BackgroundFew studies have used quantitative methods to explore the key factors affecting shared decision-making (SDM) in nursing decision-making from the perspective of orthopedic nurses.PurposeTo understand the intercorrelations among shared decision-making questionnaire–nurse (SDM-Q-NUR) factors and identify key factors for clinical nursing care decisions in orthopedics.MethodsIn May 2021, this study investigated the interdependence of the SDM-Q-NUR scale and developed an influential network-relation map (INRM) from the clinical experience of 13 trained orthopedic nurses using the Decision-making Trial and Evaluation Laboratory method.ResultsThe INRM results showed that the nine criteria corresponded to three stages: preparation, discussion, and decision. “I helped my patient or patient's family understand all the information” (C5) and “I wanted to know from my patient or patient's family how they want to be involved in making the nursing care decision” (C2) are the main key factors for the beginning of nursing decision. In the discussion and decision stages, the corresponding key factors are “I made it clear to my patient or patient's family that a nursing care decision needs to be made” (C1) and “I asked my patient or patient's family which nursing care option they prefer” (C6). The result's statistical significance confidence and gap error were 98.106% and 1.894%, respectively.ConclusionsWhen making nursing decisions with patients, orthopedic nurses need to have detailed information about how patients are involved in SDM and all relevant information. Nurses should also inform patients and their families regarding the purpose of the discussion, namely, to help one understand the content, advantages, and disadvantages of the nursing care options, and finally, make a decision.

Tibial plateau fractures are multiple fracture patterns associated with soft-tissue injuries. Among which, the combined existence of posterolateral tibial plateau depression fracture with anterior cruciate ligament (ACL) rupture has been reported rarely. Meanwhile, surgical method for the treatment of depression fracture is fairly complex. The aim of this article is to show a case series of this unusual injury pattern and the therapy of posterolateral tibial plateau depression fracture accompanying ACL rupture. In our treatment, arthroscopy assisted reduction of depression fracture and ACL reconstruction reduces surgical trauma and leads to good functional recovery. We also review the current literature.

Nursing departments in hospitals must evaluate the practical competency of newly graduated nurses and assist them to increase their competence. Competency assessments often consider multiple qualitative attributes and use expert knowledge as the basis for decision-making. This study proposes a hybrid multiple attribute decision-making (MADM) model that determines practical competency of the newly graduated nurse as an evaluation framework. A causal influence-network diagram (CIND) and influential weights are obtained from nursing experts’ clinical experience using the decision-making trial and evaluation laboratory (DEMATEL)-based analytical network process analysis (DANP). The MOORA-AS method is then used to evaluate the ability expectation ratio-gap for newly graduated nurses in practice. The CIND is used to allow each newly graduated nurse to reduce the performance ratio-gaps between the current level and the aspirational level from a systematic perspective. The empirical data applies to a third-class and a first-class hospital in China. The results show that the proposed hybrid MADM model has reliable results and allows nursing department decision-makers/managers to easily evaluate and systematically improve competencies for newly graduated nurses.

BackgroundThe global shortage and turnover of nurses is a current challenge. Past studies have shown that nurse job satisfaction may ameliorate nurse shortage. Although there are many studies on the criteria influencing nurses' job satisfaction, few have examined the causal relationships and weight of each criterion from a systematic perspective.ObjectiveIdentify the key criteria and causal relationships that affect nurses' job satisfaction, and help nurse leaders identify high-weight, high-impact dimensions and contextualize them for improvement.MethodsThe study developed a hybrid multi-criterion decision-making model, which incorporated the McCloskey/Mueller satisfaction 13-item scale (MMSS-13), and the Decision-Making Trial and Evaluation Laboratory and the Importance-Performance Analysis methods the model was used to analyze key factors of nurse satisfaction and their interrelationships based on the experience of 15 clinical nurse specialists.ResultsIn MMSS-13's dimension level, “satisfaction with work conditions and supervisor support” (C5) had the highest impact, and “satisfaction with salary and benefits” (C1) had the highest weight. In criteria level, “salary” (C11), “flexibility in scheduling time off” (C24), “maternity leave time” (C31), “opportunities for social contact after work” (C41), and “your head nurse or facility manager” (C51) had high influence under their corresponding dimensions. The “benefits package” (C13) was the top criterion with the highest impact on MMSS-13.ConclusionsThis study assessed nurses' job satisfaction from a multidimensional perspective and revealed the causal relationships between the dimensions. It refined the assessment of nurse job satisfaction to help nurse leaders better assess nurse job satisfaction and make strategic improvements. The study found that compensation and benefits had the highest weight in nurses' job satisfaction. Meanwhile, support for family responsibilities and working conditions, and support from supervisors were the cause dimensions of job satisfaction. Among the more detailed criteria, salary, benefits package, maternity leave time, and leadership had a greater impact on nurses' job satisfaction. Nurse leaders should start with these dimensions to achieve efficient improvement of nurses' job satisfaction.

PurposeThis study constructs a structure of interaction between dimensions and criteria within the diagnosis-related groups (DRGs) system from a quantitative system and identifies key factors affecting the overall performance of medical services.MethodFrom September to December 2020, the influence relation structure diagram (IRSD) of the dimensions and corresponding criteria was developed from the practical experience of a group of domain experts, based on the DEMATEL method. Subsequently, all dimensions and criteria construct influential weights from a systems perspective. Finally, the main influential factors were identified based on the analysis results.ResultsThe IRSD results showed that, in the overall performance of medical services, “Medical service capacity (C1)” was the main influential dimension, influencing both “Medical service efficiency (C2)” and “Medical service safety (C3).” At the criteria level, “Case-mix index (CMI) (C12),” “Time efficiency index (C21),” and “Inpatient mortality of medium-to-low group (C32)” were the main influential criteria in the corresponding dimensions. The influential weight results showed that “Medical service capacity (C1)” was also a key dimension. “Case-mix index (CMI) (C12),” “Cost efficiency index (C22),” and “Inpatient mortality of medium-to-low group (C32)” were the key criteria in their respective dimensions.ConclusionPatients and managers should first focus on the capacity of medical service providers when making a choice or deciding using the results of the DRGs system. Furthermore, they should pay more attention to medical safety even if it is not as weighted as medical efficiency.