Abstract: Effective nursing prioritisation of the patient need for care is integral to daily nursing practice but there is no formal acknowledgement or study of this concept. Utilising the retroductive research strategy of critical realism, this thesis explores the nursing literature for the tacit knowledge of the discipline about nursing prioritisation and proposes a 'fit' for nursing prioritisation of the patient need for care within the bigger picture of nurse clinical decision-making. The tacit knowledge discerned within the literature indicates that nurses use discretionary judgment and ongoing assessment to determine the relative importance of the many aspects of individual patient situations as they unfold. Such nursing prioritisation takes place concurrently between the competing or even conflicting needs of the several individual patient presentations within the nurse's caseload. Varied frames of reference within different practice settings create specific imperatives on this dynamic and non-sequential process. Starting with an initial set of studies in the 1960s, study of clinical decision-making in nursing has created a significant body of knowledge encompassing a range of approaches. Nursing prioritisation of the patient need for care is most readily discerned in the interpretive perspective and in the plain language descriptions of nurse decision-making. Within the selected literature it is apparent that nursing prioritisation of the patient need for care is an advanced skill of nursing that is developed in practice and honed through experiential learning.

Abstract: This paper explores the relationship between evidence, decision tools, and the effectiveness of the nursing contribution to health services. It examines a continuum of decision-making within the international trend of the Effectiveness Movement, drawing on international literature and local experience. It draws on the concept of explicit evidence-based decision-making, the guideline development movement as exemplified through the New Zealand Guidelines Group, information technology in decision support, and the challenges of an evidential approach to nursing. This article is based on a paper given at 'The Pride and Passion of Professional Nursing Practice' College of Nurses' Aotearoa (NZ) Conference, Rotorua, 8-9 October 1998.

Abstract: New graduate nurses, particularly in the first year of clinical practice, face challenges with making clinical decisions about patient care. A review of the literature revealed no studies that reported using fundamental qualitative descriptive methodology to investigate new graduate nurses' clinical decision making. Aspects of decision making by new graduates have been studied using observational and interview methods, the findings from which have been interpreted using various theoretical decision making models. There has been little research outside of the context of critical care or intensive care units, but anecdotal reports in 2006 from the New Zealand Nursing Entry to Practice Programme (NetP) coordinators network suggest that new graduates are seldom employed in critical care or intensive care units in New Zealand. Nursing educators involved in undergraduate nurse training and NetP programmes need to understand how new graduates perceive, experience and manage decision making in clinical practice, in order to assist them to develop and refine those skills. There is a need for studies utilising fundamental qualitative descriptive methodology in order to explore the experiences of new graduates' decision making in clinical practice. The author notes that the topic is particularly relevant in light of the introduction of the national NetP programmes framework in New Zealand, and to her role as a NetP programme coordinator. This dissertation examines the relevant literature about decision making by new graduates and the research methods that were used, and concludes that fundamental qualitative descriptive method is a highly appropriate method by which to study new graduates' decision making.