• Lean Keng Soon S http://orcid.org/0000-0001-8005-468X School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia. and Hani Nawaf Ibrahim AlQudah.
• School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.
• J Adv Nurs. 2017 Feb 1; 73 (2): 465-481.

AimsTo raise awareness of critical care nurses' cognitive bias in decision-making, its relationship with leadership styles and its impact on care delivery.BackgroundThe relationship between critical care nurses' decision-making and leadership styles in hospitals has been widely studied, but the influence of cognitive bias on decision-making and leadership styles in critical care environments remains poorly understood, particularly in Jordan.DesignTwo-phase mixed methods sequential explanatory design and grounded theory.Settingcritical care unit, Prince Hamza Hospital, Jordan. Participant sampling: convenience sampling Phase 1 (quantitative, n = 96), purposive sampling Phase 2 (qualitative, n = 20).MethodsPilot tested quantitative survey of 96 critical care nurses in 2012. Qualitative in-depth interviews, informed by quantitative results, with 20 critical care nurses in 2013. Descriptive and simple linear regression quantitative data analyses. Thematic (constant comparative) qualitative data analysis.ResultsQuantitative - correlations found between rationality and cognitive bias, rationality and task-oriented leadership styles, cognitive bias and democratic communication styles and cognitive bias and task-oriented leadership styles. Qualitative - 'being competent', 'organizational structures', 'feeling self-confident' and 'being supported' in the work environment identified as key factors influencing critical care nurses' cognitive bias in decision-making and leadership styles. Two-way impact (strengthening and weakening) of cognitive bias in decision-making and leadership styles on critical care nurses' practice performance.ConclusionThere is a need to heighten critical care nurses' consciousness of cognitive bias in decision-making and leadership styles and its impact and to develop organization-level strategies to increase non-biased decision-making.© 2016 John Wiley & Sons Ltd.

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