Guo Xiaoying, Li Hongxia, Zou Qian, Cao Yanjun, Lin Taoyu, Zhang Mingji
School of Medicine, Shihezi University, Shihezi, Xinjiang, China.
Shanghai East Hospital Tongji University, Shanghai, China.
J Clin Nurs. 2025 Jul;34(7):2961-2980. doi: 10.1111/jocn.17648. Epub 2025 Jan 20.
To explore the complete decision-making process and action logic of nurses making autonomous decisions that result in missed nursing care.
The complex characteristics of patients in Intensive Care Units place higher demands on the allocation of nursing resources, as well as on the professional skills, resilience and ethics of nursing staff. Preventing missed nursing care is particularly crucial in Intensive Care Units.
A theory construction qualitative study using grounded theory.
Semistructured face-to-face interviews were conducted with 20 nurses, including three head nurses and 17 bedside nurses. Head nurses provided insights into counselling and management practices.
The theoretical model of nurses' decision-making processes comprise four strategies: setting priorities, seeking help, delaying nursing care and omitting nursing care. The latter two constitute missed nursing care. Inadequate staffing, task urgency and negative emotions can lead to omitting nursing care.
This study proposes an original concept: grassroots arrangement of nursing care (GANC). Grassroots arrangement of nursing care includes the autonomous and adaptive decision-making process used by bedside nurses to optimise workflow in busy environments. It includes specific strategies and quality implications, enabling a nuanced balance between limited nursing resources, increasing patient needs and maintaining the best possible quality of care.
Nursing managers should consider the dual aspects of grassroots arrangement of nursing care, support nurses' grassroots autonomy and streamline decision-making processes.
This study follows the Consolidated Criteria for Reporting Qualitative Studies (COREQ).
No patient or public contribution.
探讨护士做出导致护理缺失的自主决策的完整决策过程及行动逻辑。
重症监护病房患者的复杂特征对护理资源的分配以及护理人员的专业技能、适应能力和职业道德提出了更高要求。在重症监护病房预防护理缺失尤为关键。
一项运用扎根理论的理论构建质性研究。
对20名护士进行了半结构化面对面访谈，其中包括3名护士长和17名床边护士。护士长提供了关于咨询和管理实践的见解。
护士决策过程的理论模型包括四种策略：确定优先级、寻求帮助、延迟护理和省略护理。后两种构成护理缺失。人员配备不足、任务紧迫性和负面情绪可能导致省略护理。
本研究提出了一个原创概念：基层护理安排（GANC）。基层护理安排包括床边护士在繁忙环境中用于优化工作流程的自主和适应性决策过程。它包括具体策略和质量影响，能够在有限的护理资源、不断增加的患者需求和维持尽可能最佳的护理质量之间实现微妙的平衡。
护理管理者应考虑基层护理安排的双重方面，支持护士的基层自主权并简化决策过程。
本研究遵循质性研究报告的综合标准（COREQ）。
无患者或公众贡献。
