Volume 35, Issue 138 (October 2022)                   IJN 2022, 35(138): 360-373 | Back to browse issues page

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Salehi T, Shojaee N, Haghani H. Relationship Between Participation in Clinical Decision-making and Organizational Culture Among Nurses in Intensive Care Units of Hospitals Affiliated to Iran University of Medical Sciences. IJN 2022; 35 (138) :360-373
URL: http://ijn.iums.ac.ir/article-1-3489-en.html
1- Department of Nursing Management, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran. , Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
2- Department of Nursing Management, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran. , nahidshojaee5@gmail.com
3- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
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Global health is undergoing considerable changes. Advances in technologies and methods of patient care have increased the complexity of decision-making in clinical care. The role of nursing profession in responding to new knowledge, political pressures, and technological advances in health care has increased, which has associated with broader decision-making. Clinical decision making is a complex process that requires the nurse’s knowledge, access to appropriate information resources, and a supportive work environment. In intensive care units (ICUs), clinical decisions are made quickly in a stressful environment; nurses must make quick and accurate decisions to avoid the worsening of patients’ condition. In addition, dealing with new and complex technology, being in contact with critically ill patients, and lack of resources, puts a heavy burden on ICU nurses and affects their decision-making skills. 
The nurse’s ability to promote health, prevent disease, relieve pain, and provide high-quality patient care depends on effective clinical decision-making. Clinical decision-making is an essential component of nursing profession which distinguishes professional nurses from non-professional ones. According to annual reports, a large number of patients die due to poor health care decision-making. Numerous factors, including individual and organizational factors affect clinical decision-making. The organizational factors have not been fully understood; identifying them can help hospital managers improve nurses’ clinical decision-making skills. One of these organizational factors is organizational culture. It is a factor to give identify to the organization and commitment of employees. It reflects the norms that determine the attitude and behavior of people in the organization and is a behavioral guide for them. Despite the importance and possible relationship between clinical decision-making and organizational culture, no study was found to examine their relationships. Therefore, this study aims to investigate the participation in clinical decision-making of nurses in the ICUs of hospitals affiliated to Iran University of Medical Sciences and examine its relationship with organizational culture.
Materials & Methods 
This is a descriptive-correlational study. The study population consists of all nurses working in the ICUs of hospitals affiliated to Iran University of Medical Sciences in Tehran, Iran. Of these, 317 nurses who met the inclusion criteria were selected by proportional stratified sampling, sequential sampling, and quota sampling methods. Due to the COVID-19 pandemic, sampling lasted four months (February-May, 2021). The data were collected using three instruments: (a) Demographic form, (b) the clinical decision-making questionnaire (CDMQ) of Kyalo which has 27 items rated on a four-point Likert scale (1=Never: 2=Rarely; 3=Sometimes; 4=Always), (c) Cameron & Quinn’s organizational culture assessment instrument (OCAI), which has 24 items and 6 subscales, each with 4 items. The content validity of these questionnaires was evaluated and confirmed by a panel of experts including three faculty members from the School of Nursing and Midwifery, Iran University of Medical Sciences. The reliability of the CDMQ with Cronbach’s alpha was obtained 0.91. For the OCAI, the reliability in the study by Cameron et al. (1990) with Cronbach’s alpha was reported higher than 0.70. The face and content validity of the Persian version of this questionnaire was confirmed by Darvish et al. (2014), who reported a Cronbach’s alpha of 0.87. The obtained data were analyzed in SPSS v.16 statistical software. Descriptive statistics (mean, standard deviation, frequency, percentage) were used to describe the data, and Pearson correlation test, independent t-test, and chi-square test were used to examine the relationships between the study variables.
The mean score of CDMQ was 70.16±11.65, which is higher than the cutoff point of the instrument (>54). This indicated that the nurses’ participation in clinical decision-making was high. The dominant organizational culture in the current conditions was the market culture, and the clan culture was the dominant culture in the preferred conditions. The organizational culture had no statistically significant relationship with clinical decision-making the current conditions (P=0.130), but this relationship was significant in the preferred conditions (P=0.014). Clinical decision-making in nurses with clan culture was significantly higher than in those with market culture (P=0.013).
The findings showed that clinical decision-making of nurses in ICUs of hospitals affiliated to Iran University of Medical Sciences was high. The current organizational culture was different from the preferred organizational culture. Nurses’ organizational culture had a significant relationship with their clinical decision-making. Given that the clan culture was recognized as the preferred culture, planning should be done to establish clan culture in the study hospitals to increase nurses’ participation in clinical decision-making. 

Ethical Considerations
Compliance with ethical guidelines

Ethical approval for this study was obtained from the Ethics Committee of Iran University of Medical Sciences (Code: IR.IUMS.REC.1399.111.

This study was extracted from a master thesis Mrs Nahid Shojaee in nursing management. It was funded by Iran University of Medical Sciences.

Authors' contributions
Supervision, data analysis: Tahmine Salehi; preparing initial draft, project management, editing & review: Nahid Shojaee; Data analysis: Hamid Haghani

Conflict of interest
The authors declare no conflict of interest.

The authors would like to thank Iran University of Medical Sciences, the staff of selected hospitals, and all the nurses who participated in the study for their support and cooperation.

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Type of Study: Research | Subject: nursing
Received: 2021/10/23 | Accepted: 2022/10/23 | Published: 2022/11/1

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