Twycross Alison, Powls Lucy
Children's Nursing, Faculty of Health Care and Social Sciences, Kingston University--St George's University of London, London, UK.
J Clin Nurs. 2006 Oct;15(10):1324-35. doi: 10.1111/j.1365-2702.2006.01453.x.
To gain an understanding of how children's nurses make clinical decisions.
Several studies have explored how nurses make clinical decisions and the factors that may affect the decision-making strategies used. However, the results of these studies are contradictory. Further, little is known about children's nurses' decision-making strategies.
The think aloud technique.
Nurses (n = 12) from three surgical wards and nurses (n = 15) from three medical wards in a Scottish children's hospital were presented with clinical scenarios and asked to think aloud. The verbal protocols were analysed to provide an indication of how children's nurses made decisions. Whether there were any differences in decision-making between experienced and less experienced nurses and between graduates and non-graduates was also explored.
Analysis of verbal protocols obtained using the think aloud technique suggested that all the nurses in the sample used a hypothetico-deductive (analytical) model of decision-making. Further, all participants appeared to use backward reasoning strategies regardless of their level of expertise. This is a characteristic of non-expert decision-making. Experienced and less experienced nurses collected similar additional information before planning nursing interventions, supporting the conjecture that they were functioning at a non-expert level in relation to decision-making. No differences were seen in the information collected by graduate and non-graduate nurses.
The decision-making strategies of children's nurses need exploring further and further research is needed to identify factors that may affect decision-making strategies. Several strategies to support nurses' clinical decision-making have been proposed but need testing to ascertain their effectiveness.
In clinical practice nurses make numerous decisions throughout the course of a shift. Sub-optimal decision-making strategies may adversely affect the quality of nursing care provided. It is imperative, therefore, to ascertain how nurses make clinical decisions and the factors that may influence the decision-making strategies used.
了解儿童护士如何做出临床决策。
多项研究探讨了护士如何做出临床决策以及可能影响所使用决策策略的因素。然而，这些研究的结果相互矛盾。此外，对于儿童护士的决策策略知之甚少。
出声思维技术。
向苏格兰一家儿童医院三个外科病房的12名护士和三个内科病房的15名护士呈现临床情景，并要求他们出声思考。对口头记录进行分析，以表明儿童护士是如何做出决策的。还探讨了经验丰富和经验不足的护士之间以及毕业生和非毕业生之间在决策方面是否存在差异。
对使用出声思维技术获得的口头记录进行分析表明，样本中的所有护士都使用了假设演绎（分析）决策模型。此外，所有参与者似乎都使用逆向推理策略，无论其专业水平如何。这是非专家决策的一个特征。经验丰富和经验不足的护士在规划护理干预措施之前收集了类似的额外信息，支持了他们在决策方面处于非专家水平的推测。毕业生护士和非毕业生护士收集的信息没有差异。
儿童护士的决策策略需要进一步探索，需要进行更多研究以确定可能影响决策策略的因素。已经提出了几种支持护士临床决策的策略，但需要进行测试以确定其有效性。
在临床实践中，护士在一个班次中要做出无数决策。次优的决策策略可能会对所提供的护理质量产生不利影响。因此，必须确定护士如何做出临床决策以及可能影响所使用决策策略的因素。
