The Effect of the Model-Based Care Decision Support System in Pediatric Intensive Care on Nurses' Decision Making and Opinions

This study is designed as a mixed-method research aiming to determine the effect of using a Model-Based Care Decision Support System in Pediatric Intensive Care on nurses' perspectives and decision-making skills. The study is a semi-experimental and qualitative research conducted using a single-group pre-test/post-test design.

The study consists of two phases. The first phase involves the development of the Model-Based Care Decision Support System. The second phase aims to evaluate the impact of the developed Care Decision Support System on nurses' perspectives regarding the system and their decision-making skills. A qualitative research method will be used to determine nurses' views on the Care Decision Support System, and a single-group pre-test/post-test semi-experimental design will be used to assess the effect of the decision support system on nurses' clinical decision-making skills.

The population of the study will consist of 38 nurses working in the Pediatric Intensive Care Unit of a university hospital located in the city center of Ankara. A sampling method will not be used in this study; instead, the study group will consist of nurses who meet the inclusion criteria and voluntarily agree to participate in the study.

Phase One - Development of the Care Decision Support System In this phase, a Model-Based Nursing Care Decision Support System will be developed. The system will be based on the Family-Centered Care Model and Watson's Theory of Human Caring, as these aspects of care are often overlooked in pediatric intensive care units due to the high demands of physical care. The Family-Centered Care Model emphasizes principles such as respecting the child and family (including their ethnic, cultural, socioeconomic, and racial characteristics, as well as their coping mechanisms), recognizing and supporting the strengths of the family, guiding families by supporting their preferences and decisions through care approaches, and ensuring that policies align with the family's cultural values and beliefs. Watson's Theory of Human Caring includes three main components: interpersonal caring relationships, the caring moment, and the healing processes. The nursing care components to be included in the decision support system will be identified through a qualitative study involving nurses working in pediatric intensive care units. Using the snowball sampling method, in-depth individual interviews will be conducted with nurses who are not part of the main study population. These interviews will explore which nursing care interventions should be integrated into the system. Nurses participating in this phase will be purposively selected based on criteria such as clinical experience and educational background. Pediatric intensive care nurses known to the researcher through personal or professional networks will be invited to participate. Interviews will be conducted at a suitable time outside working hours using digital platforms (e.g., Zoom, Google Meet). Data collected from these interviews will be analyzed using content analysis, and the nursing interventions to be included in the system will be finalized. Following this, the care content for the Decision Support System will be created. Expert opinion (from academic and clinical pediatric nursing professionals) will be sought to finalize the interventions to be included in the system. A software company will then be commissioned to develop the digital interface. The Care Decision Support System will incorporate the nursing process and will support nurses in identifying nursing diagnoses and selecting appropriate interventions based on patient data. The system will begin with the data collection phase of the nursing process. It will guide nurses on which data should be collected, provide alerts and prompts during analysis, and assist in clustering data to suggest possible nursing diagnoses. If a nurse selects a diagnosis but patient data is incomplete, the system will issue an alert and prompt for missing data, thereby assisting the nurse in the data analysis process. After a diagnosis is confirmed, the system will offer a set of care interventions associated with that diagnosis. Similarly, in the evaluation phase, the system will guide nurses on which outcomes should be assessed.

This comprehensive system, encompassing data collection, diagnosis, implementation, and evaluation phases of the nursing process, is designed to support pediatric intensive care nurses in making accurate care decisions. Once the software is complete, a pilot test will be conducted to assess usability and clarity. The pilot will be carried out with nurses not included in the main study sample. Necessary adjustments will be made based on the pilot, and the second phase of the study will then begin.

Phase Two - Implementation of the Care Decision Support System In this phase, data will be collected using the Descriptive Information Form, the Nurse Decision-Making Scale (as a pre-test), and the Semi-Structured Interview Form designed to explore nurses' views regarding the Decision Support System. Training will be provided to the nurses on how to use the Decision Support System, which was developed for use in providing continuous 24-hour nursing care for pediatric patients. To ensure participation, training sessions will be conducted in two groups, aligning with the nurses' work shifts so as not to disrupt clinical operations. The training will consist of two sessions totaling four hours. Topics covered will include the importance and use of the clinical decision support system, potential challenges, and suggested solutions. The system will then be introduced to the sample nurses (who meet the inclusion criteria) through hands-on application. Before full implementation in the clinical setting, a one-week trial period will be conducted to address any questions nurses may have about using the system. During this trial, the researcher will respond to all usage-related questions. A WhatsApp group including the participating nurses and the researcher will also be created to provide support throughout the implementation period.

Nurses will be required to use the system for a minimum of 15 days. Due to the time limitations of the doctoral dissertation, the maximum usage period will be 30 days. Fifteen days after the implementation ends, the post-test will be conducted using the Nurse Decision-Making Scale and a Semi-Structured Interview Form designed to evaluate the effectiveness and possible improvements of the Model-Based Nursing Care Decision Support System.

• Semi-Structured Interview Form for the Implementation of the Decision Support System [Time frame: two week]