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Kim: A Study on Participation in Clinical Decision Making by Home Healthcare Nurses
Original Article
Journal of Korean Academy of Nursing

Journal of Korean Academy of Nursing 2010; 40(6): 892-902.

Published online: 31 December 2010

DOI: https://doi.org/10.4040/jkan.2010.40.6.892

A Study on Participation in Clinical Decision Making by Home Healthcare Nurses

Se Young Kim

Full-time Lecturer, College of Nursing, Eulji University, Daejeon, Korea.

Address reprint requests to : Kim, Se Young. College of Nursing, Eulji University, 143-5 Yongdu-dong, Jung-gu, Daejeon 301-746, Korea. Tel: 82-42-259-1718, Fax: 82-42-259-1709, sarakimk@yahoo.co.kr

Received 5 May 2010       Accepted 28 December 2010

Copyright © 2010 Korean Society of Nursing Science

Abstract

Purpose

This study was done to identify participation by home healthcare nurses in clinical decision making and factors influencing clinical decision making.

Methods

A descriptive survey was used to collect data from 68 home healthcare nurses in 22 hospital-based home healthcare services in Korea. To investigate participation, the researcher developed 3 scenarios through interviews with 5 home healthcare nurses. A self-report questionnaire composed of tools for characteristics, factors of clinical decision making, and participation was used.

Results

Participation was relatively high, but significantly lower in the design phase (F=3.51, p=.032). Competency in clinical decision making (r=.45, p<.001), perception of the decision maker role (r=.47, p<.001), and perception of the utility of clinical practice guidelines (r=.25, p=.043) were significantly correlated with participation. Competency in clinical decision making (Odds ratio [OR]=41.79, p=.007) and perception of the decision maker role (OR=15.09, p=.007) were significant factors predicting participation in clinical decision making by home healthcare nurses.

Conclusion

In order to encourage participation in clinical decision making, education programs should be provided to home healthcare nurses. Official clinical practice guidelines should be used to support home healthcare nurses' participation in clinical decision making in cases where they can identify and solve the patient health problems.

Keywords: Home healthcare nurse, Decision making, Participation, Competency, Clinical practice guideline

Figures and Tables

Figure 1
Conceptual framework.
jkan-40-892-g001
Table 1
General Characteristics (N=68)
jkan-40-892-i001
Table 2
Descriptive Statistics of Observed Variables (N=68)
jkan-40-892-i002
Table 3
Differences in Participation in 3 Phases of Decision Making Process (N=68)
jkan-40-892-i003

*Scheffe test.

Table 4
Correlation between Variables in Clinical Decision Making Process (N=68)
jkan-40-892-i004

AG=age; TC=total career; HC=Home Healthcare career; ED=education; PO=position; CDM=competency of decision making; RDM=role of clinical decision maker; CT=character of task; DC=decentralization; NPR=nurse-physician relationship; UG=usefulness of clinical guideline; PDM=participation of decision making.

Table 5
5. Factors Affecting Participation in Clinical Decision Making in Multivariate Logistic Regression (N=68)
jkan-40-892-i005

-2 Log likelihood=62.01 (p<.001); Cox & Snell R2=.38; Nagelkerke R2=.50.

Notes

*This article is a revision of the first author's doctoral dissertation from Seoul National University.

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