The Process of Competence Attainment in New Nurse`s Clinical Judgement: A Grounded Theory Study

Abstract

Abstract: Introduction: In an increasingly complex and demanding health care system, nurses make many judges and decisions in practice that have significant and life-impacting effects on their clients. New nurses entering practice for the first time have the required knowledge, skills, and competencies of a beginning practice and they need practice experience under the supervision of more experienced nurses in order to develop their clinical judgement and associted clinical decision making skills to the level of competence but the process of competence in their clinical judgememt development is unknown and there is so little research conducted about process of developing judgement. Therefore we conducted this study to address the question of how new nurses develop competence in their clinical judgement Methods: This qualitative research was a grounded theory study conducted using the purposive sampling method and was based on the data saturation principle. Data were collected using in-depth, semi-structured interviews from 24 new nurses working at teaching hospitals in four northwest provinces of Iran during 2012 and 2014. Constant comparison analyses based on Strauss & Corbin approach 2008 were used simultaneously with data collection. Results: The main categories in this study as stages in the process of developing competence in clinical judgement were the “Becoming familiar”, “Professional development”, “Confidence improvement”, “Consolidating relationships”, and “Seeking challenges”. Five categories as contextual factors were the “Educational backgrounds”, “Job expectations”, “Challenges on decision making”, “Willingness to participate”, and “Being quotidian”. The main concern was decision errors and the outcomes were “Readiness”, “Optimality in caring", "self-belief”, “To be supporting”,and “Power demonstration”. “Sublimation based learning” was the core category in this study. Conclusion: Knowing the process of competence in new nurse`s clinical judgement will prepare new nurses, their faculty, clinical nurse educator, nursing managers, and employing agencies to better support new nursesas they learn the practice of nursing to competent level.