Decision Fatigue in Nursing: An Evolutionary Concept Analysis

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Background and Aims: Decision fatigue, a critical cognitive challenge for nurses, significantly impacts patient care quality and individual well-being. This concept analysis aims to thoroughly examine decision fatigue in nursing, a consequence of frequent and challenging decisions for healthcare personnel. Methods: Utilizing Rodgers' evolutionary method, this concept analysis of "decision fatigue" in nursing involved a systematic literature search across PubMed, Scopus, Web of Science, and Google Scholar. Relevant studies were analyzed using content analysis to extract key themes. Findings were synthesized to define the concept and explore its antecedents, consequences, and practical implications. Results: Decision fatigue, defined as the cumulative effect of continuous decision-making and associated decision fatigue, manifests across behavioral, physiological, and cognitive dimensions. It can lead to a decline in optimal decision-making capacity throughout a shift. Both personal factors (e.g., insufficient sleep, stress, lack of support) and organizational factors (e.g., personnel shortages, heavy workloads, conflicting decisions) contribute. For instance, studies showed that nurses tend to make more cautious and less efficient decisions over time, and patient admission rates decreased in the final hours of emergency department shifts. Consequences include reduced patient care quality and safety, ineffective decision-making, job stress, burnout, and increased job turnover. Conclusion: Decision fatigue poses a significant challenge for nurses, with serious implications for both nurses and patient outcomes. Understanding its contributing factors and implementing mitigation strategies are essential to support nurses and improve patient care.

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