Nurses' Clinical Decision-Making During Peripherally Inserted Central Catheter Dressing Application and Removal: A Qualitative Study.

OBJECTIVE

This study aimed to investigate the clinical decision-making and reasoning used by nurses working in cancer care when applying and removing Peripherally Inserted Central Catheter (PICC) dressings and securement devices.

METHODS

We conducted a qualitative study using Think Aloud method involving registered nurses working in two quaternary hospital cancer care wards (one adult; one paediatric) in Brisbane, Australia. Participants were purposively sampled and engaged in one-on-one TA sessions involving the (1) application and (2) removal of one of four dressing and securement combinations. Data were analysed using Framework Analysis and mapped against Dual Process Theory, distinguishing between intuitive (System 1) and analytical (System 2) thinking.

RESULTS

In total, 14 registered nurses participated between January and April 2021. Five interconnected themes emerged, including: (1) Education and Value; (2) Rituals and Culture; (3) Product Familiarity; (4) Anticipatory Assessment and Planning; and (5) Thoughtful Practice. Intuitive thinking was evident in routine behaviours, shaped by ward culture and product familiarity. Analytical thinking was evidence in deliberate, reflective decision-making, particularly in response to patient-specific needs (eg, skin integrity; consumer preferences). Mixed cognitive processes were observed in anticipatory planning, where participants proactively assessed patient and ward/resources factors to guide dressing and securement strategies.

CONCLUSIONS

This study highlights the complexity of PICC dressing and securement, demonstrating that nurses use a range of cognitive strategies that influence their practice.

IMPLICATIONS FOR NURSING PRACTICE: Our findings stress the need for targeted nursing education, structured support for reflective practice, and fostering a ward culture where nurses consistently apply evidence-based practices for PICC dressing and securement.