Thompson C, McCaughan D, Cullum N, Sheldon T A, Mulhall A, Thompson D R
Centre for Evidence-based Nursing, Department of Health Studies, University of York, York, UK.
J Adv Nurs. 2001 Nov;36(3):376-88. doi: 10.1046/j.1365-2648.2001.01985.x.
To examine those sources of information which nurses find useful for reducing the uncertainty associated with their clinical decisions.
Nursing research has concentrated almost exclusively on the concept of research implementation. Few, if any, papers examine the use of research knowledge in the context of clinical decision-making. There is a need to establish how useful nurses perceive information sources are, for reducing the uncertainties they face when making clinical decisions.
Cross-case analysis involving qualitative interviews, observation, documentary audit and Q methodological modelling of shared subjectivities amongst nurses. The case sites were three large acute hospitals in the north of England, United Kingdom. One hundred and eight nurses were interviewed, 61 of whom were also observed for a total of 180 hours and 122 nurses were involved in the Q modelling exercise.
Text-based and electronic sources of research-based information yielded only small amounts of utility for practising clinicians. Despite isolating four significantly different perspectives on what sources were useful for clinical decision-making, it was human sources of information for practice that were overwhelmingly perceived as the most useful in reducing the clinical uncertainties of nurse decision-makers.
It is not research knowledge per se that carries little weight in the clinical decisions of nurses, but rather the medium through which it is delivered. Specifically, text-based and electronic resources are not viewed as useful by nurses engaged in making decisions in real time, in real practice, but those individuals who represent a trusted and clinically credible source are. More research needs to be carried out on the qualities of people regarded as clinically important information agents (specifically, those in clinical nurse specialist and associated roles) whose messages for practice appear so useful for clinicians.
探究护士认为有助于减少其临床决策相关不确定性的信息来源。
护理研究几乎完全集中在研究实施的概念上。极少有论文探讨在临床决策背景下研究知识的运用。有必要确定护士认为信息来源在减少临床决策时所面临的不确定性方面有多大用处。
跨案例分析，包括定性访谈、观察、文献审核以及对护士群体主观性的Q方法建模。案例地点为英国英格兰北部的三家大型急症医院。对108名护士进行了访谈，其中61名还接受了总计180小时的观察，122名护士参与了Q建模练习。
基于文本和电子的研究性信息来源对临床执业者的效用不大。尽管在哪些信息来源对临床决策有用这一问题上分离出了四种显著不同的观点，但在减少护士决策者的临床不确定性方面，实践中的人际信息来源被压倒性地认为是最有用的。
在护士的临床决策中，并非研究知识本身无足轻重，而是其传递的媒介。具体而言，从事实时实际决策的护士并不认为基于文本和电子的资源有用，而那些被视为可信且临床可靠的信息来源的个人则被认为有用。需要对被视为临床重要信息提供者（特别是临床专科护士及相关角色）的人的特质进行更多研究，他们提供的实践信息似乎对临床医生非常有用。
