Spiers Judith A, Lo Eliza, Hofmeyer Anne, Cummings Greta G
Associate Professor, Faculty of Nursing, University of Alberta, Edmonton, AB.
Patient Care Manager, Alberta Health Services, Edmonton, AB.
Nurs Leadersh (Tor Ont). 2016;29(2):64-81. doi: 10.12927/cjnl.2016.24805.
To describe how organizational context and restructuring influenced nurse leaders' use of evidence in decision-making in their management practice.
Qualitative descriptive study. Fifteen leaders at executive and front-line manager levels in one organization were interviewed using a semi-structured format.
Inductive content analysis generated five main themes: leaders strove to keep relationships that preserve best decision-making ability; and sought the best knowledge to inform their decisions. However, a context of constant change; more scope; less autonomy; and decisional inertia in a sea of change had profound effects on their ability to employ evidence in decision-making.
Evidence-informed decision-making is a dynamic social process highly influenced by political instability in work environments. Organizational restructuring creates threats to common decision-making strategies, including information flow, relationships and priority setting. Healthcare restructuring is now a global constant, and there is a need for hospital leaders to understand and mitigate the effect restructuring has on the ability of leaders to engage in evidence-informed decision-making. Strategies are proposed to manage uncertainty and support nurse leaders in their evidence-informed decision-making to deliver quality health services. This research provides an in-depth examination of how evidence-informed decision-making is influenced in the context of instability and uncertainty due to ever-present organizational restructuring.
描述组织背景和重组如何影响护士领导者在管理实践决策中对证据的运用。
定性描述性研究。采用半结构化形式对一个组织中15名行政和一线管理层面的领导者进行了访谈。
归纳性内容分析产生了五个主要主题：领导者努力维护有助于保持最佳决策能力的关系；并寻求最佳知识为其决策提供依据。然而，持续变化的背景；更多的范围；更少的自主权；以及在变革浪潮中的决策惯性对他们在决策中运用证据的能力产生了深远影响。
循证决策是一个动态的社会过程，受到工作环境中政治不稳定的高度影响。组织重组对包括信息流、关系和优先级设定在内的常见决策策略构成威胁。医疗保健重组现在是全球普遍现象，医院领导者需要了解并减轻重组对领导者进行循证决策能力的影响。提出了应对不确定性的策略，并支持护士领导者进行循证决策以提供优质医疗服务。本研究深入探讨了由于持续的组织重组导致的不稳定和不确定性背景下循证决策是如何受到影响的。
