School of Nursing and Midwifery, Western Sydney University, Translational Research and Social Innovation group, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.
Transforming early Education and Child Health, Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia.
J Adv Nurs. 2023 Dec;79(12):4568-4579. doi: 10.1111/jan.15736. Epub 2023 Jun 14.
To explore nurse decision-making processes in the delivery of sustained home-visiting care for mothers of young children who are experiencing adversity.
Qualitative descriptive research design using focus group interviews.
Thirty-two home-visiting nurses participated in four focus group interviews exploring their decision-making in the care they provide to families. The data were analysed using a reflexive thematic analysis approach.
Four steps of a recurring stepwise decision-making process were identified: (1) information gathering; (2) exploring; (3) implementing; (4) checking. The facilitators and barriers to effective decision-making processes were also identified and included elements relating to good relationship skills, a good attitude, high quality training and mentoring and resources.
The findings indicate that a recurring stepwise process of decision-making requires both analytical and intuitive approaches. The intuition required by home-visiting nurses is to sense unvoiced client needs and identify the right time and way to intervene. The nurses were engaged in adapting the care in response to the client's unique needs while ensuring the fidelity of the programme scope and standards. We recommend creating an enabling working environment with cross-disciplinary team members and having well-developed structures, particularly the feedback systems such as clinical supervision and case reviews. Enhanced skills to establish trusting relationships with clients can help home-visiting nurses make effective decisions with mothers and families, particularly in the face of significant risk.
This study explored nurse decision-making processes in the context of sustained home-visiting care, which has been largely unexplored in the research literature. Understanding the effective decision-making processes, particularly when nurses customize or individualize the care in response to the client's unique needs, assists with the development of strategies for precision home-visiting care. The identification of facilitators and barriers informs approaches designed to support nurses in effective decision-making.
探索在为经历逆境的幼儿母亲提供持续家访护理时，护士的决策过程。
采用焦点小组访谈的定性描述性研究设计。
32 名家访护士参加了 4 个焦点小组访谈，探讨他们在为家庭提供护理时的决策过程。使用反思性主题分析方法对数据进行分析。
确定了一个反复出现的分步决策过程的四个步骤：（1）信息收集；（2）探索；（3）实施；（4）检查。还确定了有效决策过程的促进因素和障碍，包括与良好的关系技巧、良好的态度、高质量的培训和指导以及资源相关的因素。
研究结果表明，反复出现的分步决策过程既需要分析方法，也需要直觉方法。家访护士需要的直觉是感知客户未表达的需求，并确定干预的正确时间和方式。护士致力于根据客户的独特需求调整护理，同时确保方案范围和标准的保真度。我们建议创建一个具有跨学科团队成员的有利工作环境，并制定完善的结构，特别是反馈系统，如临床监督和案例审查。增强与客户建立信任关系的技能可以帮助家访护士在面对重大风险时为母亲和家庭做出有效的决策。
本研究探讨了在持续家访护理背景下护士的决策过程，这在研究文献中基本上没有探讨过。了解有效的决策过程，特别是当护士根据客户的独特需求定制或个性化护理时，有助于制定精确家访护理的策略。确定促进因素和障碍为支持护士有效决策的方法提供了信息。
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