Vázquez-Calatayud Monica, Pumar-Méndez María J, Oroviogoicoechea Cristina
Area of Nursing Professional Development and Research, Clínica Universidad de Navarra, Pamplona, Spain.
Innovation for a Person-Centred Care Research Group (ICCP-UNAV), University of Navarra, Pamplona, Spain.
Nurs Open. 2024 Sep;11(9):e2232. doi: 10.1002/nop2.2232.
To develop a conceptual framework for nurses' protocol-based care decision-making.
Miles & Huberman's bottom-up approach to developing conceptual frameworks was followed, using data collected from a multiple embedded case study examining protocol-based decision-making by nurses in three hospital wards within a university hospital in northern Spain.
The qualitative data from the case study, obtained through documentary analysis, observations, and interviews, underwent a secondary analysis consisting of four steps: data reduction, data display, comparison, and drawing conclusions.
The framework for protocol-based care decision-making comprises four components: (1) protocol-based care, as a balance between standardisation and individualised care, (2) the process, (3) the context, and (4) the elements of protocol-based care decision-making. These components and their relationship as a context-dependent, linear, variable and multifactorial process, directly influenced by the perception of risk, are described and illustrated.
This study provides a rigorous bottom-up framework for nurses' protocol-based care decision-making. The framework could be a valuable resource for managers, clinical nurses, educators, and researchers to guide and evaluate nurses' decision-making, leading to improved care quality and reduced variability in clinical practice. Furthermore, the framework lays a foundation for further research and practical applications.
This study addressed the problem of understanding nurses' protocol-based care decision-making and the need for a specific conceptual framework. The main findings of the study contribute to the development of a rigorous bottom-up framework comprising four components of protocol-based care decision-making. The framework has the potential to improve care quality, reduce variability, enhance patient safety, and increase healthcare efficiency by guiding nurses' decision-making in various healthcare settings.
Patient or public contribution was not applicable since the study focused on nurses' decision making.
构建一个用于护士基于方案的护理决策的概念框架。
采用迈尔斯和休伯曼自下而上构建概念框架的方法，使用从一项多重嵌入式案例研究中收集的数据，该研究考察了西班牙北部一所大学医院三个病房中护士基于方案的决策。
通过文献分析、观察和访谈获得的案例研究定性数据进行了二次分析，包括四个步骤：数据简化、数据展示、比较和得出结论。
基于方案的护理决策框架包括四个组成部分：（1）基于方案的护理，作为标准化护理与个性化护理之间的平衡；（2）过程；（3）背景；（4）基于方案的护理决策要素。描述并说明了这些组成部分及其作为一个依赖于背景、线性、可变且多因素的过程之间的关系，该过程直接受风险认知的影响。
本研究为护士基于方案的护理决策提供了一个严谨的自下而上的框架。该框架对于管理人员、临床护士、教育工作者和研究人员指导和评估护士的决策可能是一个有价值的资源，有助于提高护理质量并减少临床实践中的变异性。此外，该框架为进一步的研究和实际应用奠定了基础。
本研究解决了理解护士基于方案的护理决策问题以及对特定概念框架的需求。该研究的主要发现有助于构建一个严谨的自下而上的框架，该框架由基于方案的护理决策的四个组成部分构成。该框架有可能通过在各种医疗环境中指导护士的决策来提高护理质量、减少变异性、增强患者安全并提高医疗效率。
由于该研究关注护士的决策，因此患者或公众参与不适用。
