Faculty of Nursing, Université de Montréal, Montréal, Québec, Canada.
Nurs Inq. 2024 Jul;31(3):e12628. doi: 10.1111/nin.12628. Epub 2024 Feb 26.
Strategies based on performance measurement and feedback are commonly used to support quality improvement among nurses. These strategies require practice change, which, for nurses, rely to a large extent on their capacity to coordinate with each other effectively. However, the levers for coordinated action are difficult to mobilize. This discussion paper offers a theoretical reflection on the challenges related to coordinating nurses' actions in the context of practice changes initiated by performance measurement and feedback strategies. We explore how Jürgen Habermas' theory of Communicative Action may shed light on the issues underlying nurses' collective actions and self-determination in practice change and the implications for the design of strategies based on performance measurement and feedback. Based on this theory, we propose differences between communicative and functional coordination according to the nature of the actions and the purposes involved. The domains of action underlying these coordination processes, which Habermas referred to as the lifeworld and the system, are then used to draw a parallel with aspects of nursing practice. Further exploration of these concepts allows us to consider the tensions between the demands of the system and the self-determination of nurses within their practice.
基于绩效衡量和反馈的策略常用于支持护士的质量改进。这些策略需要实践的改变，而对于护士来说，这在很大程度上依赖于他们彼此之间有效协调的能力。然而，协调行动的杠杆很难调动。本文讨论了在绩效衡量和反馈策略引发的实践变革背景下，协调护士行动所面临的挑战。我们探讨了于尔根·哈贝马斯的交往行动理论如何阐明护士在实践变革中的集体行动和自我决定的潜在问题，以及该理论对基于绩效衡量和反馈的策略设计的意义。基于这一理论，我们根据行动的性质和目的，提出了交往协调和功能协调之间的差异。哈贝马斯称之为生活世界和系统的这些协调过程的行动领域，然后被用来与护理实践的各个方面进行类比。进一步探讨这些概念使我们能够考虑到系统的要求与护士在实践中的自我决定之间的紧张关系。
