Gerdtz M F, Bucknall T K
School of Postgraduate Nursing, University of Melbourne, Victoria, Australia.
Accid Emerg Nurs. 1999 Jan;7(1):50-7. doi: 10.1016/s0965-2302(99)80103-9.
This paper discusses major themes presented in the published literature concerning clinical decision making and links these to the practice of emergency department nurse triage. Themes discussed include: approaches to decision research in nursing and medicine; decision autonomy in nursing practice and clinical decision making under conditions of uncertainty. Some assumptions underpinning clinical decision-making frameworks are explored and the use of triage scales, algorithms and intuitive thought processes are discussed in terms of clinical practice. In addition, the strengths and limitations of each approach are outlined. It is argued that naturalistic research methods are necessary in order to describe the often uncertain and frequently chaotic environment in which triage decisions are made. This research must occur in order to evaluate and improve both the triage process and the outcomes of these decisions in practice.
本文讨论了已发表文献中有关临床决策的主要主题，并将这些主题与急诊科护士分诊实践联系起来。讨论的主题包括：护理和医学中的决策研究方法；护理实践中的决策自主权以及在不确定情况下的临床决策。探讨了临床决策框架的一些基本假设，并从临床实践的角度讨论了分诊量表、算法和直觉思维过程的使用。此外，还概述了每种方法的优缺点。有人认为，为了描述分诊决策所处的往往不确定且经常混乱的环境，自然主义研究方法是必要的。必须进行这项研究，以便在实践中评估和改进分诊过程以及这些决策的结果。
