Buckingham C D, Adams A
European Institute of Health and Medical Sciences, University of Surrey, England.
J Adv Nurs. 2000 Oct;32(4):981-9.
This is the first of two linked papers exploring decision making in nursing which integrate research evidence from different clinical and academic disciplines. Currently there are many decision-making theories, each with their own distinctive concepts and terminology, and there is a tendency for separate disciplines to view their own decision-making processes as unique. Identifying good nursing decisions and where improvements can be made is therefore problematic, and this can undermine clinical and organizational effectiveness, as well as nurses' professional status. Within the unifying framework of psychological classification, the overall aim of the two papers is to clarify and compare terms, concepts and processes identified in a diversity of decision-making theories, and to demonstrate their underlying similarities. It is argued that the range of explanations used across disciplines can usefully be re-conceptualized as classification behaviour. This paper explores problems arising from multiple theories of decision making being applied to separate clinical disciplines. Attention is given to detrimental effects on nursing practice within the context of multidisciplinary health-care organizations and the changing role of nurses. The different theories are outlined and difficulties in applying them to nursing decisions highlighted. An alternative approach based on a general model of classification is then presented in detail to introduce its terminology and the unifying framework for interpreting all types of decisions. The classification model is used to provide the context for relating alternative philosophical approaches and to define decision-making activities common to all clinical domains. This may benefit nurses by improving multidisciplinary collaboration and weakening clinical elitism.
这是两篇相关论文中的第一篇，探讨护理中的决策制定，整合了来自不同临床和学术学科的研究证据。目前有许多决策理论，每个理论都有其独特的概念和术语，而且不同学科倾向于将自己的决策过程视为独特的。因此，确定良好的护理决策以及何处可以改进存在问题，这可能会损害临床和组织效能以及护士的专业地位。在心理学分类的统一框架内，这两篇论文的总体目标是澄清和比较各种决策理论中确定的术语、概念和过程，并展示它们潜在的相似性。有人认为，跨学科使用的一系列解释可以有效地重新概念化为分类行为。本文探讨了将多种决策理论应用于不同临床学科所产生的问题。关注在多学科医疗保健组织背景下对护理实践的不利影响以及护士角色的变化。概述了不同的理论，并强调了将它们应用于护理决策的困难。然后详细介绍了一种基于通用分类模型的替代方法，以引入其术语和解释所有类型决策的统一框架。分类模型用于为关联不同的哲学方法提供背景，并定义所有临床领域共有的决策活动。这可能通过改善多学科协作和削弱临床精英主义而使护士受益。
