• Clinical decision making;
  • emergency nursing;
  • moral reasoning

PURPOSE:  To explore the relationship between multiple variables within a model of critical thinking and moral reasoning.

METHODS:  A quantitative descriptive correlational design using a purposive sample of 200 emergency nurses. Measured variables were accuracy in clinical decision-making, moral reasoning, perceived care environment, and demographics. Analysis was by bivariate correlation using Pearson's product-moment correlation coefficients, chi square and multiple linear regression analysis.

FINDINGS:  The elements as identified in the integrated ethically-driven environmental model of clinical decision-making (IEDEM-CD) corrected depict moral reasoning and environment of care as factors significantly affecting accuracy in decision-making.

CONCLUSIONS:  The integrated, ethically driven environmental model of clinical decision making is a framework useful for predicting clinical decision making accuracy for emergency nurses in practice, with further implications in education, research and policy.

PRACTICE IMPLICATIONS:  A diagnostic and therapeutic framework for identifying and remediating individual and environmental challenges to accurate clinical decision making.