Challenges of Clinical Decision-making in Emergency Nursing: An Integrative Review

Background The Emergency department (ED) is a complex environment where nurses must make critical decisions under time pressure. This dynamic environment requires advanced clinical decision-making skills to ensure patient safety and positive outcomes. Objective The objective of this study is to investigate the challenges faced by emergency nurses in decision-making processes in the emergency department. Methods This integrative review study was conducted based on Broome’s method in three stages: the search process, critical appraisal of research, and analysis and synthesis. A search was performed for relevant studies in seven electronic databases (IranMedex, Scientific Information Database (SID), MagIran, Science Direct, PubMed, Google Scholar, and ProQuest) and it was limited to papers published in English and Persian after 2005. Results This integrative review identified several key challenges in clinical decision-making for emergency nurses. These include significant time constraints, ambiguous clinical scenarios, insufficient patient history, and limited access to diagnostic tools. Inexperience among newly qualified nurses, emotional stress, and poor communication further complicate decision-making. Resource limitations, ethical dilemmas, cultural diversity, and legal concerns also affect the process. These findings highlight the need for targeted interventions to support emergency nurses and improve patient care. Conclusion This review highlights critical challenges in clinical decision-making for emergency nurses, including time and resource constraints. Enhancing decision-making skills through targeted interventions and support systems is essential for improving patient care and outcomes in ED. Future research should focus on effective strategies to address these issues.