School of Nursing & Midwifery, Trinity College, Dublin, Ireland.
J Adv Nurs. 2010 Dec;66(12):2711-21. doi: 10.1111/j.1365-2648.2010.05412.x. Epub 2010 Aug 16.
This paper reports a study conducted to explore how nurses working at advanced practice level in chronic and acute care outpatient contexts responded to decision-making concerns in clinical practice.
Current theoretical explanations of clinical judgement offer insight into how healthcare professionals process information; however, they are incomplete as they do not consider psychosocial issues. Research evidence informing clinical judgement practice is based largely on acute care hospital settings. Consequently, little is known about how practitioners make clinical judgements in outpatient contexts where patients can participate in their own care.
A grounded theory approach was used to analyse interview data about clinical judgements made in actual clinical practice. Twenty-one nurses working at advanced practice level in mental healthcare clinics and accident and emergency in the Republic of Ireland were recruited. Concurrent data collection and analysis, constant comparative analysis and theoretical sampling were conducted in 2002-2005.
The core category to emerge from the data was 'mutual intacting'. This refers to the main strategies that practitioners used to resolve concerns about eliciting patient information and selecting treatments that were acceptable to patients. It highlights the clinical judgement practices that practitioners find useful to engage patients to facilitate effective decision-making.
Practitioners could draw from the various strategies identified in this research to develop their clinical judgement practice further in ways that include the development of an effective relationship with their patients. Negotiation and compromise are particularly useful strategies that should be used to facilitate effective treatment delivery that takes account of patients' circumstances.
本文报告了一项研究，旨在探讨在慢性和急性门诊护理环境中工作的高级实践护士如何应对临床实践中的决策问题。
当前关于临床判断的理论解释提供了对医疗保健专业人员如何处理信息的深入了解；然而，它们并不完整，因为它们没有考虑到心理社会问题。为临床判断实践提供信息的研究证据主要基于急性护理医院环境。因此，对于在门诊环境中从业者如何做出临床判断的了解甚少，在这些环境中，患者可以参与自己的护理。
采用扎根理论方法分析了关于实际临床实践中做出的临床判断的访谈数据。在爱尔兰共和国的精神保健诊所和急症室工作的 21 名高级实践护士被招募。在 2002-2005 年期间进行了同期数据收集和分析、不断比较分析和理论抽样。
数据中出现的核心类别是“相互完整”。这是指从业者用来解决有关征求患者信息和选择患者可接受的治疗方案的问题的主要策略。它突出了从业者发现有助于让患者参与以促进有效决策的有用临床判断实践。
从业者可以从这项研究中确定的各种策略中汲取灵感，进一步发展他们的临床判断实践，包括与患者建立有效的关系。谈判和妥协是特别有用的策略，应用于促进考虑患者情况的有效治疗。
