British Journal of Healthcare and Medical Research - Perception of Decision-Making Among Nurse Interns

British Journal of Healthcare and Medical Research - Vol. 9, No. 4
Publication Date: August, 25, 2022
DOI:10.14738/jbemi.94.12476.
Alharbi, M., AlQurashi, N. & Yehia, H. (2022). The Perception of Decision-Making During Patient Care Among Nurse Interns at Umm
Al Qura University. British Journal of Healthcare and Medical Research, 9(4). 1-16.
Services for Science and Education – United Kingdom
The Perception of Decision-Making During Patient Care Among
Nurse Interns at Umm Al Qura University
Mona Alharbi
Nouf AlQurashi
Hala Yehia
ABSTRACT
Aims: The study assesses the perception of decision-making and its effect on the
patient are among nurses at Umm-al-Qura University. Backgrounds: The interns
who are inducted into the program for a year are included, which leads to the
residency program. Methods: The cross-sectional quantitative study is adapted
from the sample of (n=30) to the nursing interns in Umm-al-Qura University
hospital. The clinical decision- making skills were measured as a part of a
questionnaire taken from Wiens (1991) reference article. The methods, such as
descriptive statistics, independent t-test, and Cronbach alpha, are utilized for the
study. Results: The findings show that the successful integration of the cross-section
survey was high, which indicate the high reliability of the results. Among various
means for the perceived dimension management received the lowest score in the
decision-making; clinical quality is regarded as the highest attribute for dimension
with a mean of 4.10, and the lowest dimension is the clinical instructions as a
dimension with a 3.3 mean. The percentage distribution according to the
perception of stress indicates that there is a 63.3% strong agreement and 36.7%
strong disagreement for both the stress that interns feel in the clinical setting.
Besides, there was no significant correlation found between decision-making and
competence among both males and female interns. Conclusions: The knowledge
gathered from the study is beneficial to the nursing staff, interns, administration,
and the university authorities to formulate the curriculum based on skill gaps that
interns faced during their internship period.
INTRODUCTION
The promulgation of advanced management practices in the healthcare sector can help change
decision-making skills among nursing interns. Previously, the concept of decision-making was
only restricted to doctors and upper nursing staff. As social literacy promulgates in the
professional workplace, the value of decision-making qualities became equally acceptable at all
levels, which include medical interns. Since the inception of nursing student in colleges, they
are trained for the holistic care of the patients and to remain in continuous collaboration with
the doctors and paramedic staff (Hussain, 2016). Nursing graduates or internees who practice
in hospitals often find it stressful, enduring, and effort-demanding for professional decision-
making. Besides skill and technical expertise, the nursing internees often face difficulties in
interventions, adjusting to cultural diversity, dealing with interpersonal skills, and adapting to
the advancements in the technology that is utilised in the healthcare sector (Melin 2017).
Therefore, it is necessary to implement decision-making practices that can help in building their
professional value and help them in managing the working staff.

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Vol 9, Issue 4, August - 2022
British Journal of Healthcare and Medical Research (BJHMR)
The care, productivity, and quality of service are expected from every nurse, regardless of their
professional levels. From top to bottom level, including interns, senior nurses, and nursing
managers- all are expected to deliver the best service to patients. Internship being a first
experience of students into a professional world, it is found that majority of the interns faces
difficulty in recuperating the theoretical knowledge and applying it to practical life due to their
lack of decision-making. Despite of their rational understanding, the mindset lacks the effective
cooperation between inter-personal and intellectual knowledge. There are multiple models to
demonstrate decision-making integrity in nurses, but intern’s adversity is not fully explored in
this regard. Therefore, it is necessary to assess the perception of decision-making during
patient care among nurse interns. The research work will provide a pathway for future research
in nursing leadership and development at Umm-Al-Qura University. The research is of
significant importance as it focuses on the managerial and self-development skills of the nurses.
After completing the research work, the results can serve as a primary incentive to enhance the
interns’ productivity in hospitals. The study can inspire nursing management and help
understand the importance of decision making in the healthcare sector. Nurses perform a
crucial responsibility in delivering high-quality care and restoring health standards among
ailing individuals. They require positive perception, sufficient knowledge and critical decision-
making skills when dealing with patients to improve health outcomes. To develop these skills,
nursing students are subjected to baccalaureate activities, also known as an internship, to help
them transition from theoretical student teachings to practical and professional nurses. The
study purposes to assess the perception of decision among nurse's intern during different
patient care.
METHODS
Design
The study employed cross section research design.
Sampling and sample size
A simple random sampling method was adopted to select the participants from the eligible
baccalaureate nursing students at the faculty of nursing in Umm Al Qura University. The sample
size was estimated according to the study power 80%, level of significance was set at 5%. Then,
the required sample size was 250 nursing students. The researchers included intern nursing
students beginning their training year at different hospitals across Saudi Arabia and fourth-
year baccalaureate nursing student. The sample included students who were looking to
transition to professional practice by attending a preceptorship or mentorship program. The
participants were local and foreign interns attending their final year training and nursing
education at the faculty of Nursing at Umm Al Qura University. On the other hand, the exclusion
criteria comprised second or third year nursing students or interns who had completed their
training after graduating from the Umm Al Qura University. Students or interns from other
colleges or universities other than Umm Al Qura University were excluded from the recruitment
process. Inclusion criteria is male and female nursing intern were included to participate in the
current study. Exclusion criteria: staff nurse and temporary residing students were not part of
this research study
Procedure
Participants were recruited from Umm Al Qura University through an invitation link. The
respondents were accessible through the college of a nursing database within the Umm Al Qura

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Alharbi, M., AlQurashi, N. & Yehia, H. (2022). The Perception of Decision-Making During Patient Care Among Nurse Interns at Umm Al Qura
University. British Journal of Healthcare and Medical Research, 9(4). 1-16.
URL: http://dx.doi.org/10.14738/jbemi.94.12476
University. Some of the respondents were known to the researcher. However, the knowledge
of the respondents did not translate into undue influence over the participants due to the self-
administered of the online questionnaires.
Research Setting
The research questionnaire is sent to the nursing of the Umm-al-Qura Nursing Department.
Notably, only the permanent nursing interns are selected for the research work; temporary
residing students and staff nurse were not part of this research study. The Nursing Department
holds a significant position for being a pioneer in healthcare and research facilities. Professional
values, such as accountability, safety, excellence, collaboration, and transparency, make the
services of the Umm-al-Qura Nursing Department superior to other competitive healthcare
institutes.
Outcome measures
There is a tool known as the Decision-Making Questionnaire (DMQ) that was utilized for this
research. The tools comprise different questionnaire sections developed by Wiens (1991) to
define the characteristics of the decision-making qualities of a novice nurse. Generally, DMQ
comprises 40 items in the questionnaire, formulated by a researcher that characterizes
different decision-making dimensions as indicated in Appendix 1. The Modelling domain (15
items), b) the Cognitive ability (6 items), c) the Experience (7 items) d) the Management (4
items), e) the Clinical quality (2 item), f) the Instructions (2 item) , h) the Social skills (2 item) ,
i) the stress (2 items). The respondents were asked to give their responses on a 5-point Likert-
scale (Strongly Disagree to Strongly Agree). The total score of the questionnaire is 200, in which
the maximum score is 200 and the minimum score is 40. This questionnaire is valid and reliable
based on author, therefore no need to do validity and reliability. After collecting results, the
data will be treated using statistical tools using SPSS to find the mean, median, mode, and
standard deviation of different questions.
The tool was utilized to assist in formulating the delegated activities and task in order to
determine the personal response of each intern. These points can also be used to generate
expert opinion and reiterate the research work without making separate survey for individual
candidates. Also, it is a reliable and proven method of testing the perception of decision-making
among interns.
Data analysis
Processing the results and conducting statistical (t-test) evaluation on the data sets. Research
question test statistics is a basic tool for determining the significance of two-interval data sets.
Ethical consideration
The Committee from the Faculty of Nursing at Umm Al Qura University approved the research
protocol. Informed verbal consent was secured from each subject after the research provided
an exhaustive explanation of the rights to refuse to participate. In addition, the study
participants confidentiality was assured.
Results
The majority of the samples were females (86.7 %), and their age ranged between 20 and 25
years (Table 1). (96.7 %) of students their age 21 years and over, and 90% are single.

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Table 1.Socio-demographic characteristics of nursing students in the study sample (n=30)
Items
Gender Frequency Percent
• Female 26 86.7
• Male 4 13.3
Age (years ) Frequency Percent
• 18-21 years 1 3.3
• 21 years and over 29 96.7
Marital status
• Divorced or Widowed 1 3.3
• Married 2 6.7
• Single 27 90.0
The results demonstrate that the mean and median scores of all four subscales and the total
score of do not show statistically significant differences between the students and interns. In
both, the scores are higher for the subscales of searching for alternatives and canvassing
objectives/values. The medians range between 3 (corresponding to 60% of the maximum
score) for the subscale of searching for information and unbiased assimilation of new
information among students and 3.3 (corresponding to 66% of the maximum score) for the
subscales of searching for alternative canvassing objectives/values among interns. Perceiving
the clinical decision-making competence, it was found that the majority of the participants were
21 years older and above (96.7%), whereas there was only one participant (3.3%) under 18-21
years, as indicated in Table 1. The gender frequency data reveals that 26 females (86.7%) and
four males (13.3%) are included in the study. From the significance of the martial data, it was
found that 1 participant (3.3%) was divorced, 2 participants (6.7%) were married, and 27
participants (90%) were single. All of these participants were undertaking a one-year
internship in the Umm-al-Qura Hospital. The content reliability tests produced that reliability
test from Cronbach alpha analysis shows that 𝛼 = 0.86. The scale as measured for 30 samples,
indicating a high correlative translation from the adaption, reliability and validation of the
available data (Table 2). The reliability score of 0.86 indicates a high correlative relationship
with the collected data.
Table 2. Cronbach alpha analysis for the study sample (n=30)
Sum of Individual Variance 3.307227
Sum of Variance 20.72917
Alpha 0.869436576
The results showed that nurse interns are agreed to use cognitive ability in making decision
making. Nurses are mainly followed theoretical perspective in making decision and utilize
systematic approach in solving problems.

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Table 3. Percentage distribution and means of study sample according their perception of
Modelling
Items SA (A) D (SD) Mean Std.
1. When I work in the clinical setting, I feel I
am well accepted and a valued
member of the team.
16(53.5%) 14 (46.7%) 3.87 .730
5. The nursing staff in my latest clinical
rotation discouraged me from making my
own decisions about patient care.
11 (36.7%) 19(63.3%) 2.90 1.155
6. The clinical instructor in my most recent
clinical experience encouraged me to
independently arrive at decisions
regarding patient care.
14 (46.7% ) 16(53.5%) 3.33 1.124
8. My observations of nursing staff in the
practice of patient care influences me greatly
as I make decisions about patient care.
17 (56.7%) 13 (43.3% ) 3.80 .847
13. In this setting (see question #12) I
was able to use my unique ideas as I
participated in patient care.
23 (76.7%) 7 (23.3%) 3.70 .702
14. In this setting (see question # 12) my
relationship with my clinical instructor was
a factor in my decision making regarding
patient care.
18 (60%) 12 (40%) 3.60 .855
21. I find myself deciding to perform skills
the way staff nurses do, even
though they are different than the way I
learned them in the nursing program.
19 (63.3%) 11(36.7%) 3.59 .733
23. The routines in the clinical setting
discourage students from making
independent decisions about patient care.
16 (53.3%) 14 (46.6 %) 3.47 .730
24. I use the nursing process (assessment,
planning, intervention, and evaluation)
when making decisions regarding patient
care.
19 (63.3%) 11 (36.7%) 3.67 .922
25. Doctors’ orders and hospital rules
prevent me from making important
decisions about patient care.
16 (53.3%) 14 (46.6%) 3.60 .894
26. I was provided with sufficient
opportunities to make independent
decisions about patient care in order to
develop decision-making skills.
15 (50%) 15(50%) 3.33 .994
28. I have the necessary skills to make sound
24 (80%) 6 (20%) 3.83 .834

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29. I am often prevented from carrying out
my decisions about patient care because
nursing staff on the unit tell me to do
something different.
12 (40%) 18 (60%) 3.17 .791
33. My knowledge of the nursing process
(assessment, intervention, and
evaluation) does not really influence my
decision making regarding patient care.
9 (30%) 21 (70%) 2.90 1.125
34. I feel confident about making decisions
25 (83.3%) 5 (16.7%) 4.07 .907
36. I make decisions about patient care that
count.
16 (53.3%) 14 (46.7%) 3.43 .858
The instrumentation of the results involves the integral study of assessing the decision- making
capability of nursing interns. Out of 103 expected responses, 30 active responses on the intern
nurses are collected for the survey. This makes the response rate 60%. The sample size for the
two-tailed test shows that the significant characteristic between the dimensions and effect size
is 0.5. These results show that the study was appropriate in producing the nominal size effect
and the exponential power of statistical analysis, which was sufficient for the correlations and
differences. The majority of the participants perceived that they are confident that the clinical
decision-making is inclined towards a practical approach and understanding its impact on the
quality service of healthcare service. The majority of the dimensions were related to Healthcare
Administration; this can help achieve the direct and indirect impact of the skills possessed by
the individual nursing student.
Table 4 Percentage distribution and means of study sample according their perception of
Cognitive ability
Items SA A S D SD Mean Std.
My use of intuition or 'gut feeling'
results in my best decisions about
patient care.
18 (60%) 12 (40%) 3.66 .857
The theory related to problem
solving and decision making that I
learned in the nursing program
influences me as I make decisions
about
patient care.
20 (66.7%) 10 (33.3%) 3.73 .868
My most successful approach to
decision making is to carefully
examine the data and analyze the
options before determining a
course of
action
24 (80%) 6(20%) 3.80 .714
I often use intuition when making
14 (46.7%) 16 (53.5%) 3.33 .959

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I best solve problems or make
decisions by analyzing all the
information available to me
before forming conclusions.
28 (93.3%) 2 (6.7%) 4.03 .556
Experience
Students with previous
health related work
experience make better
decisions about patient care
than those who don't have
this
experience
24 (80%) 6(20%) 4.03 .850
My clinical nursing
experiences thus far have
not assisted me in
developing decision-
making skills.
12 (40%0 18 (60%) 3.13 1.196
. In my latest clinical
rotation, the nursing staff
on the unit encouraged
students to make decisions
regarding
patient care.
11 (36.7%) 19 ( 63.3%) 3.18 .945
The best predictor of
"sound" decision making is
clinical nursing experience.
19 (63.3%0 11 (36.7%0 3.63 .928
My previous life
experiences have
strengthened my ability
to make sound decisions
about patient care.
20 ( 66.7) 10 (33.3%) 3.80 .761
The clinical instructor in
my most recent clinical
experience was a positive
role-model in decision-
making
21 (70%) 9 (30%) 3.67 .922
The clinical instructor in
my most recent clinical
experience undermined
(did not support) the
decisions I made
regarding patient care
13 (43.3%) 17 (56.7%) 3.13 1.074

8
Management
The experience of
developing and writing out
nursing care plans does not
influence my
ability to make decisions
about patient care.
4 (13.3%) 26 (86.7%) 2.57 .898
The fact that I am evaluated
in the clinical setting
influences the
decisions I make about
patient care.
24 (80%) 6(20%) 3.93 .604
The fact that I am evaluated
in the clinical setting
influences the decisions I
make about
patient care.
22 (73.3%) 8 (26.7%) 3.33 1.061
The participants perceived those eight essential clinical learning elements describe the
rationale of nurses learning the functional assessments, documenting care, and listing the skills.
A similar study was conducted emphasizing the gender factor proposed that the females are
most likely to be confident, compared to the males. This shows the clinical decision making in
females is more likely to be perceived by females than males. Based on the extended survey, it
is evident that the self-efficacy and the importance of the nursing interns were grouped
according to the graduated age group, gender, training hospital, and length of internship period
(A. Aboshaiqah & Qasim, 2018). This is a primary study that caters all the reliability, testing,
and correlation coefficient that is similar to our study is many aspects. Also, the instruments
presented in the research questionnaire are similar to the framework presented in our study.
Table 7 Percentage distribution of study sample according their perception of Clinical quality
When I am caring for a
patient. I feel I am
responsible for making the
decisions about their care.
24 (80%) 6 (20%) 4.10 0.712
Table 8 Percentage distribution of study sample according their perception of Instructions
I consider what my instructor say when I think
about possible choices 1 would could make in
patient care
15 (50%) 15(50%) 3.33 .994
The first part of the study deals with translating cultural adaption, validation, and data
reliability that leads to effective decision making among nursing students. Besides, the study

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further perceived the importance of clinical learning among Saudi intern nurses. The results
show that the interns perceived confidence in realizing the effect of clinical learning objectives.
From the analysis, as indicated in Table 3, it is evident that the percentage distribution and
means of the study sample according to their perception of modelling are interrelated. The
findings show that the ranking of the highest mean is significant for three dimensions: “I feel
confident about making decisions regarding patient care”, which is (4.07 ±0.907). “When I work
in the clinical setting, I feel I am well accepted and a valued member of the team” is second with
a mean of 3.87 ±0.730. Thirdly, the dimension “I have the necessary skills to make sound
decisions about patient care” has a mean of 3.83 ±0.834. While the lowest mean was given to:
“I am often prevented from carrying out my decisions about patient care because nursing staff
on the unit tell me to do something different” with 3.17 ±0.791. Secondly, the “nursing staff in
my latest clinical rotation discouraged me from making my own decisions about patient care”
with 2.90± 1.15. Lastly, “my knowledge of the nursing process (assessment, intervention, and
evaluation) does not influence my decision-making regarding patient care” received a 2.90
±1.25 means score.
Table 9 Percentage distribution of study sample according their perception of Social skills
My relationship with the clinical
instructor in my most recent clinical
experience negatively affected my
attempts at decision making about
patient care.
19 (63.3%) 11 (36.7%) 3.57 0.774
Taken all the dimensions of interns-perceived confidence collectively, it is clear that the highest
level of competence is achieved for nurses who were provided ethical and individual practices.
Considering this fact, Table 4 represents that percentage distribution and means of study
sample according to their perception of cognitive ability, and the findings represented that
ranking of highest mean was given to: “I best solve problems or make decisions by analyzing all
the information available to me before forming conclusions” with a mean of 4.03±0.556.
“Second highest dimension is the “my most successful approach to decision making is to
carefully examine the data and analyze the options before determining a course of action” with
3.80 ±0.714. Lastly, “the theory related to problem-solving and decision making that I learned
in the nursing program influences me as I make decisions about patient care” at a mean of 3.73
±0.868. While the lowest mean was given to “my use of intuition or 'gut feeling' results in my
best decisions about patient care” that is 3.66 ± 0.857, and “I often use intuition when making
decisions about patient care” (3.33 ±0.959).

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Stress
The stress I feel in the
clinical setting, affects my
ability to make
sound decisions about
patient care.
19 (63.3%) 11 (36.7%) 3.77 1.073
I find that my clinical
experience is stressful.
19 (63.3%) 11 (36.7%) 3.73 .980
Experience as a dimension is employed as an essential factor in decision-making among nurse
interns. Research by Nibbelink & Brewer (2018) shows that the experienced decision- making
use the classical approach in real-life circumstances. Comparative to the decision- making
patterns, experience as a dimension is based on critical factors, such as uncontrolled, time-
limited, and high-stress circumstances. Table 5 represents the Percentage distribution and
means of the study sample according to their perception of Experience. The study findings
represented that ranking of highest mean was given to: “Students with previous health-related
work experience make better decisions about patient care than those who do not have this
experience” with 4.03 ±0.850. Second is the “my previous life experiences have strengthened
my ability to make sound decisions about patient care” 3.80 ± 0.761. The third is the “the clinical
instructor in my most recent clinical experience was a positive role-model in decision-making
regarding patient care” with 3.67 ±0.922. While the lowest mean was given to: “the best
predictor of "sound" decision making is clinical nursing experience” has 3.63 ±0.928. The
second lowest is “in my latest clinical rotation, the nursing staff on the unit encouraged students
to make decisions regarding patient care” with 3.18 ±0.954. Lastly, “the clinical instructor in
my most recent clinical experience undermined (did not support) the decisions I made
regarding patient care” with 3.13 ±1.07.
Table 11. Percentage distribution of participants according to their perception DM
Modelling as dimension 270 (45.45%) 210 (48.6%) 3.52 0.688
Cognitive ability as a
dimension
90 (15.15%) 30(6.9%) 3.70 0.446
Experience as a
dimension
120(20.20%) 90 (20.8%) 3.51 0.612
Management as
dimension
50 (8.4%) 40 (9.25%) 3.28 0.574
Clinical quality as
dimension
24 (4.04%) 6 (1.39%) 4.10 0.712
Instructions as a
dimension
15 (2.52%) 15 (3.47%) 3.33 .994
Stress as dimension 38(6.39%) 22 (5.1%)
Social skills as dimension 11 (1.85%) 19 (4.39%) 3.57 0.774
total 594 432 3.13 0.601

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Nursing management comprises a major portion of the healthcare sector. It is a practice that
advances various evidence-based practices and technology. Although there are several
challenging factors that contribute to the demographic dynamics, a study from Nageshwar et
al. (2016) indicates a similar framework related to the post-operative framework among the
nursing staff. Compared to other results, as indicated in Table 6, it represents that percentage
distribution and means of study sample according to their perception of Management, the study
findings represented the ranking of means as: “the fact that I am evaluated in the clinical setting
influences the decisions I make about patient care is found” to have a mean of 3.93 ± 0.604.
Secondly, “the fact that I am evaluated in the clinical setting influences the decisions I make
about patient care” has 3.33 ± 1.06. Lastly, “the experience of developing and writing out
nursing care plans does not influence my ability to make decisions about patient care” has 2.57
± 0.898.
Table 12. Difference in DM according to gender
Items Female male
Z P
Mean
rank
Sum of
Ranks
Mean rank Sum of
Ranks
Modelling as dimension 14.32 358.00 19.25 77.00 -1.077- 0.280
not significant
Cognitive ability as a
dimension
14.16 354.00 20.25 81.00 -1.353- 0.176
not significant
Experience as a dimension 14.00 364.00 21.00 42.00 -1.175- 0.240
not significant
Management as dimension 13.96 363.00 21.50 43.00 -1.276- 0.202
not significant
Clinical quality as
dimension
15.21 395.50 17.38 69.50 -.499- 0.618
not significant
Instructions as a dimension 16.10 418.50 11.63 46.50 -1.023- 0.306
not significant
Stress as dimension 15.46 402.00 15.75 63.00 -.062- 0.915not
significant
Social skills as dimension 15.96 415.00 12.50 50.00 -.752- 0.452
not significant
Total score 12.75 306.00 22.50 45.00 -1.734- 0.083
not significant

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Perception of clinical quality is a fundamental factor that indicates that the percentage
distribution is indicated in Table 7 and mean of study sample according to their perception
Clinical quality, the study findings represented that (80%) of the study sample were strongly
agreed and agree about "When I am caring for a patient. I feel I am responsible for making the
decisions about their care" by 4.10 ± 0.712. Table 8 represents the Percentage distribution and
mean of the study sample according to their perception of Instructions. The study findings
represented that (50%) of the study sample were strongly agree and agree about " I consider
what my instructor say when I think about possible choices 1 would make in patient care " by
(3.33 ± 0.994). Also, Table 9 represents the percentage distribution and mean of study sample
according to their perception of social skills; the study findings represented that (63.3 %) of the
study sample were strongly agree and agree about " My relationship with the clinical instructor
in my most recent clinical experience negatively affected my attempts at decision making about
patient care " by (3.57 ± 0.774). Table 10 shows represent the percentage distribution and
mean of the study sample according to their perception of Stress. The study findings
represented that (63.3 %) of the study sample were strongly agreed and agree about “The
stress I feel in the clinical setting affects my ability to make sound decisions about patient care".
Furthermore, "I find that my clinical experience is stressful" by (3.57 ± 0.774).
Table 13. Percentage distribution of Choose 3 that influence you the LEAST and rank them
Items Most
influential
ModerateMild Sometime least
n % n % n % n % n %
1 my previous life experience 21 (70%) 9 (30%)
2 my previous nursing
experience
23 (76.7%) 7(23.3%)
3 the environment on the unit 23 (76.7%) 7(23.3%)
4 hospital policies 18 (60%) 12 (40%)
5 the attitude of the staff 23 (76.7%) 7 (23.3%)
6 my knowledge of the nursing
process
19 (63.3%) 11 (36.7%)
7 my relationship with the
instructor
19 (63.3%) 11 (36.7%)
8 my status as a student 15 (50%) 15 (50%)
9 the consequences of my
decision
19 (63.3%) 11 (36.7%)
10 my knowledge of patients and
their condition
24 (80%) 6 (20%)
11 my 'gut' feelings about the
situation (instincts)
19 (63.3%) 11 (36.7%)
12 my level of self confidence 21 (70%) 9 (30%)
13 my observations of other staff
members
20 (66.7%) 10 (33.3%)
14 the knowledge that I was being
evaluated
18 (60%) 12 (40%0
15 the time constraints I had to
work within
17 (56.7%) 13.(43.3%)
16 fatigue 15 (50%) 15 (50%)

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Items Most
influential
Moderate Mild Sometime least
n % n % n % n % N %
1 my previous life experience 3 (10%) 14 (46.7%) 13
(43.3%)
2 my previous nursing experience 5
(16.7%)
10 (33.3%) 15
(50%)
3 the environment on the unit 4
(13.3%)
16 (53.3%) 10(33.3
%)
4 hospital policies 2 (6.7%) 16 (53.3%) 12
(40%)
5 the attitude of the staff 4
(13.3%)
10 (33.3%) 16
( 53.3%
6 my knowledge of the nursing
process
1(3.3%) 18 (60%) 11
(36.7%)
7 my relationship with the
instructor
5
(16.7%)
18 (60%) 7
(23.33%
)
8 my status as a student 9 (30%) 11
(36.7%0
10
(33.3%)
9 the consequences of my
decision
3 (10%) 19 (63.3%) 8
(26.7%0
10 my knowledge of patients and
their condition
7
(23.33%
)
12 (40%) 11
(36.7%)
11 my 'gut' feelings about the
situation (instincts)
6 (20%) 15 (50%) 9 (30%)
12 my level of self confidence 30(10%)12 (40 %) 15
(50%)
13 my observations of other staff
members
4
(13.3%)
17 (56.7%) 9 (30%)
14 the knowledge that I was being
evaluated
4
(13.3%)
14 (46.7%) 12
(40%0
15 the time constraints I had to
work within
2
(607%)
18 (60%) 10(33.3
%)
16 fatigue 2 (6.7%) 12 (40%) 16
(53.3%)
DISCUSSION
A study on the perception by Ibrahim & Aly (2018) indicates the cognitive ability and
prevalence of intellectual skills on the decision-making capability. The research indicates that
the preceptors and educational training of the nurses tends to affect the cognitive ability in
decision-making. Comparing the percentage distribution and the study sample according to the
perception, it was found that 93.3% of the mean is related to the “I best problem to make a

14
decision is to analyze all information available to me and before forming conclusion”. However,
dimension, such as intuition of decision-making about patient care narrows –down to the
53.5% of strong disagreement among the nurse interns. Perception about the distribution of
study according to the interns’ experience is well-explained by A. E. Aboshaiqah et al. (2018),
which indicates that the development of self-confidence and the utilization of rationale is found
to effective in decision-making. The research work has proved that experience includes the
negative and positive factors that lead to appropriate decision-making. For instance, the
utilization of confidence-oriented communication and decision-making plays a critical role in
nursing practices. This leads to protocols that are essential for patient care and influences their
nursing practices' capability. Upon comparing the research results, it is proved that 80% of the
interns strongly agree of that student with previous health related work experience make
better decisions about patient care than those who don't have this experience. In contrast,
63.3% interns strongly disagree that in their latest clinical rotation, the nursing staff on the unit
encouraged students to decide patient care.
Nursing interns’ perception of the management practices is research by Abdel Kader,
Mohamed, & Abood (2012). It is evident from their findings that management practices and
their related education play a critical role in effective decision making. Besides improving the
situational awareness among professionals, it is helpful to cater to the patient’s management
and influence the effective interventions of dealing with emergencies and supporting abilities
that increases self-confidence. In our study, it is evident that 86.7% of interns strongly disagree
with the fact that the experience of developing and writing out nursing care plans does not
influence my ability to make decisions about patient care; however, 72.3% indicate that the fact
that I am evaluated in the clinical setting influences the decisions I make about patient care.
Since all this affect the percentage distribution of clinical quality is defined by all the above
factors; therefore, 80% of the interns believe that when they are caring for a patient, they feel
they are responsible for making the decisions about their care.
To date, the most comprehensive argument on the supplementary class of residency program
is influenced by direct instructions in promoting graduate critical thinking (Mousa, Menssey, &
Kamel, 2017). The critical analysis of the percentage distribution of the study sample in
accordance to the perception of instructions indicates that 50% of the interns strongly agree
and 50% strongly disagree with the fact that we consider what my instructor say when we think
about possible choices, we will make in patient care. Besides, the percentage of sample
perception of social skills strongly agrees with the 63.3% of the relationship with the clinical
instructions in recent clinical experiences negatively affect the attempt at decision making
about patient care. This shows that focusing on professional growth requires instructions and
both social skills. Perceptions of the stress related to decision-making in nursing interns are
assessed by the study (Sperling, 2020). This indicates that the preceptors that intern's guidance
and evaluation is necessary during the increased stress. This can either be related to interns
lacking skills and clinical knowledge, leading to subtle skills. Comparing to our research, the
percentage distribution according to the perception of stress indicates that there is a 63.3%
strong agreement and 36.7% strong disagreement for both the stress that interns feel in the
clinical setting, as it affects the ability to make sound decisions about patient care, and they find
that clinical experience is stressful, respectively.

15
In line with effective decision-making, it is integrated that dealing with the professional cases
has a consequential effect on the interns and their abilities to observe and apply theoretical
knowledge. Focusing on the findings from various studies, it is clear that the developing logical
pertinent is associated with the psychological and practice behaviours. The congruent study, as
explained by the holistic review, is based on the ambiguous recognition of nursing standards
and clinical practices needed to take a suitable decision. Van Graan & Williams (2017) asserts
that professional nurses should have thinking talents that are needed for the fundamental
practices and dealing with the scientific roles. These preceptors in the clinical instructions for
equipping the nursing students with the knowledge and the nursing profession. Considering
the participant's response regarding the lack of educational preparation as a virtue of decision-
making, the collected responses are gathered in terms of modelling, cognitive ability,
experience, management, clinical quality, instructions, and social skills.
CONCLUSION
The present study concluded that nurse interns perceived the highest level of their perception
toward decision making was the modelling dimension, followed by experiences, while the
lowest level of their perception was the social skills dimension. The findings from the study
confirm that the adapted dimension in the questionnaire is a reliable source for self—efficacy
and perceiving decision-making among nursing interns. In the light of the survey and analysis,
there are no statistical differences found between male and female students among the study
sample in all domains of decision making.
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