Leprohon J, Patel V L
Center for Medical Education, McGill University, Montreal, Quebec, Canada.
Med Decis Making. 1995 Jul-Sep;15(3):240-53. doi: 10.1177/0272989X9501500307.
Decision-making strategies used by nurses in telephone triage involving public emergency calls for medical help were investigated as a function of task urgency and complexity in the real-world dynamic environment. The sample included 34 nurses as call receivers. Transcripts of 50 nurse-client dialogues and 50 explanations of the decision-making process, elicited immediately after completion of the calls, were analyzed using methods of discourse and protocol analyses. In high-urgency situations, heuristic rules based on symptoms were used, and the decisions were mostly accurate. With the increase in problem complexity, more causal explanations were found, and the decisions were more often inaccurate. Furthermore, the explanations supporting the accurate decisions were often inaccurate, showing a decoupling of knowledge and action. Alternate strategies were used in moderate- to low-urgency conditions, where contextual knowledge of the situations was exploited to identify the needs of the clients and to negotiate the best plan of action to meet these needs, resulting in more accurate decisions.
研究了护士在涉及公共紧急医疗求助电话分诊中所采用的决策策略，该研究将其作为现实世界动态环境中任务紧迫性和复杂性的函数。样本包括34名接听电话的护士。采用话语分析和协议分析方法，对50次护士与患者对话的记录以及通话结束后立即引出的50份决策过程解释进行了分析。在高紧迫性情况下，使用了基于症状的启发式规则，决策大多是准确的。随着问题复杂性的增加，发现了更多因果解释，决策往往不准确。此外，支持准确决策的解释往往不准确，表明知识与行动脱节。在中度至低度紧迫性情况下使用了替代策略，在这种情况下，利用情境的背景知识来确定患者的需求，并协商出满足这些需求的最佳行动方案，从而做出更准确的决策。
