Managing patient care: A substantive theory of clinical decision making

2.50
Hdl Handle:
http://hdl.handle.net/10755/150355
Type:
Presentation
Title:
Managing patient care: A substantive theory of clinical decision making
Abstract:
Managing patient care: A substantive theory of clinical decision making
Conference Sponsor:Sigma Theta Tau International
Conference Year:1991
Author:dela Cruz, Felicitas, DNSc
P.I. Institution Name:Azusa Pacific University, School of Nursing
Title:Professor
This study investigates the phenomenon of clinical decision making, deriving a grounded substantive theory to explain how home health care nurses make patient care decisions. The study employs a field research design using grounded theory based on symbolic interactionism. Data collection involves the triangulation of theoretically sampled data sources: participant observation with open-ended interviews of eleven home health care nurses, open-ended interviews of ten home health agency nurse supervisors and administrators, and analysis of patients' records and home care nursing practice policy documents. The study uses the constant comparative technique for data analysis and incorporates measures to enhance its credibility, transferability, dependability, and confirmability. Managing patient care emerged as the basic social process that explains home health care nurses' clinical decision making. This process has three components. First, it embodies the problem solving process with the phases of problem finding and problem management. Problem finding consists of the cognitive processes and decisions of cue searching and inferring patient problems, while problem management consists of planning, intervening, and evaluating. Second, to manage patient care, home care nurses use three styles based on their approach to gathering and evaluating information--skimming, surveying, and sluething. Third, interacting clinical and non-clinical factors influence patient care management: the nurse's education and experience, the patient's health-related attributes, the nurse-patient interaction, and the organizational, legal, and economic factors. With these three components, the emergent theory of managing patient care integrates elements of three cognitive theories--information processing, cognitive continuum, and skills acquisition--thus bridging the traditionally dichotomous rational and phenomenological perspectives underpinning clinical decision making. The emergent theory raises issues critical to the teaching and improvement of clinical decision making among practicing and future home care nurses, in the context of the potential ethical dilemmas implied by the sometimes conflicting factors that influence patient care management. It serves as the springboard for extending the study to other clinical specialties, building a body of substantive theories that would lead to a formal theory of clinical decision making in nursing.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleManaging patient care: A substantive theory of clinical decision makingen_GB
dc.identifier.urihttp://hdl.handle.net/10755/150355-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Managing patient care: A substantive theory of clinical decision making</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">1991</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">dela Cruz, Felicitas, DNSc</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Azusa Pacific University, School of Nursing</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Professor</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">fdelacru@apu.edu</td></tr><tr><td colspan="2" class="item-abstract">This study investigates the phenomenon of clinical decision making, deriving a grounded substantive theory to explain how home health care nurses make patient care decisions. The study employs a field research design using grounded theory based on symbolic interactionism. Data collection involves the triangulation of theoretically sampled data sources: participant observation with open-ended interviews of eleven home health care nurses, open-ended interviews of ten home health agency nurse supervisors and administrators, and analysis of patients' records and home care nursing practice policy documents. The study uses the constant comparative technique for data analysis and incorporates measures to enhance its credibility, transferability, dependability, and confirmability. Managing patient care emerged as the basic social process that explains home health care nurses' clinical decision making. This process has three components. First, it embodies the problem solving process with the phases of problem finding and problem management. Problem finding consists of the cognitive processes and decisions of cue searching and inferring patient problems, while problem management consists of planning, intervening, and evaluating. Second, to manage patient care, home care nurses use three styles based on their approach to gathering and evaluating information--skimming, surveying, and sluething. Third, interacting clinical and non-clinical factors influence patient care management: the nurse's education and experience, the patient's health-related attributes, the nurse-patient interaction, and the organizational, legal, and economic factors. With these three components, the emergent theory of managing patient care integrates elements of three cognitive theories--information processing, cognitive continuum, and skills acquisition--thus bridging the traditionally dichotomous rational and phenomenological perspectives underpinning clinical decision making. The emergent theory raises issues critical to the teaching and improvement of clinical decision making among practicing and future home care nurses, in the context of the potential ethical dilemmas implied by the sometimes conflicting factors that influence patient care management. It serves as the springboard for extending the study to other clinical specialties, building a body of substantive theories that would lead to a formal theory of clinical decision making in nursing.</td></tr></table>en_GB
dc.date.available2011-10-26T10:22:30Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T10:22:30Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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