Hagbaghery Mohsen Adib, Salsali Mahvash, Ahmadi Fazlolah
Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tohid Square, Tehran, Iran.
BMC Nurs. 2004 Apr 6;3(1):2. doi: 10.1186/1472-6955-3-2.
Nurses' practice takes place in a context of ongoing advances in research and technology. The dynamic and uncertain nature of health care environment requires nurses to be competent decision-makers in order to respond to clients' needs. Recently, the public and the government have criticized Iranian nurses because of poor quality of patient care. However nurses' views and experiences on factors that affect their clinical function and clinical decision-making have rarely been studied. METHODS: Grounded theory methodology was used to analyze the participants' lived experiences and their viewpoints regarding the factors affecting their clinical function and clinical decision-making. Semi-structured interviews and participant observation methods were used to gather the data. Thirty-eight participants were interviewed and twelve sessions of observation were carried out. Constant comparative analysis method was used to analyze the data. RESULTS: Five main themes emerged from the data. From the participants' points of view, "feeling competent", "being self-confident", "organizational structure", "nursing education", and "being supported" were considered as important factors in effective clinical decision-making. CONCLUSION: As participants in this research implied, being competent and self-confident are the most important personal factors influencing nurses clinical decision-making. Also external factors such as organizational structure, access to supportive resources and nursing education have strengthening or inhibiting effects on the nurses' decisions. Individual nurses, professional associations, schools of nursing, nurse educators, organizations that employ nurses and government all have responsibility for developing and finding strategies that facilitate nurses' effective clinical decision-making. They are responsible for identifying barriers and enhancing factors within the organizational structure that facilitate nurses' clinical decision-making.
护士的工作是在研究和技术不断进步的背景下进行的。医疗保健环境的动态性和不确定性要求护士成为有能力的决策者，以便满足患者的需求。最近，公众和政府因伊朗护士护理质量差而对其提出批评。然而，很少有人研究护士对影响其临床功能和临床决策因素的看法和经历。
采用扎根理论方法分析参与者关于影响其临床功能和临床决策因素的生活经历和观点。使用半结构化访谈和参与观察方法收集数据。对38名参与者进行了访谈，并进行了12次观察。采用持续比较分析法对数据进行分析。
数据中出现了五个主要主题。从参与者的角度来看，“感觉有能力”、“自信”、“组织结构”、“护理教育”和“得到支持”被认为是有效临床决策的重要因素。
正如本研究中的参与者所暗示的，有能力和自信是影响护士临床决策的最重要个人因素。此外，组织结构、获得支持资源的机会和护理教育等外部因素对护士的决策有加强或抑制作用。个体护士、专业协会、护理学院、护士教育工作者、雇佣护士的组织和政府都有责任制定和寻找促进护士有效临床决策的策略。他们有责任识别障碍并加强组织结构中促进护士临床决策的因素。
