Thompson Carl, Spilsbury Karen, Dowding Dawn, Pattenden Jill, Brownlow Ros
Department of Health Sciences, University of York, York, UK.
J Clin Nurs. 2008 Aug;17(16):2174-84. doi: 10.1111/j.1365-2702.2008.02303.x.
To unpack specialist heart failure nurses' decision-making and explore whether viewing a decision as 'hard' or 'easier' is associated with different decision-making characteristics.
Specialist heart failure nurses exemplify modern nursing roles. They face diagnostic, prognostic and treatment uncertainties of varying degrees of complexity in the choices they face. Nurses' cognitive handling of complexity is largely unknown.
Judgement analysis survey.
Judgement analysis with 29 nurses and two judgement tasks was undertaken. A drug titration decision (classed as 'easier' by nurses) was compared with a 'harder' palliative care referral choice. Measures of agreement between the nurses, the linearity and non-linearity in information processing by nurses and the degree of cognitive control exercised by them were explored. Differences between nurses with varying degrees of education were explored using paired t-testing. The relationship between experience and key measures was explored using bivariate correlations.
Nurses varied in their judgements and the weighting afforded to information. Self-reported decision difficulty was less important for cognitive handling of information and agreement between nurses than we predicted. Nurses had high degrees of cognitive control in the drug task and far less in the palliative referral condition. However, there was no change in the linear or non-linear processing of information of the two tasks. Education and clinical experience were not related to agreement or information processing.
Nurses' self-reported difficulty in decisions should not be relied upon as valid indicators of decisional complexity. The title 'specialist nurse' should not be assumed to equate by default with clinical expertise. Thinking in a more sophisticated way about the relationship between experience, uncertainty, decision structure and information available may help nurses make better choices.
Teaching nurses about what makes for hard and difficult decisions and increasing awareness of the decisions they make may lead to better quality choices. Practice developers should pay attention to the quality of clinical experience as well as the quantity when considering decision-making expertise.
剖析专科心力衰竭护士的决策过程，并探究将决策视为“困难”或“容易”是否与不同的决策特征相关。
专科心力衰竭护士代表了现代护理角色。他们在面临的选择中，会遇到不同程度复杂性的诊断、预后和治疗不确定性。护士对复杂性的认知处理情况在很大程度上尚不清楚。
判断分析调查。
对29名护士进行了判断分析，并开展了两项判断任务。将药物滴定决策（护士认为“较容易”）与“更困难”的姑息治疗转诊选择进行比较。探讨了护士之间的一致性度量、护士信息处理中的线性和非线性以及他们行使的认知控制程度。使用配对t检验探讨了不同教育程度护士之间的差异。使用双变量相关性探讨了经验与关键度量之间的关系。
护士的判断以及对信息的权重各不相同。自我报告的决策难度对于信息的认知处理和护士之间的一致性而言，其重要性低于我们的预期。护士在药物任务中具有高度的认知控制，而在姑息治疗转诊情况下则少得多。然而，两项任务的信息线性或非线性处理没有变化。教育和临床经验与一致性或信息处理无关。
护士自我报告的决策困难不应被视为决策复杂性的有效指标。不应默认认为“专科护士”这一称谓等同于临床专业知识。以更复杂的方式思考经验、不确定性、决策结构和可用信息之间的关系，可能有助于护士做出更好的选择。
教导护士了解构成艰难决策的因素并提高他们对所做决策的认识，可能会带来质量更高的选择。实践开发者在考虑决策专业知识时，应关注临床经验的质量以及数量。
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