Lamond D, Crow R A, Chase J
European Institute of Health & Medical Sciences, University of Surrey, Guildford, UK.
J Eval Clin Pract. 1996 Aug;2(3):211-6. doi: 10.1111/j.1365-2753.1996.tb00047.x.
The decisions which health care professionals make are the basis of treatment and care given. In order to evaluate effective care it seems logical to suggests that an awareness of the decisions which health care professionals make and how they make them is needed. This study examines the processes nurses use when making decisions about the health care needs of acutely ill patients. In stage one, 104 qualified nurses were interviewed to identify how they decide health care needs. In stage two, a 'think aloud' technique was used with patient simulations to obtain verbal protocols from a further 55 qualified nurses to identify the information strategies they used when making these decisions. The results suggest that nurses base their health care decisions mainly on their assessment of qualitative patient states or conditions. Initial indications are that the processes used differ from those characterized in the diagnostic reasoning model, with the context in which decisions are made being an important influence together with nurses' experience. It is suggested that, in order to develop effective predictive models and clinical guidelines which aid decision making, more research into the nature of health care professionals' decision making is carried out.
医疗保健专业人员所做的决策是所提供治疗和护理的基础。为了评估有效的护理，似乎有理由认为需要了解医疗保健专业人员所做的决策以及他们如何做出这些决策。本研究考察了护士在为急性病患者的医疗需求做出决策时所采用的过程。在第一阶段，对104名合格护士进行了访谈，以确定他们如何确定医疗需求。在第二阶段，对患者模拟使用“出声思考”技术，从另外55名合格护士那里获取口头记录，以确定他们在做出这些决策时所使用的信息策略。结果表明，护士的医疗决策主要基于他们对患者定性状态或状况的评估。初步迹象表明，所采用的过程与诊断推理模型中所描述的过程不同，决策所处的背景以及护士的经验是重要的影响因素。建议为了开发有助于决策的有效预测模型和临床指南，应对医疗保健专业人员决策的本质进行更多研究。
