Psychosocial assessment : a critical incident analysis of child and family health nurses' decision-making in an early parenting setting

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Child and family health nurses are skilled professionals, responsible for making decisions regarding care. Decision-making in nursing is a complex process involving both formal and informal thinking to gather and analyse information, evaluate significance, weigh alternative actions and to make judgements regarding care. The nurses’ ability to make decisions affects access to and the outcomes of care. Psychosocial assessment of women in the first postnatal year is critical to ensure access to care. Many women caring for their babies experience mental illness. It is essential that these women are recognised and help is offered to them to reduce the risk of mental illness onset or, when present, to provide support and treatment for mental illness. The objective of this research is to describe the clinical decision-making process of child and family health nurses when they undertake psychosocial assessment of women in the postnatal period. A description of the clinical decision-making process of nurses will provide information and education for health care professionals undertaking postnatal psychosocial assessment. Critical Incident technique is the methodology used to explore the process of clinical decision-making. Thinking in Practice is the theoretical framework that is used to understand the clinical decision-making process. Twelve Child and Family Health nurses working in an early parenting service were interviewed in this research study. Both template and thematic analysis were used to work with the data. This research found that decision-making in regard to postnatal psychosocial assessment is a complex process. The nurses move through relevant domains of information that are specific to each woman, most commonly information on parenting and care of the child, information from assessment tools and women determined issues or goals were considered. The nurses used a variety of thinking strategies in each information domain, most commonly searching for information, recognising pattern, drawing a conclusion and judging the value of the information.
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