An integrated, ethically driven environmental model of clinical decision making in emergency settings.

PURPOSE To explore the relationship between multiple variables within a model of critical thinking and moral reasoning. METHODS A quantitative descriptive correlational design using a purposive sample of 200 emergency nurses. Measured variables were accuracy in clinical decision-making, moral reasoning, perceived care environment, and demographics. Analysis was by bivariate correlation using Pearson's product-moment correlation coefficients, chi square and multiple linear regression analysis. FINDINGS The elements as identified in the integrated ethically-driven environmental model of clinical decision-making (IEDEM-CD) corrected depict moral reasoning and environment of care as factors significantly affecting accuracy in decision-making. CONCLUSIONS The integrated, ethically driven environmental model of clinical decision making is a framework useful for predicting clinical decision making accuracy for emergency nurses in practice, with further implications in education, research and policy. PRACTICE IMPLICATIONS A diagnostic and therapeutic framework for identifying and remediating individual and environmental challenges to accurate clinical decision making.