Expert Consensus on Bedside Decision Support Strategies for Nursing Clinical Reasoning in Postanesthesia Care: A Modified e-Delphi Study.

Purpose

To evaluate decision support strategies that enhance bedside clinical reasoning among PACU nurses, focusing on feasibility, applicability, and contextual relevance.

Design

A modified e-Delphi study.

Methods

The study was conducted in four phases: questionnaire development, pilot testing, iterative expert consensus rounds, and data analysis. Fourteen strategies were evaluated: Journaling, Thinking Aloud, Mentoring, Shared Decision-Making, Gibbs' Reflective Cycle, NEWS, Integrative Nurse Coach, Multi-Criteria Decision Analysis, NEXUS, Toolkit (4A, 5MP, TAM, and Feedback), Restraint Decision Tree, Team Concept Mapping, Shared Decision-Making with Personal Health Records, and the Universal Form of Treatment Options. Data were collected via Google Forms and analyzed using SPSS and content analysis. Consensus was defined as greater than or equal to 75% agreement.

Findings

Of 30 invited experts, 20 completed Round 1 and 14 completed Round 2 (67% response rate; 30% dropout). Ten strategies reached consensus in Round 1, with strong support for reflective, collaborative, and evidence-based approaches such as mentoring, shared decision-making, and team concept mapping. Four strategies were refined and re-evaluated in Round 2. Simulation training and structured briefing/debriefing were also noted as beneficial. Barriers included digital literacy, ethical concerns, and contextual fit.

Conclusions

Adaptable, ethically sound, and interdisciplinary strategies are needed to support clinical reasoning in PACU nursing, informing future education, practice, and policy.