Exploring the perception and judgment of senior baccalaureate student nurses in clinical decision-making from a nursing theoretical perspective

This study focused on theoretical clarification of Brooks' Theory of Intrapersonal Perceptual Awareness (BTIPA), a newly developed mid-range theory from Imogene King's (1981) Interacting Systems Framework. BTIPA provides a wholistic approach to clinical decision-making. The central premise of BTIPA asserts that the nurse, as a whole person (perceiving, judging, intuiting, sensing, thinking and feeling) makes decisions. This study had two purposes: (a) to clarify BTIPA by identifying and classifying intrapersonal factors which are integral to decision-making in baccalaureate student nurses, and (b) to extend King's work, through BTIPA, by explicating the concepts of perception, judgment and decision-making in the personal system. One research question addressed the central premise. In a descriptive-exploratory design, with structured interview and theoretically derived, open-ended questions, 18 senior baccalaureate students were interviewed and audiotaped. A coding scheme, developed from the theoretical definitions, was used in content analysis to systematically analyze each verbatim transcript. The findings supported the central premise and clarified the interaction of perception (sensory and intuitive) and judgment (cognitive and affective) as whole-person (intrapersonal perceptual awareness) decision-making processes of self. Self emerged as the core concept to intrapersonal perceptual awareness. The researcher concluded that it is actually the interaction of the intrapersonal characteristics of self through which whole-person decision-making occurs. The findings were used to reconceptualize BTIPA as a whole-person process. Because perception and judgment occurred interactively through self, the findings did not support bringing the concepts (perception, judgment and decision-making), as separate concepts, into King's personal system, as originally proposed in BTIPA. Instead, the researcher concluded that self and person are the same, and the findings are used to demonstrate a recommended reconceptualization of King's personal system as self, the whole person. In reconceptualization, perception and judgment could be brought into the personal system through self. The findings did not support bringing decision-making, as originally proposed, into the personal system because intrapersonal and interpersonal decisions (from which the BTIPA decision was derived) were not the same. BTIPA has implications for developing a wholistic approach in teaching decision-making, viewing students wholistically, curriculum development, and understanding intrapersonal processes for socialization of professional nurse values.