Conceptualising a system for quality clinical decision-making in nursing: review

Abstract

Quality clinical decision-making in nursing is the essence of quality nursing care delivery. The purpose of this article is to conceptualise a system for quality clinical decision-making in nursing. A system for quality clinical decisionmaking in nursing was conceptualised based on a review of the literature pertaining to clinical decision-making. To that effect, both published and unpublished references were reviewed. The review revealed two predominant theoretical perspectives of the process of clinical decision-making: a positivistic perspective and a postmodernistic perspective. These perspectives are respectively exemplified by an information-processing approach and the intuitive approach to clinical decision-making in nursing. The strengths and weaknesses of both approaches were explored and, as a result, a third theoretical approach emerges: the idea of a dialectic, integrative, interactive approach that culminates in the conceptualisation of a system for quality clinical decision-making in nursing. According to a system for quality clinical decision-making, clinical decision-making is viewed as an open system in which both approaches, described as a "piece-meal" approach (Tabak & Bar-Tal, 1996:1-2) and an intuitive approach (Benner, 1984) can be used in a complementary manner to achieve quality clinical decisions in nursing. As a feedback mechanism to promote or improve the quality of clinical decisions in nursing, standards for quality clinical decision-making are proposed in an exemplary manner. In addition, a system for quality clinical decisionmaking in nursing capitalises on the heritage of the nursing process. Considering the changes and the complexities associated with clinical decision-making in nursing, the system accommodates recent knowledge development activities in nursing, such as developments in nursing classification systems and the classification of nursingsensitive patient outcomes.


Key Words: Clinical decision-making; Quality; Rational interaction; Standard and system





OPSOMMING

Gehalte kliniese besluitneming in verpleging word beskou as die essensie van gehalte verpleegsorg. Die doel van hierdie artikel is om ‘n sisteem vir gehalte besluitneming in verpleging te konseptualiseer. Die konseptualisering van ‘n sisteem vir gehalte kliniese besluitneming in verpleging is op die bestudering van die literatuur oor kliniese besluitneming gegrond. Beide gepubliseerde en ongepubliseerde verwysingsbronne is bestudeer. Twee dominante perspektiewe, ‘n positivistiese perspektief en ‘n postmodernistiese perspektief, met betrekking tot die proses van kliniese besluitneming is na aanleiding van die bestudering van die literatuur geïdentifiseer. Hierdie perspektiewe word onderskeidelik deur ‘n inligtingsverwerkingsbenadering en ‘n intuïtiewe benadering tot kliniese besluitneming in verpleging beliggaam. Die goeie hoedanighede en tekortkominge van beide benaderings is verken en ‘n derde teoretiese benadering het gevolglik tot stand gekom: die idee van ‘n dialektiese, geïntegreerde, interaktiewe benadering wat in die konseptualisering van ‘n sisteem vir gehalte besluitneming in verpleging kulmineer. Volgens ‘n sisteem vir gehalte besluitneming in verpleging, word kliniese besluitneming beskryf as ‘n stuksgewyse benadering (Tabak & Bar-Tal, 1996:1-2) en/of ‘n intuïtiewe benadering (Benner, 1984), wat op ‘n aanvullende wyse aangewend kan word, om gehalte besluitneming in verpleging te kan laat plaasvind. Standaarde vir gehalte besluitneming, in die vorm van ‘n voorbeeld, word as terugvoermeganisme voorgestel, ten einde die gehalte van kliniese besluitneming in verpleging te bevorder en te verbeter. Voorts, kapitaliseer ‘n sisteem vir gehalte besluitneming in verpleging op die herkoms van die verpleegproses. Deur die veranderinge en kompleksiteit wat met kliniese besluitneming gepaard gaan, akkommodeer dit resente kennis in verband met ontwikkelingsaktiwiteite in verpleging, soos die ontwikkeling van ‘n verpleegklassifikasiesisteem en die klassifikasie van uitkomste ten opsigte van die verpleegsensitiewe-pasiënt.



Health SA Gesondheid Vol.9(3) 2004: 66-81