to detect the need to take action in acute care and the impact of time pressure on nurses' decision-making performance.


Methods: Experienced acute care registered nurses (n = 241) were presented with 50 vignettes of real clinical risk assessments. Each vignette contained seven information cues. In response to these vignettes, nurses had to decide whether to intervene or not. The 26 vignettes were time limited and mixed randomly into the 50 cases. Signal detection analysis was used to establish nurses' performance, personal decision thresholds ([beta]), and their abilities (d') to distinguish a signal of clinical risk from the clinical noise of noncontributory information.


Results: Nurses had significantly lower d' and were significantly less likely to indicate intervening under time pressure. For ability-but not threshold-there was a significant interaction of time pressure and years of experience in acute care. With no time pressure, d' increased in line with years of experience. Under time pressure, there was no effect.


Discussion: Time pressure reduced nurses' ability to detect the need and the tendency to report intervening. Thus, there were more failures to report appropriate intervention under time pressure, and the positive effects of clinical experience were negated under time pressure. More and larger scale research on the effect on clinical outcomes of time pressured nursing choices is required.