臨床決策之概念分析：以護理角度出發

A Conceptual Analysis of Clinical Decision-Making From a Nursing Perspective

顏旻萱(Min-Syuan Yen) ； 楊鎮宇(Cheng-Yu Yang) ； 施倩鈴(Chien-Ling Shih) ； 蔡慧于(Hui-Yu Tsai) ； 謝菁怡(Ching-Yi Hseh) ； 奉秀盈(Shion-Ying Fong) ； 蕭乃嘉(Nai-Chia Hsiao) ； 吳麗敏(Li-Min Wu)

《榮總護理》 38卷3期 (2021/09) Pp. 269-278

https://doi.org/10.6142/VGHN.202109_38(3).0006

摘要

護理人員面對臨床各種情境，必須透過評估、分析後做出決定，此過程稱為「臨床決策」且此為動態過程。臨床決策是護理人員必須具備的能力，但隨著多元社會和全球化，臨床決策變得更複雜亦需要注入更多考量。故本文依Walker與Avant（2011）的步驟進行概念分析，結果確認此概念之定義性特徵為：一、過去的知識和實務經驗；二、透過資料或證據了解病人的需求，並辨別出病情變化；三、依據病人最佳利益，確定事件的優先順序；四、綜整後得出最佳行動方案的結論，並對事件做出回應；五、預期達成一個或多個特定的目標。藉由典型、邊緣及相反案例的列舉，更清楚分析此概念及確認臨床決策發生之前置因素與後果，透過實證工具的應用將此抽象的概念具體化，讓臨床護理受用。故本文希望透過概念分析後，護理人員在進行臨床決策時除了透過過往經驗外，更能經由思考、實證依據及與病人或家屬溝通後進行決策，達到護病雙贏的結果。

關鍵字

臨床決策 ； 判斷 ； 推理 ； 護理 ； 概念分析

並列摘要

Nurses must assess and analyze various clinical situations to make decisions. This dynamic process is called clinical decision-making. Due to globalization and the increasingly pluralization of societies, clinical decision-making has become more complicated and requires greater consideration. This conceptual analysis is guided by Walker and Avant (2011). The attributes of clinical decision-making are 1. drawing on knowledge and experience; 2. recognizing the patient's needs and their disease conditions using data or evidence; 3. prioritizing an event based on what is in the patients' best interests; 4. coming to a conclusion on the best course of action and responding to the event; 5. expecting to accomplish a specific goal or goals. Exemplars of model, borderline, and contrary cases are presented to clearly illustrate clinical decision-making and better understand the antecedents and consequences. Empirical referents are used to render the abstract concept measurable and thus beneficial to nursing practice. Therefore, this article hopes to encourage nurses to make clinical decisions based not only on experience but also on critical thinking, empirical evidence, and communication with patients or patients' family members to achieve a win-win outcome.

並列關鍵字

clinical decision-making ； judgement ； reasoning ； nursing ； concept analysis

參考文獻

Adamson, K. A., Gubrud, P., Sideras, S., & Lasater, K. (2012). Assessing the reliability, validity, and use of the Lasater Clinical Judgment Rubric: three approaches. The Journal of Nursing Education, 51(2), 66-73.

Brunt, B. A. (2005). Critical thinking in nursing: An integrated review. The Journal of Continuing Education in Nursing, 36(2), 60-67.

Canova, C., Brogiato, G., Roveron, G., & Zanotti, R. (2016). Changes in decision-making among Italian nurses and nursing students over the last 15 years. Journal of Clinical Nursing, 25(5-6), 811-818.

Dowding, D., & Thompson, C. (2003). Measuring the quality of judgement and decision‐making in nursing. Journal of Advanced Nursing, 44(1), 49-57.

Edeer, A. D. & Sarıkaya, A. (2015). Adaptation of clinical decision making in nursing scale to undergraduate students of nursing: The study of reliability and validity. International Journal of Psychology and Educational Studies, 2(3), 1-9.