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

Abstract

Nursing prioritization of the patient need for care: A tacit knowledge embedded in the clinical decision-making literatureEvery day in clinical settings, nurses practise in complex and dynamic situations. Nurses work to achieve emergent order in these situations through nursing prioritization of the patient need for care. As direct research on nursing prioritization had not been reported, a study, using critical realism as method, was designed to discern the profession's embedded understanding from within the clinical decision-making literature. The research synthesizes a tacit knowledge on nursing prioritization of the patient need for care from key international literature (from 1966 to 2003). Nursing prioritization was discerned in both education and practice literatures; interrelationships between these and theoretical approaches were also identified. Nursing prioritization of the patient need for care was revealed both as a non-sequential decision-making process throughout unfolding patient situations and as an advanced skill of nursing practice. Increasing confidence with this skill is the hallmark of developing expertise.

Professional Nursing Duties in the Central Services: Hospital Pharmacy Nurses

“…The prioritization of activities is a basic element in nursing [32], and, in the case of the central services, the person who requests a task does not see how it is carried out. Consequently, the on-demand work undertaken by pharmacy nurses results in enormous pressure, arising, for example, from ward nurses making an urgent request by telephone or by notes on the PRN drug forms; day-hospital nurses urging a cytotoxic treatment to be brought forward; hospital porters requesting the narcotics; pharmacists demanding the immediate preparation of solutions or sterile preparations; outpatients seeking their eye-drops; and preparing inhaled mixtures or parenteral nutrition [33].…”

Exploring student perceptions of ward simulation as an exercise to improve decision-making skills in the clinical context

“…The majority of literature on teaching clinical decision-making has found there tends to be a focus on making a diagnosis, with other aspects such as prioritisation, recognising limits and asking for help often neglected (Lake, 2005). It is therefore unsurprising that evidence capturing the perceptions of junior doctors has found that graduates are least prepared in basic 'doctoring skills', with substandard clinical decision-making a consistent finding (Wall et al, 2006).…”

Intervenciones de enfermería del campo fisiológico complejo en unidades de Cuidado Intensivo

“…En las unidades de cuidado intensivo (UCI), las características de los pacientes hospitalizados y los equipos de alta tecnología, demandan del profesional de enfermería competencias cognitivas y procedimentales interdisciplinarias específicas para resolver e intervenir adecuadamente asuntos críticos del cuidado [14] . No obstante, ellos no encuentran aplicabilidad a la metodología NIC, NANDA y NOC en el área clínica; 78,57% la utilizan en sus actividades de enseñanza y/ o investigación y sólo 18,18% la emplean en la práctica asistencial [7] .…”

“…No obstante, ellos no encuentran aplicabilidad a la metodología NIC, NANDA y NOC en el área clínica; 78,57% la utilizan en sus actividades de enseñanza y/ o investigación y sólo 18,18% la emplean en la práctica asistencial [7] . Al parecer, la sobrecarga de trabajo asociada al alto número de pacientes asignados interfieren en la asunción de roles propios [4] Además, en las funciones asignadas se prioriza la optimización del tiempo y los recursos de acuerdo con las exigencias institucionales, limitando el accionar profesional a la ejecución de intervenciones rutinarias que resuelven necesidades básicas; excluyendo asuntos de mayor complejidad a la hora de definir el plan de atención de Enfermería, [2,4,14,15] . Estas observaciones son similares a las expuestas por los profesionales participantes en este estudio.…”