Nibbelink Christine W, Carrington Jane M
Author Affiliations: Department of Biomedical Informatics, University of California, San Diego (Dr Nibbelink); and College of Nursing, University of Arizona, Tucson (Dr Carrington).
Comput Inform Nurs. 2019 Mar;37(3):151-160. doi: 10.1097/CIN.0000000000000521.
Effective nurse decision making is essential for best patient outcomes in the acute care nurse practice environment. The purpose of this study was to explore acute care RNs' perceptions of clinical decision making for a patient who experienced a clinical event. Clinical events include changes in patient condition and are manifested by fever, pain, bleeding, changes in output, changes in respiratory status, and changes in level of consciousness. Naturalistic decision making framework supported the exploration of important contextual factors associated with decision making, provided new information for nursing science, and served as the conceptual framework for this research. Data collected from interviews of 20 acute care nurses were analyzed using qualitative content analysis. The emergent categories included Awareness of Patient Status, Experience and Decision Making, Following Established Routine, Time Pressure, Teamwork/Support From Staff, Goals, Education, Resources, Patient Education, Consideration of Options to Meet Goals, and Nursing Roles. Acute care nurses incorporated a wide variety of complex factors when decision making. This study sought to improve understanding of the factors nurses found important to their decision making for the potential development of improved decision support in the electronic health record.
在急性护理护士的实践环境中，有效的护士决策对于实现最佳患者治疗效果至关重要。本研究的目的是探讨急性护理注册护士对经历临床事件的患者进行临床决策的看法。临床事件包括患者病情变化，表现为发热、疼痛、出血、尿量变化、呼吸状态变化和意识水平变化。自然决策框架支持对与决策相关的重要背景因素进行探索，为护理科学提供新信息，并作为本研究的概念框架。采用定性内容分析法对从20名急性护理护士访谈中收集的数据进行分析。新出现的类别包括对患者状态的认知、经验与决策、遵循既定常规、时间压力、团队合作/工作人员支持、目标、教育、资源、患者教育、考虑实现目标的选项以及护理角色。急性护理护士在决策时纳入了各种各样的复杂因素。本研究旨在增进对护士认为对其决策很重要的因素的理解，以便在电子健康记录中潜在地开发改进的决策支持。
