Department of Biomedical Informatics, University of California, San Diego, La Jolla, CA, USA.
College of Nursing, University of Arizona, Arizona.
J Clin Nurs. 2018 Mar;27(5-6):917-928. doi: 10.1111/jocn.14151. Epub 2018 Jan 23.
To identify and summarise factors and processes related to registered nurses' patient care decision-making in medical-surgical environments. A secondary goal of this literature review was to determine whether medical-surgical decision-making literature included factors that appeared to be similar to concepts and factors in naturalistic decision making (NDM).
Decision-making in acute care nursing requires an evaluation of many complex factors. While decision-making research in acute care nursing is prevalent, errors in decision-making continue to lead to poor patient outcomes. Naturalistic decision making may provide a framework for further exploring decision-making in acute care nursing practice. A better understanding of the literature is needed to guide future research to more effectively support acute care nurse decision-making.
PubMed and CINAHL databases were searched, and research meeting criteria was included. Data were identified from all included articles, and themes were developed based on these data.
Key findings in this review include nursing experience and associated factors; organisation and unit culture influences on decision-making; education; understanding patient status; situation awareness; and autonomy.
Acute care nurses employ a variety of decision-making factors and processes and informally identify experienced nurses to be important resources for decision-making. Incorporation of evidence into acute care nursing practice continues to be a struggle for acute care nurses. This review indicates that naturalistic decision making may be applicable to decision-making nursing research.
Experienced nurses bring a broad range of previous patient encounters to their practice influencing their intuitive, unconscious processes which facilitates decision-making. Using naturalistic decision making as a conceptual framework to guide research may help with understanding how to better support less experienced nurses' decision-making for enhanced patient outcomes.
确定并总结与医疗环境中注册护士患者护理决策相关的因素和过程。本次文献综述的次要目标是确定医疗外科决策文献是否包含似乎与自然决策（NDM）概念和因素相似的因素。
急性护理护理中的决策需要评估许多复杂的因素。虽然急性护理护理中的决策研究很普遍，但决策错误仍导致患者预后不良。自然决策可能为进一步探索急性护理护理实践中的决策提供框架。需要更好地了解文献，以指导未来的研究，以更有效地支持急性护理护士的决策。
搜索了 PubMed 和 CINAHL 数据库，并纳入了符合标准的研究。从所有纳入的文章中确定数据，并根据这些数据开发主题。
本综述的主要发现包括护理经验及相关因素；组织和单位文化对决策的影响；教育；了解患者状况；情境意识；和自主权。
急性护理护士采用各种决策因素和过程，并非正式地确定有经验的护士是决策的重要资源。将证据纳入急性护理实践仍然是急性护理护士的一项挑战。本次审查表明，自然决策可能适用于护理决策研究。
有经验的护士将广泛的先前患者接触带到他们的实践中，影响他们的直觉、无意识的决策过程。将自然决策作为指导研究的概念框架，可能有助于理解如何更好地支持经验不足的护士的决策，以提高患者的结果。
