Yıl: 2012 Cilt: 9 Sayı: 1 Sayfa Aralığı: 52 - 59 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Hemşirelikte Klinik Karar Verme, Etkileyen Etmenler Ve Karar Verme Modelleri

Öz:
Klinik karar verme, topluma kaliteli ve güvenli bakım sunma ve hasta bakım sonuçlarını geliştirmede yaşamsaldır. Hemşireler sağlık bakım sisteminde çok yönlü ve karmaşık ortamlarda yoğun bilgi kullanarak kısa sürede klinik kararlar almak zorundadır. Hemşirenin doğru ve etkili klinik karar vermesini; bilgisi, deneyimi, bireysel özellikleri, görevin karmaşıklığı ve ortamın özellikleri etkiler. Klinik karar vermenin sınırlarını ise yasalar, etik ilkeler ve kültürel yapı belirler. Hemşirelikte klinik karar verme sürecinde analitik ve sezgisel yaklaşım kullanılmaktadır. Bu yaklaşımların ve bunlara temellenen modellerin hemşirelik hizmetlerinin kalitesinde önemli etkileri olduğu belirtilmektedir. Klinik karar vermenin anlaşılması, hemşirelik alanlarında doğru klinik karar vermeyi sağlayacak yöntemlerin geliştirilmesine yardım eder. Klinik karar vermenin geliştirilmesi de topluma güvenli sağlık bakım hizmetinin sunulmasına katkı sağlar. Bu derlemede hemşirelikte klinik karar verme, karar vermeyi etkileyen etmenler, karar vermeyi destekleyen yaklaşımlar ve karar verme modellerinin tartışılması amaçlanmıştır.
Anahtar Kelime:

Konular: Hemşirelik

Decision Making in Clinical Nursing: DecisionMaking Models and Affecting Factors

Öz:
Decision making in clinical settings is vital in order to provide safe, top quality care for the community and to improve patient care outcomes. Nurses have to make clinical decisions in complex, information-intensive environments. Knowledge level, personal characteristics, past experience, job complexities and environmental factors can all have an effect on the accurate and efficient clinical decisions that nurses make. Laws, ethical principles and culture determine the boundaries of clinical decision making. An analytical and intuitive approach must be used for effective clinical decision making in nursing. It is stated that these approaches and the models that they are based on affect the quality of nursing practice. An understanding of clinical decision making helps develop new methods that lead to correct clinical decision making in nursing. The development of clinical decision making contributes to the safe delivery of health care services to society. Clinical decision making in nursing, factors affecting decision making, decision-making models and approaches thatsupport decision making will be discussed in this review.
Anahtar Kelime:

Konular: Hemşirelik
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Salehi SH, Bahrami M, Hosseini SA et al. Critical thinking and clinical decision making in nurse. Iranian Journal of Nursing and Midwifery Research Winter 2007;12(1):13-16.
  • 2. Bakalis N, Bowman GS, Porock D. Decision making in Greek and English registered nurses in coronary care units. International Journal of Nursing Studies 2003;40(7): 749-760
  • 3. Botti MR. Role of knowledge and ability in student nurses' clinical decision-making. Nursing and Health Sciences 2003;5(1):39-49.
  • 4. Lauri S, Salanterä S, Chalmers K, et al. An exploratory study of clinical decision-making in five countries. Journal of Nursing Scholarship 2001;33(1):83-90.
  • 5. Bjørk IT, Hamilton GA. Clinical decision making of nurses working in hospital setting. Nursing Research and Practice 2011;8:1-8.
  • 6. Radwin LE. Empirically generated attributes of experience in nursing. Journal of Advanced Nursing 1998;27(3):590-95.
  • 7. Hagbaghery AM, Salsali M, Ahmadi F. The factors facilitating and inhibiting effective clinical decision-making in nursing: A qualitative study. BioMed Central Nursing 2004;3(2):1-11.
  • 8. Hedberg B, Larsson US. Environmental elements affecting the decisionmaking process in nursing practice. Journal of Clinical Nursing 2004;13(3):316-324.
  • 9. Azak A, Taşçı S. Klinik Karar Verme ve Hemşirelik. Turkiye Klinikleri Tıp Etiği- Hukuku Dergisi 2009;17(3):176–83.
  • 10. Türk Dil Kurumu Sözlüğü. “Karar” Retrived: May 19, 2010, from http ://td k. or g.tr/TR/Gene l/S ozB ul. a sp x ?&Ke lime=ka r a r
  • 11. Lauri S, Salanterä S. Decision-making models in different fields of nursing. Research in Nursing & Health 1998;21(5):443-452.
  • 12. Banning MA. review of clinical decision making: Models and current research. Journal of Clinical Nursing 2008;17(2):187-195.
  • 13. Rashotte J, Carnevale FA. Medical and nursing clinical decision making: A comparative epistemological analysis. Nursing Philosophy 2004;5(2):160-174.
  • 14. İraz R. Organizasyonlarda karar verme ve iletişim sürecinin etkinliği bakımından bilgi teknolojilerinin rolü. Selçuk Üniversitesi Sosyal Bilimler Enstitüsü Dergisi 2004;11(1):407-422.
  • 15. Benner P, Tanner C, Chesla C. From beginner to expert: Gaining a differentiated clinical world in critical care nursing. Advances in Nursing Science 1992;14(3):13-28.
  • 16. Taylor C. Clinical problem-solving in nursing: Insightsfrom the literature. Journal of Advanced Nursing 2000;31(4):842-849.
  • 17. Thompson CA. Conceptual treadmill: The need for ‘middle ground’ in clinical decision making theory in nursing. Journal of Advanced Nursing 1999;30(5):1222-1229.
  • 18. O’Neill ES, Dluhy NM, Chin E. Modelling novice clinical reasoning for a computerized decision support system. Journal of Advanced Nursing 2005;49(1):68-77.
  • 19. Shin KR. Clinical thinking ability and clinical decision-making skills among senior nursing studentsin associate and baccalaureate programmes in Korea. Journal of Advanced Nursing 1998;27(2): 414-418.
  • 20. Junnola T, Eriksson E, Salanterä S et al. Nurses’ decision-making in collecting information for the assessment of patients’ nursing problems. Journal of Clinical Nursing 2002;11(2):186-196.
  • 21. Aitken LM. Critical care nurses’ use of decision-making strategies. Journal of Clinical Nursing 2003;12(4):476-483.
  • 22. Benner P, Hughes RG, Sutphen M. Clinical Reasoning, Decision making, and Action: Thinking Critically and Clinically. In: Hughes RG eds. Patient safety and quality: an evidence-based handbook for nurses. (3th.ed.), Agency for Healthcare Research and Quality.2008.p.87-109. Retrieved Mayıs 2010, from http://www.ncbi.nlm.nih.gov/books/NBK2643/
  • 23. Orsolini-Hain L, Malone R. Examining the impending gap in clinical nursing expertise. Policy, Politics & Nursing Practice 2007;8(3):158- 169.
  • 24. Brykczynski KA. Patricia Benner: from novice to expert: excellence and power in clinical nursing practice. In A Marriner-Tomey, MR Alligood (eds.) Nursing theorists and their work, (5th.ed.), St. Louis, MO: Mosby 2002;165-180.
  • 25. Lamond D, Farnell S. The treatment of pressure sores: A comparison of novice and expert nurses’ knowledge, information use and decision accuracy. Journal of Advanced Nursing 1998;27(2):280-286
  • 26. Reischman RR, Yarandi HN. Critical care cardiovascular nurse expert and novice diagnostic cue utilization. Journal of Advanced Nursing 2002;39(1):24-34.
  • 27. Hoffman K, Donoghue J, Duffield C. Decision-making in clinical nursing: Investigating contributing factors. Journal of Advanced Nursing 2004;45(1):53-62.
  • 28. Taylor C. Problem solving in clinical nursing practice. Journal of Advanced Nursing 1997;26(2):329-336.
  • 29. Hicks D, Merritt SL, Elstein AS. Critical thinking and clinical decision making in critical care nursing: A pilot study. Heart & Lung 2003;32(3):169-180.
  • 30. Hoffman KA, Aitken LM, Duffield CA. Comparison of novice and expert nurses’ cue collection during clinical decision-making: Verbalprotocol analysis. International Journal of Nursing Studies 2009;46(10):1335-1344.
  • 31. Tabak N, Bar-Tal Y, Cohen-Mansfield J. Clinical decision making of experienced and novice nurses. Western Journal of Nursing Research 1996;18(5):534-47.
  • 32. Bakalis NA, Watson R. Nurses’ decision-making in clinical practice. Nursing Standard 2005;19(23):33-39.
  • 33. O’Neill ES, Dluhy NM, Fortier P et al. Knowledge acquisition, synthesis and validation: A model for decision support systems. Journal of Advanced Nursing 2004;47(2):134-142.
  • 34. Katoaka-Yahiro M, Saylor C. A Critical thinking model for nursing judgment. Journal of Nursing Education 1994;33(8):351-356.
  • 35. Girot EA. Graduate nurses: Ciritical thinkers or beter decision-maker? Journal of Advanced Nursing 2000;31(2):288-297.
  • 36. Martin C. The theory of critical thinking of nursing. Nurse Education Perspective 2002;23(5):243-247.
  • 37. Hoffman K, Elwin C. The relationship between critical thinking and confidence in decision-making. Australian Journal of Advanced Nursing 2004;22(1):8-12.
  • 38. Hedberg B, Larsson US. Observations, confirmations and strategies - useful tools in decision-making process for nurses in practice? Journal of Clinical Nursing 2003; 12(2):215-222.
  • 39. Bucknall TK. The clinical landscape of critical care: Nurses’ decisionmaking. Journal of Advanced Nursing 2003;43(3):310-319.
  • 40. Currey J, Worrall-Carter L. Making decisions: Nursing practices in critical care. Australian Critical Care 2001;14(3):127-131.
  • 41. Thompson C, Dowding D. Responding to uncertaintyin nursing practice. International Journal of Nursing Studies 2001;38:609–615.
  • 42. Narayan SM, Corcoran-Perry S, Drew D et al. Decision analysis as a tool to support an analytical pattern of reasoning. Nursing & Health Sciences 2003;5(3):229-243.
  • 43. Thompson C, Dowding D. Decision analysis. In C Thompson, D Dowding (eds.), Clinical decision making and judgement in nursing, (1th ed.), Churchill Livingstone, Edinburg, 2002.p:131-146.
  • 44. Randell R, Mitchell N, Dowding D et al. Effects of computerized decision support systems on nursing performance and patient outcomes: A systematic review. Journal of Health Services Research & Policy 2007;12(4):242-249.
  • 45. Friedman CP. Fundamental theorem of biomedical informatics. Journal of American Medical Informatic Association 2009;16(2):169-170.
  • 46. Bucknall TK. Critical care nurses’ decision making activities in the natural clinical setting. Journal of Clinical Nursing 2000;9(1):25-36.
  • 47. Offredy M, Meerabeau L. The use of ‘think aloud’ technique, information processing theory and schema theory to explain decision-making processes of general practitioners and nurse practitioners using patient scenarios. Primary Health Care Research and Development 2005;6:45-49.
  • 48. Rothe H. Approaches to pattern recognition, advanced pattern recognition techniques. NATO-RTO lecture series 214, Lisbon Portugal,1998,1-29.
  • 49. Cioffi J, Markham R. Clinical decision-making by midwives: Managing case complexity. Journal of Advanced Nursing 1997;25(2):265-272.
  • 50. King L, Macleod CJ. Intuition and the development of expertise in surgical ward and intensive care nurses. Journal of Advanced Nursing 2002;37(4):322-329.
  • 51. Manias E, Aitken R, Dunning T. Decision-making models used by ‘graduate nurses’ managing patients’ medications. Journal of Advanced Nursing 2004;47(3):270-278.
  • 52. Blum CA. Using the Benner intuitive-humanistic decision-making model in action: A case study. Nurse Education Practice 2010;10(5):303-307.
  • 53. Cioffi J. Nurses’ experience of making decisionsto call emergency assistance to their patients.Journal of Advanced Nursing 2000;32(1):108-114.
  • 54. Anderson JA, Willson P. Clinical decision support systems in nursing: Synthesis of the science for evidence-based practice. Computers, Informatics, Nursing 2008; 26(3):151-158.
APA SUCU DAĞ G, DİCLE A, SAKA O (2012). Hemşirelikte Klinik Karar Verme, Etkileyen Etmenler Ve Karar Verme Modelleri. , 52 - 59.
Chicago SUCU DAĞ GÜLTEN,DİCLE Aklime,SAKA Osman Hemşirelikte Klinik Karar Verme, Etkileyen Etmenler Ve Karar Verme Modelleri. (2012): 52 - 59.
MLA SUCU DAĞ GÜLTEN,DİCLE Aklime,SAKA Osman Hemşirelikte Klinik Karar Verme, Etkileyen Etmenler Ve Karar Verme Modelleri. , 2012, ss.52 - 59.
AMA SUCU DAĞ G,DİCLE A,SAKA O Hemşirelikte Klinik Karar Verme, Etkileyen Etmenler Ve Karar Verme Modelleri. . 2012; 52 - 59.
Vancouver SUCU DAĞ G,DİCLE A,SAKA O Hemşirelikte Klinik Karar Verme, Etkileyen Etmenler Ve Karar Verme Modelleri. . 2012; 52 - 59.
IEEE SUCU DAĞ G,DİCLE A,SAKA O "Hemşirelikte Klinik Karar Verme, Etkileyen Etmenler Ve Karar Verme Modelleri." , ss.52 - 59, 2012.
ISNAD SUCU DAĞ, GÜLTEN vd. "Hemşirelikte Klinik Karar Verme, Etkileyen Etmenler Ve Karar Verme Modelleri". (2012), 52-59.
APA SUCU DAĞ G, DİCLE A, SAKA O (2012). Hemşirelikte Klinik Karar Verme, Etkileyen Etmenler Ve Karar Verme Modelleri. Hemşirelikte Eğitim ve Araştırma, 9(1), 52 - 59.
Chicago SUCU DAĞ GÜLTEN,DİCLE Aklime,SAKA Osman Hemşirelikte Klinik Karar Verme, Etkileyen Etmenler Ve Karar Verme Modelleri. Hemşirelikte Eğitim ve Araştırma 9, no.1 (2012): 52 - 59.
MLA SUCU DAĞ GÜLTEN,DİCLE Aklime,SAKA Osman Hemşirelikte Klinik Karar Verme, Etkileyen Etmenler Ve Karar Verme Modelleri. Hemşirelikte Eğitim ve Araştırma, vol.9, no.1, 2012, ss.52 - 59.
AMA SUCU DAĞ G,DİCLE A,SAKA O Hemşirelikte Klinik Karar Verme, Etkileyen Etmenler Ve Karar Verme Modelleri. Hemşirelikte Eğitim ve Araştırma. 2012; 9(1): 52 - 59.
Vancouver SUCU DAĞ G,DİCLE A,SAKA O Hemşirelikte Klinik Karar Verme, Etkileyen Etmenler Ve Karar Verme Modelleri. Hemşirelikte Eğitim ve Araştırma. 2012; 9(1): 52 - 59.
IEEE SUCU DAĞ G,DİCLE A,SAKA O "Hemşirelikte Klinik Karar Verme, Etkileyen Etmenler Ve Karar Verme Modelleri." Hemşirelikte Eğitim ve Araştırma, 9, ss.52 - 59, 2012.
ISNAD SUCU DAĞ, GÜLTEN vd. "Hemşirelikte Klinik Karar Verme, Etkileyen Etmenler Ve Karar Verme Modelleri". Hemşirelikte Eğitim ve Araştırma 9/1 (2012), 52-59.