Measuring Nurses' Uncertainty in Clinical Decision-making: An Integrative Review

Mitra Mousavi Shabestari1
, Akram Ghahramanian1
, Fariborz Roshangar1, *
, Faranak Jabbarzadeh Tabrizi1
, Vahid Zamanzadeh1
, Parvin Sarbakhsh2

1 Department of Medical Surgical Nursing, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
2 Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran

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© 2023 Shabestari et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Medical Surgical Nursing, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran; Tel: 0989144024683; E-mail:



There are complexities and controversies regarding the concept of uncertainty in clinical decision-making, making this concept difficult to use.


This study aimed to review the definitions and instruments related to uncertainty in clinical decision-making to help researchers select better tools when examining uncertainty in nursing practice.


To retrieve the related studies, we searched seven electronic databases, including IranMedex, Scientific Information Database (SID), MagIran, PubMed, Science Direct, Google Scholar, and ProQuest. The COSMIN Consensus-based Standards for the Selection of Health Measurement Instruments (consensus-based standards for the selection of health measurement instruments) was used to determine better tools, and the PRISMA checklist was followed.


In most of the reviewed studies, the main characteristics of uncertainty were ambiguity, lack of confidence and control, complexity, being on the horns of a dilemma, unpredictability, and unexpectedness. Concerning the measurement tools, despite their acceptable validity, they were mostly measuring uncertainty tolerance.


According to the results of the reviewed studies, the available tools were not specifically dedicated to measuring the uncertainty of nurses in clinical decision-making. A suitable tool can be helpful in measuring nurses' awareness about their degree of uncertainty in decision-making and nursing managers' awareness about nurses' uncertainty, thereby helping in planning to reduce the complications caused by nurses' uncertainty in clinical decision-making. Hence, it is necessary to develop suitable tools.

Keywords: Decision-making, Health care provider, Judgment, Uncertainty, Nurse, Tool.