Revealing the nature of clinical decision making and judgement of acute care dietitians using philosophical hermeneutics

The practice of acute care clinical dietetics involves daily decision making regarding patient care. The aim of this research is to uncover the nature of clinical decision making of dietitians in the acute setting. The method is a qualitative study within the interpretive paradigm using the approach of philosophical hermeneutics. Philosophical hermeneutics is concerned with the human experience but more specifically, the interpreted meaning of this experience. The first study has commenced and involves two recorded semi-structured interviews with ten acute care dietitians to which so far has resulted in transcribed text and preliminary interpretation. This research approach will provide the framework for a second study which will be a hermeneutic study of the literature. Findings from the empirical study so far have shown a dietitian’s decision making is highly contextual, dynamic and layered with strong influences from professional interactions. Their decision making is underpinned by clinical judgement, a fluid construct, that’s constantly evolving as it is evaluated within the large amounts of ever changing patient information. Their decision making involves dimensions of practitioner perceptions & characteristics as well as a complex yet fluid cognitive dimension that underpins each step of the process of caring for the patient’s nutritional needs. It is also dominated by an interactive reasoning process mostly with the medical practitioner illuminating themes of power and autonomy. A deeper understanding of this phenomenon will provide insight into how decision making occurs and therefore potentially contribute to education, professional development and research activities which subsequently optimise patient care.