Aim: To develop an understanding of how nurses take account of patient preferences in nursing decision-making in evidence-based practice to provide individual tailored nursing care. Design: Qualitative grounded theory. Methods: Semi-structured interviews were conducted with 27 nurses in four medium-sized hospitals in the Netherlands. Furthermore, seven nurses were observed during their shift. Constant comparative analysis underpinned by Strauss and Corbin's framework was used. Results: Three communication tools of nurses were identified to discern and attend to patient preferences: (a) a click-making tool enables to build rapport instantly; (b) antennae monitor individual patient's needs; and (c) asking empathic questions to fine-tune to individual patient preferences. Participants emphasized that giving individual attention enhances the patient's experienced quality of life.Conclusions: Excellent nurses in evidence-based practice consciously spend time to discover patient preferences using the set of implicit and intuitive communication tools to attune their professional care. The use of these tools leads to individual tailored nursing care and appears to be part of the nurses' practical wisdom. Further studies on how nurses balance patient preferences in nursing decision-making in the evidence-based practice are recommended. Impact:The findings fill a gap in the literature on how nurses discover and balance all three aspects of the evidence-based practice in their decision-making: evidence derived from science, best practice, and patient preferences. Moreover, the use of this implicit knowledge in nursing deserves further research and attention in practice and education. K E Y W O R D Santennae, click or instant connection, empathic questions, evidence-based practice, grounded theory, nursing, nursing decision-making, patient preferences, quality of life

Aims and objectives: To explore how excellent nurses in hospitals take into account patient preferences in nursing decision-making in the evidence-based practice towards personalised care. Background:In evidence-based practice, nursing decision-making is based on scientific evidence, evidence of best practice and individual patient preferences. Little is known about how nurses in hospitals take into account patient preferences in nursing decision-making.Design: Qualitative grounded theory.Methods: Data collection entailed 27 semi-structured interviews with nurses designated by their colleagues as excellent caregivers, followed by 57 hours of participant observation. Data analysis was conducted using three-level coding with constant comparison and theoretical sampling. The COREQ checklist for qualitative research was followed.Results: A main finding was that participants used three implicit tools to discover patient preferences: establishing a connection, using antennae and asking empathic questions, thus instantly reassuring patients from the very first contact. Their starting point in care was the patient's perception of quality of life wherein they shifted towards their patient's perspective: "Teach me to provide the best care for you in this situation." During the observations, it was confirmed that the excellent nurses behaved as they had described before. Conclusion:Excellent nurses actively turn towards patients' expectations and experienced quality of life by carefully blending individual sensitive and situation specific patient preferences with scientific evidence and evidence of best practice. In doing so, they are able to balancing more equally patient preferences in to the equation called evidence-based practice, thus leading to wise decision-making in personalised nursing care.Relevance to clinical practice: Patient preferences become a fully fledged part of nursing decision-making in EBP when in education and practice, the implicit knowledge of excellent nurses about how to take into account patient preferences to provide personalised care is more valued and taught.

Since decades, nursing education struggles with a persistent gap between the theoretical knowledge offered in the study program and its application in professional practice. To bridge this gap competence-based curricula were developed with instructional designs as authentic learning contexts and self-directed learning. In this project we explored final year Bachelor Nursing (BN) students’ experiences in learning in a newly developed curriculum, and their knowledge quality outcomes and the degree of agreement with knowledge requirements. An instrumental multiple case study was conducted with interviews, concept mapping and a domain knowledge list. Results show that a third of the participants had positive learning experiences and got high appraisals for their knowledge quality. Similar to the medium and low scoring participants, they developed instrumental knowledge but integrated other forms of learning into a system of meaning, which is needed to solve non-routine problems in future practice. Medium and low scoring participants did not profit from learning in authentic contexts and self-directed learning. In conclusion, developing sufficient professional knowledge in a constructivist competence-based curriculum is influenced by students’ intrinsic motivation to build a strong knowledge base, by their perception of how to learn and use professional knowledge, and their expectations of the degree of supervision and guidance by the teacher. It is recommended to evaluate the extent to which the intended curriculum is being taught.

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