Department of Healthcare/nursing, Christian University of Applied Sciences, Ede, The Netherlands.
Department of Healthcare/nursing, Fontys University of Applied Sciences, Eindhoven, The Netherlands.
J Clin Nurs. 2021 Jul;30(13-14):1904-1915. doi: 10.1111/jocn.15743. Epub 2021 Mar 25.
To explore how excellent nurses in hospitals take into account patient preferences in nursing decision-making in the evidence-based practice towards personalised care.
In evidence-based practice, nursing decision-making is based on scientific evidence, evidence of best practice and individual patient preferences. Little is known about how nurses in hospitals take into account patient preferences in nursing decision-making.
Qualitative grounded theory.
Data collection entailed 27 semi-structured interviews with nurses designated by their colleagues as excellent caregivers, followed by 57 hours of participant observation. Data analysis was conducted using three-level coding with constant comparison and theoretical sampling. The COREQ checklist for qualitative research was followed.
A main finding was that participants used three implicit tools to discover patient preferences: establishing a connection, using antennae and asking empathic questions, thus instantly reassuring patients from the very first contact. Their starting point in care was the patient's perception of quality of life wherein they shifted towards their patient's perspective: "Teach me to provide the best care for you in this situation." During the observations, it was confirmed that the excellent nurses behaved as they had described before.
Excellent nurses actively turn towards patients' expectations and experienced quality of life by carefully blending individual sensitive and situation specific patient preferences with scientific evidence and evidence of best practice. In doing so, they are able to balancing more equally patient preferences in to the equation called evidence-based practice, thus leading to wise decision-making in personalised nursing care.
Patient preferences become a fully fledged part of nursing decision-making in EBP when in education and practice, the implicit knowledge of excellent nurses about how to take into account patient preferences to provide personalised care is more valued and taught.
探讨医院优秀护士如何在循证实践向个性化护理的过程中，将患者偏好纳入护理决策。
在循证实践中，护理决策基于科学证据、最佳实践证据和患者个体偏好。关于医院护士如何在护理决策中考虑患者偏好知之甚少。
定性扎根理论。
数据收集包括对被同事指定为优秀护理人员的 27 名护士进行 27 次半结构化访谈，并进行 57 小时的参与式观察。数据分析采用三级编码、恒比抽样和理论抽样进行。遵循 COREQ 定性研究清单。
主要发现是参与者使用了三种隐性工具来发现患者的偏好：建立联系、使用天线和提出共情问题，从而在与患者的首次接触中立即让患者感到安心。他们护理的起点是患者对生活质量的感知，在这种情况下，他们转向患者的角度：“教我在这种情况下为你提供最好的护理。”在观察过程中，证实了优秀护士的行为与他们之前描述的一致。
优秀护士通过仔细地将个体敏感和特定情况的患者偏好与科学证据和最佳实践证据融合在一起，积极转向患者的期望和体验到的生活质量。通过这种方式，他们能够更平等地平衡患者偏好，将其纳入到循证实践的方程式中，从而在个性化护理决策中做出明智的决策。
当在教育和实践中更重视和教授优秀护士关于如何考虑患者偏好以提供个性化护理的隐性知识时，患者偏好将成为 EBP 中护理决策的一个完全成熟的部分。
