Wound care in the community setting: clinical decision making in context

Abstract

Sixty-two community nurses in northern England of grades B and D to H were interviewed by a team of four researchers. The interviews were semi-structured, and were tape-recorded, fully transcribed and content analysed. They were conducted as part of a larger study, the aim of which was to examine community nurses' perceptions of quality in nursing care. One of the main themes the work focused on was decision-making as an element of quality. Data relating to wound care were considered from the perspective of the insights they offered into clinical decision-making. Data were interpreted in the light of a literature review in which a distinction had been made between theories which represented clinical decision-making as a linear or staged process and those which represented it as intuitive. Within the former category, three sub-categories were suggested: theorists could be divided into 'pragmatists', 'systematisers' and those who advocated 'diagnostic reasoning'. The interpretation of the data suggested that the clinical decisions made by community nurses in the area of wound care appeared largely intuitive, yet were also closely related to 'diagnostic reasoning'. They were furthermore based on a range of sources of information and justified by a number of different types of rationale.

Nursing prioritization of the patient need for care: A tacit knowledge embedded in the clinical decision‐making literature

“…Differences in the relative values of clinical criteria according to practice setting imply reframing of nursing prioritization to meet the aims of the patient need for care in each setting. The patient need for care might relate to life‐threatening situations in the critical care setting, 52–61 through access to acute services, 37,62–69 to facilitation of individuals' continued independence in the community, 70–74 or providing support for patients' choices at the end of life 75,76 …”

Diagnostic and treatment decision making in community nurses faced with a patient with possible venous leg ulceration: A signal detection analysis

“…It is one of only a few studies that have looked explicitly at cognition, judgement and decision making in wound care and amongst wound care nurses. With some notable exceptions, most studies focus on styles of reasoning (40,55,56), few examine what happens at the cognitive level of information synthesis. (57) Because being competent and offering value-for-money is a key goal for many healthcare professionals (46) our use of self-reported measures was subject to a social desirability bias.…”

Strategies used by nurses for decision-making in the paediatric orthopaedic setting

“…Intuition when analysed can normally be related to factual information, experience, similarity in findings and skill or knowledge (Hallett et al, 2000;Easen, 1996). Pyles andStern (1983, cited in Higgs andJones 2000), in a study of nursesÕ reasoning processes, described intuition or Ônursing gestaltÕ as being as important to decision-making as knowledge.…”

“…Pattern recognition or inductive reasoning (Higgs and Jones, 2000) enables the nurse to extract salient points of a situation that fit or fall outside of a pattern (Hallett et al, 2000) using a forward or backward reasoning strategy. Had the childÕs condition not matched the clinical presentation a backward reasoning process would have been implemented, involving a data search to support the proposed diagnosis (Higgs and Jones, 2000;Thompson and Dowding, 2002).…”