School of Nursing, Tianjin Medical University, Tianjin, China.
J Clin Nurs. 2012 Jun;21(11-12):1706-15. doi: 10.1111/j.1365-2702.2011.03925.x. Epub 2011 Dec 17.
To explore Chinese baccalaureate-prepared nurses' perceptions of the concept and practices of clinical decision-making.
Clinical decision-making is an integral part of nursing practice. Several studies have explored the experiences and factors which influence nurses' clinical decisions and these have recognised the cultural impact. However, little is known about the experience of clinical decision-making from the perspective of Chinese baccalaureate-prepared nurses.
A qualitative, exploratory study.
Data were obtained through in-depth, semi-structured interview with a convenience sample of 12 baccalaureate-prepared registered nurses. Interviews focused on registered nurses' understanding and perceptions of clinical decision-making in clinical practice. They were tape-recorded, transcribed verbatim and content analysed.
Two major themes were identified, namely, functional perspectives of clinical decision-making and perceived autonomy in clinical decision-making. There were two sub-themes for the first theme: emphasising a full understanding of the patient's health status and undertaking appropriate nursing judgements and problem-solving. Three sub-themes emerged for perceived autonomy in clinical decision-making: relying on a doctor's instructions, making judgements on a doctor's orders and making decisions independently in emergency care.
The findings indicate that Chinese nurses understand the essence of clinical decision-making, but they have low autonomy in such decisions in their daily practice. More importantly, the results also reveal the importance of social and cultural factors in nurses' perceptions of this topic.
A better understanding of the perceptions and concepts of clinical decision-making among nurses in mainland China and other countries as well, can help in establishing nurses' roles and responsibilities in participating in making effective decisions for patient care. The findings can also inform us of potential strategies which may be adopted to develop the knowledge and skills of Chinese baccalaureate-prepared nursing students and graduates in making autonomous and accurate clinical decisions.
探讨中国本科护士对临床决策概念和实践的看法。
临床决策是护理实践的一个组成部分。多项研究探讨了影响护士临床决策的经验和因素，这些研究认识到了文化的影响。然而，对于中国本科护士的临床决策经验，人们知之甚少。
定性、探索性研究。
通过对 12 名本科注册护士的方便样本进行深入、半结构化访谈，获取数据。访谈重点是注册护士对临床实践中临床决策的理解和看法。访谈内容被录音、逐字转录，并进行内容分析。
确定了两个主要主题，即临床决策的功能视角和临床决策中的感知自主性。第一个主题有两个子主题：强调充分了解患者的健康状况，并进行适当的护理判断和解决问题。临床决策中的感知自主性有三个子主题：依赖医生的指示、对医嘱做出判断和在急救护理中独立做出决策。
研究结果表明，中国护士理解临床决策的本质，但在日常实践中，他们在决策方面自主性较低。更重要的是，结果还揭示了社会和文化因素在护士对这一主题的看法中的重要性。
更好地了解中国大陆和其他国家护士对临床决策的看法和概念，可以帮助确定护士在参与为患者护理做出有效决策中的角色和责任。研究结果还可以为我们提供潜在的策略，以培养中国本科护理学生和毕业生在做出自主和准确的临床决策方面的知识和技能。
