Abstract
BACKGROUND: Uncertainty and time pressure in emergency departments add a challenge to the rational decision-making process, specifically when encountering a critical patient who requires a prompt response. However, there has been little attempt to develop a mental structure model to understand the thought processes and identify cognitive weaknesses points in nurses' decision-making. A better understanding can inform changes in both practice learning strategies and decision-making in emergency department. This study aims to better understand how newly employed nurses process information and initiate actions in emergency situations characterized by time constraints and uncertainty. METHOD: Participants worked under time pressure and uncertainty to solve a simulated shock case by establishing an assumption of what type of shock the simulated patient might have and its cause. An 8-minute window was available to initiate action. Following the simulation, a retrospective think-aloud interview was conducted. FINDINGS: Participants' ability to identify the category of shock was better than their ability to identify the underlaying cause of the shock. This influenced their ability to intervene correctly. Participants' thinking process in an emergency situation can be organized using ABCDE acronym as follows: (1) awareness of the situation, followed by, an instant (2) generation of beliefs (presumption), (3) controlling the consequence (first-line management action), (4) involvement in deliberate thinking and, finally (5) execution, actions (second-line management action). The cognitive weakness was mainly noticed during the first-line management action when participants were involved in immediate lifesaving activities. CONCLUSION: Classification of the steps involved in decision-making when encountering emergency situations may provide insight into the strengths and weaknesses of the thought process at different stages. Further studies are required.