Abstract:
INTRODUCTION:Nurses in rural settings are often the first to assess and interpret the patient's clinical presentations. Therefore, an understanding of how nurses experience decision-making is important in terms of educational preparation, resource allocation to rural areas, institutional cultures, and patient outcomes. METHODS:Theory development was based on the in-depth investigation of 12 novice nurses practicing in rural critical access hospitals in a north central state. This grounded theory study consisted of face-to-face interviews with 12 registered nurses, nine of whom were observed during their work day. The participants were interviewed a second time, as a method of member checking, and during this interview they reviewed their transcripts, the emerging themes and categories. Directors of nursing from both the research sites and rural hospitals not involved in the study, experienced researchers, and nurse educators facilitated triangulation of the findings. RESULTS:'Sociocentric rationalizing' emerged as the central phenomenon and referred to the sense of belonging and agency which impacted the decision-making in this small group of novice nurses in rural critical access hospitals. The observed consequences, which were conceptualized during the axial coding process and were derived from observations and interviews of the 12 novice nurses in this study include: (1) gathering information before making a decision included assessment of: the credibility of co-workers, patients' subjective and objective data, and one's own past and current experiences; (2) conferring with co-workers as a direct method of confirming/denying decisions being made was considered more realistic and expedient than policy books and decision trees; (3) rural practicum clinical experiences, along with support after orientation, provide for transition to the rural nurse role; (4) involved directors of nursing served as both models and protectors of novice nurses placed in high accountability positions early in their careers. These novice nurses were often working with a limited staff, while managing an ever-changing census and acuity of patients. The significance of interdependence and welcoming relationships with their co-workers and directors of nursing was pivotal in the clinical decision-making process. CONCLUSIONS:Despite access to a number of resources at their disposal (including policy books, decision trees, standing orders, textbooks, and in some cases internet resources), the 12 nurses in this study indicated collaboration with co-workers was a major means of facilitating their decision-making. Rural novice nurses require facilitation of social skills as much as critical thinking skills both within their programs of nursing and during their new employee orientation; however, decision-making must be guided by more experienced nurses who are willing to mentor novice nurses and advise them to to reflect upon their decisions as they care for patients using evidenced based practice. In a rural setting, this is especially important because novice nurses are tasked early in their career with decision-making, which often involves ill-structured problems set in dynamic and changing environments, in high-stakes situations where patient safety is a concern.
journal_name
Rural Remote Healthjournal_title
Rural and remote healthauthors
Seright TJsubject
Has Abstractpub_date
2011-01-01 00:00:00pages
1726issue
3issn
1445-6354pii
1726journal_volume
11pub_type
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journal_title:Rural and remote health
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abstract:INTRODUCTION:The 'Commission on the Future of Health Care in Canada' recognized that people living in rural and remote areas of Canada are at a disadvantage in health status, access to care and health professionals, and it considers the fight against these problems as a national priority. Although some attention has be...
journal_title:Rural and remote health
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journal_title:Rural and remote health
pub_type: 杂志文章
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journal_title:Rural and remote health
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journal_title:Rural and remote health
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journal_title:Rural and remote health
pub_type: 杂志文章
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journal_title:Rural and remote health
pub_type: 杂志文章,评审
doi:
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journal_title:Rural and remote health
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journal_title:Rural and remote health
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journal_title:Rural and remote health
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更新日期:2012-01-01 00:00:00
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journal_title:Rural and remote health
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更新日期:2010-07-01 00:00:00
abstract::Many rural Australian communities continue to endure a prolonged drought. The mental health effects of short-term natural disaster are well known; those of a long-term and chronic natural disaster such as drought are less well understood. However, in addition to immediate distress there are likely to be feelings of lo...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2008-07-01 00:00:00
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journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2003-10-01 00:00:00
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journal_title:Rural and remote health
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更新日期:2015-07-01 00:00:00
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journal_title:Rural and remote health
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journal_title:Rural and remote health
pub_type: 杂志文章
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journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2016-04-01 00:00:00
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journal_title:Rural and remote health
pub_type: 杂志文章,多中心研究
doi:
更新日期:2011-01-01 00:00:00
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journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2016-10-01 00:00:00
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journal_title:Rural and remote health
pub_type: 杂志文章
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更新日期:2005-10-01 00:00:00
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journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2012-01-01 00:00:00
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journal_title:Rural and remote health
pub_type: 杂志文章
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更新日期:2012-01-01 00:00:00
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journal_title:Rural and remote health
pub_type: 杂志文章
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