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A bottom-up framework for nurses' protocol-based care decision-making.

Monica Vázquez-Calatayud1,2,3, María J Pumar-Méndez3,4,5, Cristina Oroviogoicoechea2,3,6

  • 1Area of Nursing Professional Development and Research, Clínica Universidad de Navarra, Pamplona, Spain.

Nursing Open
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PubMed
Summary

This study developed a framework for nurses' protocol-based care decision-making. This model aids in balancing standardization with individualized care, improving quality and reducing practice variability.

Keywords:
decision‐makingframeworknursingnursing educationprotocol‐based care

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Area of Science:

  • Nursing Science
  • Healthcare Management
  • Clinical Decision-Making

Background:

  • Understanding nurses' decision-making in protocol-based care is crucial for quality improvement.
  • Existing frameworks may not fully capture the complexities of nurses' protocol adherence.
  • A need exists for a structured approach to guide nurses in applying protocols effectively.

Purpose of the Study:

  • To develop a conceptual framework for nurses' protocol-based care decision-making.
  • To provide a model that integrates standardization with individualized patient care.
  • To establish a foundation for evaluating and enhancing nurses' decision-making processes.

Main Methods:

  • A qualitative, multiple embedded case study approach was employed.
  • Data were collected using documentary analysis, observations, and interviews.
  • A bottom-up conceptual framework development method (Miles & Huberman) was utilized, involving data reduction, display, comparison, and conclusion drawing.

Main Results:

  • A four-component framework for protocol-based care decision-making was developed.
  • Components include: protocol-based care (balancing standardization and individualization), the process, the context, and decision-making elements.
  • The framework illustrates a context-dependent, linear, variable, and multifactorial process influenced by risk perception.

Conclusions:

  • A rigorous, bottom-up framework for nurses' protocol-based care decision-making has been established.
  • The framework can guide and evaluate nurses' decision-making, enhancing care quality and reducing practice variability.
  • This framework supports further research and practical applications in diverse healthcare settings, potentially improving patient safety and efficiency.