Determinants of Nursing Decision-Making: A Systematic Literature Review

Abstract

Nursing decision-making is a dynamic clinical process in which nurses identify salient cues, interpret incomplete or uncertain information, select a course of action, and evaluate its consequences. This systematic literature review synthesized primary empirical evidence on determinants of nursing decision-making published during the prespecified eleven-year eligibility period. A PRISMA-informed search of MEDLINE via PubMed, Europe PMC, OpenAlex, and the Directory of Open Access Journals, supplemented by backward and forward citation tracing, identified 118 records. After 18 duplicates were removed, 100 records were screened, 76 full-text reports were assessed, and 47 studies met the eligibility criteria. Methodological quality was appraised with the Mixed Methods Appraisal Tool, and findings were coded across thirteen inductively consolidated determinants. Experience was examined in 40 studies (85.1%), knowledge in 37 (78.7%), work environment in 32 (68.1%), and team support in 28 (59.6%). By contrast, evidence and technology were examined in only eight studies (17.0%). Narrative thematic synthesis indicated that effective decisions arise from interactions among experiential pattern recognition, analytical reasoning, accessible knowledge, psychological readiness, collaborative support, professional autonomy, workload conditions, and patient-specific ethical complexity. Individual capability was often insufficient when information systems, staffing, hierarchy, or communication constrained action. The evidence supports a multilevel account of nursing decision-making but remains limited by heterogeneous constructs, predominantly cross-sectional and self-report designs, single-reviewer screening, and weak linkage to patient outcomes. Future research should prioritize longitudinal, multilevel, intervention, and measurement studies and should evaluate digital decision support in ways that preserve accountable professional judgment.