Critical Thinking, Self-Confidence, and Clinical Decision-Making in Managing Patient Deterioration Events Among Medical Surgical Staff Nurses in Selected Hospitals in Manila.

Abstract:

Purpose: This study aimed to determine which nurse-related factors—specifically critical thinking, self-confidence, and selected demographic characteristics— significantly predict the clinical decision-making of medical-surgical nurses when managing patient deterioration. Background: Patient deterioration in medical-surgical units poses a serious challenge to patient safety, often requiring prompt and sound clinical decision-making from nurses. While critical thinking and self-confidence are believed to influence nurses' decisions, few empirical studies have examined their predictive role, particularly in the Philippine hospital context. Method: A predictive correlational research design was employed. Data were collected from 290 medical-surgical staff nurses working in selected level 2 and level 3 hospitals across Manila. Standardized instruments were used to measure critical thinking (CTSAS), self-confidence (Hicks Scale), and clinical decision-making (CDMNS). Multiple linear regression (MLR) was used to identify significant predictors of clinical decision-making. Results: The ten-variable full model significantly predicted clinical decision-making, F(10, 273) = 47.6, p < .001, with an adjusted R² of 0.677. A four-factor reduced model—consisting of critical thinking, self-confidence, prior rotation in non-medicalsurgical units, and previous rapid response team (RRT) training—retained similar explanatory power (adjusted R² = 0.676). Specifically, clinical decision-making scores increased with higher critical thinking (b = 0.280, p < .001), self-confidence (b = 1.124, p < .001), non-MS unit experience (b = 4.502, p = .005), and prior RRT training (b = 6.196, p < .001). Conclusion: The study confirms that critical thinking and self-confidence are significant predictors of nurses’ clinical decision-making during patient deterioration events. Contextual factors, such as prior rotations and RRT-related training, also enhance decision-making capacity. These findings emphasizes the need for structured education and training programs that cultivate cognitive competence and experiential preparedness among medical-surgical nurses. Implications: Nursing practice should incorporate simulation-based learning, mentorship, and scenario-based training to enhance nurses' critical thinking and confidence. Nurse educators and hospital administrators are encouraged to provide diverse clinical exposure and continuous professional development to strengthen decision-making skills vital for early recognition and management of patient deterioration.