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'Creating a protective picture:' a grounded theory of RN decision making when using a charting-by-exception
1School of Nursing, Illinois Wesleyan University, Bloomington, IL, USA.
Medsurg Nursing : Official Journal of the Academy of Medical-Surgical Nurses
|June 28, 2013
Summary
Medical-surgical nurses use a three-step process to decide on charting-by-exception policies. This grounded theory, "Creating a Protective Picture," guides their decision-making for accurate documentation.
Area of Science:
- Nursing
- Health Policy
- Qualitative Research
Background:
- Charting-by-exception policies are increasingly adopted in healthcare settings.
- Nurses face challenges in adhering to or deviating from these policies.
- Understanding nurses' decision-making processes is crucial for effective policy implementation.
Purpose of the Study:
- To describe the process medical-surgical nurses use when deciding whether to follow a charting-by-exception policy.
- To develop a grounded theory explaining this decision-making process.
Main Methods:
- Grounded theory methodology was employed.
- Data were collected through interviews with medical-surgical nurses.
- Analysis involved constant comparative methods to develop the theory.
Main Results:
- A three-step process, conceptualized as 'Creating a Protective Picture,' emerged from the data.
- The steps involve: 1. Perceiving the situation, 2. Evaluating the need for documentation, 3. Acting to chart or not chart.
- Nurses' decisions are influenced by patient safety, legal risks, and institutional policies.
Conclusions:
- The grounded theory 'Creating a Protective Picture' provides a framework for understanding nurses' charting-by-exception decisions.
- This theory can inform nursing practice, education, and policy development.
- Further research should explore the generalizability of this theory across different nursing specialties and healthcare systems.
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