Volume 29, Issue 3 (8-2026)
J Arak Uni Med Sci 2026, 29(3): 205-207 |
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Sari Ojaghi Z, Rostamnezhad A. Professional Silence or Limited Authority? Bridging the Gap Between Clinical Judgment and Nurses’ Ability to Act in Intensive Care. , J Arak Uni Med Sci. 2026; 29 (3) :205-207
URL: http://jams.arakmu.ac.ir/article-1-8393-en.html
URL: http://jams.arakmu.ac.ir/article-1-8393-en.html
1- MSc in Psychiatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran , ojaghi.zahra@yahoo.com
2- MSc Student in Geriatric Nursing, Faculty of Nursing, Khoy University of Medical Sciences, Khoy, Iran
2- MSc Student in Geriatric Nursing, Faculty of Nursing, Khoy University of Medical Sciences, Khoy, Iran
Abstract: (203 Views)
Clinical judgment among nurses in intensive care units is formed under conditions in which treatment decisions involve uncertainty, urgency, and, at times, conflicts between the patient’s interests, family preferences, and the views of the healthcare team. Despite the essential role of nurses in detecting changes in patients’ conditions and delivering care, possessing professional judgment does not necessarily mean having sufficient authority to translate that judgment into action. Existing evidence, including Iranian studies, has primarily examined nurses’ moral distress, clinical decision-making, and professional autonomy, whereas the gap between “professional judgment” and “actual authority to act” has received less attention. This gap becomes particularly important when a nurse’s judgment is not aligned with the decision of the family or healthcare team and the nurse, despite being professionally accountable for care, has limited ability to voice disagreement, influence the decision, or prevent an action that conflicts with their professional judgment. From this perspective, some ethical conflicts in intensive care may reflect not merely communication problems or deficiencies in individual skills, but a structural gap between nurses’ professional responsibility and their actual authority to act. Therefore, evaluating the quality of decision-making in intensive care should extend beyond care outcomes to include nurses’ actual participation in sensitive decisions, opportunities to voice professional disagreement, autonomy within their scope of competence, and effective mechanisms for resolving ethical conflicts. Aligning professional responsibility with commensurate authority to act is an important prerequisite for meaningful professional accountability and safe care.
Keywords: Nurses, Intensive Care Units, Clinical Decision-Making, Clinical Reasoning, Professional Autonomy, Moral Distress
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