Nurses’ competence in hemodynamic monitoring and Its impact on clinical decision-making in cardiac ICUs

Background Hemodynamic monitoring enables the optimization of care for patients admitted in a critical state. Nurses often rely on their own clinical judgment and intervention in the cardiac ICU environment, especially when feedback loops are interrupted. This is very much dependent on nurses being competent in hemodynamic monitoring and interventions, an area in which research has been limited, particularly in low-resource settings like Iraq. Aim The study aimed to investigate the relationships between competencies in hemodynamic monitoring and clinical decision-making, surrounding contextual factors that helped or hindered these practices within the Iraq context. Methods To achieve the aim of this study, a mixed-methods approach was used to bring together a cross-sectional survey of the 120 ICU nurses and 17 detailed interviews. The quantitative surveys included during the study produced data with measures of knowledge, interpretation, and clinical decision-making ability. To understand the lived experiences of nurses in this context, qualitative data was collected and systematically analysed using thematic analysis. Results The quantitative results found a statistically significant that the competency levels of the hemodynamic monitoring of patients were positively correlated to the quality of clinical decision-making outcomes ( r = 0.59, p < 0.001). The regression analysis found that competency level, years of ICU experience and level of education were significant predictors ( R 2 = 0.42, p < 0.001). The qualitative analysis identified many barriers to competence, including the absence of advanced training opportunities, relying on physicians for decision-making, and inconsistency of protocols. Conclusion Although clinical competence significantly influences nurses’ clinical decision-making, its effective application is strongly shaped by organizational and contextual factors, including training opportunities, workload, and institutional support.