Gillespie Brigid M, Chaboyer Wendy, St John Winsome, Morley Nicola, Nieuwenhoven Paul
NHMRC Research Centre for Clinical Excellence in Nursing Interventions (NCREN) & Centre for Healthcare Practice Innovation (HPI), Griffith Health Institute, Griffith University, Gold Coast Campus, Queensland, Australia.
School of Nursing & Midwifery, Griffith University, Gold Coast Campus, Queensland, Australia.
J Adv Nurs. 2015 Jun;71(6):1238-48. doi: 10.1111/jan.12598. Epub 2014 Dec 19.
To develop a conceptual understanding of the decision-making processes used by healthcare professionals in wound care practice.
With the global move towards using an evidence-base in standardizing wound care practices and the need to reduce hospital wound care costs, it is important to understand health professionals' decision-making in this important yet under-researched area.
A grounded theory approach was used to explore clinical decision-making of healthcare professionals in wound care practice.
Interviews were conducted with 20 multi-disciplinary participants from nursing, surgery, infection control and wound care who worked at a metropolitan hospital in Australia. Data were collected during 2012-2013. Constant comparative analysis underpinned by Strauss and Corbin's framework was used to identify clinical decision-making processes.
The core category was 'balancing practice-based knowledge with evidence-based knowledge'. Participants' clinical practice and actions embedded the following processes: 'utilizing the best available information', 'using a consistent approach in wound assessment' and 'using a multidisciplinary approach'. The substantive theory explains how practice and evidence knowledge was balanced and the variation in use of intuitive practice-based knowledge versus evidence-based knowledge. Participants considered patients' needs and preferences, costs, outcomes, technologies, others' expertise and established practices. Participants' decision-making tended to be more heavily weighted towards intuitive practice-based processes.
These findings offer a better understanding of the processes used by health professionals' in their decision-making in wound care. Such an understanding may inform the development of evidence-based interventions that lead to better patient outcomes.
形成对医疗保健专业人员在伤口护理实践中所采用决策过程的概念性理解。
随着全球朝着在标准化伤口护理实践中使用循证基础以及降低医院伤口护理成本的方向发展，了解医疗保健专业人员在这个重要但研究不足的领域中的决策至关重要。
采用扎根理论方法来探究医疗保健专业人员在伤口护理实践中的临床决策。
对来自澳大利亚一家大都市医院的护理、外科、感染控制和伤口护理领域的20名多学科参与者进行了访谈。数据收集于2012年至2013年期间。运用以施特劳斯和科尔宾框架为基础的持续比较分析来确定临床决策过程。
核心类别是“将基于实践的知识与循证知识相平衡”。参与者的临床实践和行动包含以下过程：“利用可得的最佳信息”、“在伤口评估中采用一致的方法”以及“采用多学科方法”。该实质性理论解释了实践知识和循证知识是如何平衡的，以及基于直觉的实践知识与循证知识在使用上的差异。参与者考虑了患者的需求和偏好、成本、结果、技术、他人的专业知识以及既定做法。参与者的决策往往更倾向于基于直觉的实践过程。
这些发现有助于更好地理解医疗保健专业人员在伤口护理决策中所采用的过程。这样的理解可能为制定能带来更好患者结局的循证干预措施提供参考。
