Buckingham C D, Adams A
European Institute of Health and Medical Sciences, University of Surrey, England.
J Adv Nurs. 2000 Oct;32(4):990-8.
This is the second of two linked papers exploring decision making in nursing. The first paper, 'Classifying clinical decision making: a unifying approach' investigated difficulties with applying a range of decision-making theories to nursing practice. This is due to the diversity of terminology and theoretical concepts used, which militate against nurses being able to compare the outcomes of decisions analysed within different frameworks. It is therefore problematic for nurses to assess how good their decisions are, and where improvements can be made. However, despite the range of nomenclature, it was argued that there are underlying similarities between all theories of decision processes and that these should be exposed through integration within a single explanatory framework. A proposed solution was to use a general model of psychological classification to clarify and compare terms, concepts and processes identified across the different theories. The unifying framework of classification was described and this paper operationalizes it to demonstrate how different approaches to clinical decision making can be re-interpreted as classification behaviour. Particular attention is focused on classification in nursing, and on re-evaluating heuristic reasoning, which has been particularly prone to theoretical and terminological confusion. Demonstrating similarities in how different disciplines make decisions should promote improved multidisciplinary collaboration and a weakening of clinical elitism, thereby enhancing organizational effectiveness in health care and nurses' professional status. This is particularly important as nurses' roles continue to expand to embrace elements of managerial, medical and therapeutic work. Analysing nurses' decisions as classification behaviour will also enhance clinical effectiveness, and assist in making nurses' expertise more visible. In addition, the classification framework explodes the myth that intuition, traditionally associated with nurses' decision making, is less rational and scientific than other approaches.
这是两篇探讨护理决策的关联论文中的第二篇。第一篇论文《临床决策分类：一种统一方法》研究了将一系列决策理论应用于护理实践时所面临的困难。这是因为所使用的术语和理论概念具有多样性，这不利于护士比较在不同框架内分析的决策结果。因此，护士难以评估其决策的质量以及何处可以改进。然而，尽管存在各种术语，但有人认为所有决策过程理论之间存在潜在的相似之处，并且应该通过整合到一个单一的解释框架中来揭示这些相似之处。一个提议的解决方案是使用心理分类的通用模型来澄清和比较不同理论中确定的术语、概念和过程。文中描述了分类的统一框架，并且本文将对其进行实际应用，以展示临床决策的不同方法如何能够被重新解释为分类行为。特别关注护理中的分类以及对启发式推理的重新评估，启发式推理一直特别容易出现理论和术语上的混乱。展示不同学科在决策方式上的相似性应该会促进多学科协作的改善以及临床精英主义的弱化，从而提高医疗保健中的组织效率和护士的专业地位。随着护士的角色不断扩展以涵盖管理、医疗和治疗工作的要素，这一点尤为重要。将护士的决策分析为分类行为也将提高临床效果，并有助于使护士的专业知识更加明显。此外，分类框架打破了传统上与护士决策相关的直觉不如其他方法合理和科学的神话。
