| Summary: | The purpose of this study was to investigate the process of decision
making that nurses use when determining whether critically ill individuals are
competent to consent to treatment. Grounded theory was employed as the
research approach to this qualitative study. Through the use of theoretical
sampling, data was collected from thirteen informants through audiotaped
interviews. The findings of the study reveal that nurses use a subconscious
process of decision making. Through the normal course of patient care,
nurses acquire considerable knowledge and understanding of their patients.
As nurses come to know their patients they make decisions about patient
competency. The process of decision making consists of four stages. In the
first stage, the nurse assimilates knowledge about the patient’s illness and
initiates the nurse-patient relationship. During the second stage, the nurse
comes to know the patient’s responses to their illness and to the environment.
In stage three, the nurse learns about the personal aspects of the patient.
Finally, in the fourth stage, the nurse integrates the knowledge gained from
the first three stages of the process, and tests the patient’s decision making
abilities. The completion of all four stages of the process places the nurse in
a position to make a clinical judgment about the patient’s competency.
However, for these informants, a determination of patient competence does not always ensure the patient’s involvement in decision making.
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