Barriers and facilitators to managing uncertainty in nurses’ clinical reasoning in post-anaesthesia care units: a qualitative thematic analysis

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Lara Daniela Matos Cunha
Márcia Pestana-Santos
Lurdes Lomba
Margarida Reis Santos


Clinical decision-making, Clinical Reasoning, Patient Safety, Post-anaesthesia Nursing, Postoperative Period, Uncertainty


Objective: To describe and analyse barriers and facilitators to managing uncertainty in nurses’ clinical reasoning in post-anaesthesia care units.

Background: The diagnostic process in complex clinical settings often involves uncertainty. This can bias clinical reasoning and compromise the safety of healthcare. Still, little is known about how nurses deal with uncertainty in their clinical practice.

Study design and methods: This study employs a qualitative descriptive design. Fourteen nurses working at a post-anaesthesia care unit were selected through convenience sampling. Data was collected through semi-structured interviews and analysed using thematic analysis. The deductive analysis was undertaken based on the Theory of Reasoned Action. This study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

Results: Two major themes emerged from the analysis: ‘barriers’ and ‘facilitators’. Each major theme aggregated four themes: intention to perform the behaviour, attitudes, subjective norms, and external variables.

Discussion: The perceptions of barriers and facilitators provide valuable insights into current and desired practices that can help minimise uncertainty in nurses’ clinical reasoning in post-anaesthesia care units. They provide knowledge and future direction for clinical practice improvements by addressing motivations for reasoning behaviour. The need to create more nurse-friendly working conditions and reduce the cognitive and emotional impact of uncertainty was also identified.

Conclusion: This study provides a comprehensive list of barriers and facilitators of uncertainty management in clinical reasoning based on nurses’ perceptions. Recognising behaviours based on reasoned action is essential to manage uncertainty in nurses’ clinical reasoning.

Implications for research, policy, and practice:

These findings can be used by different stakeholders to better manage uncertainty in healthcare settings. They are valuable resources for health professionals, researchers, and healthcare institutions attempting to improve health practices and enhance safety in health services.

What is already known about the topic?

  • The safety and quality of post-anaesthesia care is highly influenced by the clinical reasoning of healthcare providers.

  • In complex clinical settings, such as postanaesthesia care units, uncertainty in clinical reasoning is common and expected.

  • Identifying barriers and facilitators of clinical reasoning is essential to support nurses cope with uncertainty in post-anaesthesia care units.

What this paper adds:

  • Embracing uncertainty as an opportunity for personal and professional development is a facilitating factor.

  • The barriers to managing uncertainty are related to individual personality characteristics and the nature of interpersonal and professional relationships.

  • Maladaptation to uncertainty in clinical reasoning has a major impact on nurses’ wellbeing in postanaesthesia care units.

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