66: EXPLORING THE APPLICATION OF EVIDENCE IN THE IRANIAN NURSES' CLINICAL JUDGMENT AND DECISION MAKING: A HYBRID QUALITATIVE STUDY

Background and aims: Clinical judgment is based on data collection, information, interpretation, and deduction due to clinical decision making for election of kind/place and time for an intervention or priority. This process needs to apply appropriate evidences; so this study was conducted in order to explain how to use the evidence of Iranian Nurses9 Clinical Judgment and Decision Making. Methods: This Qualitative Study was a hybrid content and concept analysis. This study was a part of a research project approved by the National Institute of Health Research that was conducted at Kurdistan University of medical sciences in 2015. Based on purposive sampling, 26 open and semi structure interviews were conducted with 18 participants. Data collection simultaneously analyzing was continued till saturation and emerging themes. In the concept analyzing, literatures including, 12 articles, 2 books, and 1thesis were selected. Then these literatures were reviewed based on thematic analyzing, Results: Results of content analysis showed two main themes including; integration of the type of evidence based on situational of practice (for example guidelines in emergency ward) and how to access evidence (for example access by internet). Results of content analysis showed two factors determining the level of evidence used, including normal or urgent clinical conditions, having enough time. Conclusion: Combined results showed that integrating evidence in clinical judgment and decision making were based on access to evidence; clinical conditions, and time. Guidelines are the best integrated evidence in emergency wards and critical condition. When the guidelines were not available or there was insufficient time, nurses used their own experiences or the expert opinion. Therefore, it is recommended to update the guidelines and localize them for having appropriate integration of evidence.