Summary
Patient preferences in nursing decisionmaking.
A theory about fine-tuning knowledge in acute care
Ria den Hertog-Voortman
The general objective of this grounded theory study was to develop a substantive theory of how good nurses in acute care tune in to patient preferences in nursing decision making, and what knowledge they deploy in doing so. In Evidence-Based Practice (EBP) literature, the focus is mostly on the evidence from scientific research to the detriment of patient preferences. The operationalization of patient preferences in EBP is dependent on the espoused scientific tradition of the researcher. Because the answer is not found in the literature, an empirical study was conducted to describe how good nurses address norms, values and patients’ preferences in the daily nursing decision-making. The respondents (n=27) emphasized in the interviews the importance of a good nursepatient relationship as a prerequisite to discover the patient preferences and took account of them in the nursing decision making. They established instant connection in creating a ‘click’, using ‘antennae’ or probes and communicating openly by asking ‘empathic’ questions. Based on the acquired knowledge they formed, often unconsciously, a broad frame of reference and used it in nursing decision-making. Additionally, seven ‘good’ nurses were observed during their shifts on a nursing ward to discover what can be seen regarding attuning to patient preferences and the use of tools in daily nursing practice. One of the respondents summarized their working attitude as ‘Teach me the best way to take care of you in this situation’. ‘Finetuning knowledge’ is the new discovery concerning professional knowledge that takes into account patient preferences in order to provide adequate, individualized care. The three dimensions of this knowledge in nursing practice have been compiled in a ‘theory on finetuning knowledge’, i.e. a model of knowing why, knowing how and knowing what. The theory is compared with other theories of practical knowledge and it is ascertained that in Benner’s theory of adaptive knowledge in nursing. The knowing-why is missing. Other authors show that the finetuning knowledge has been found in reflective practice, moreover, in the practical wisdom of professionals. The literature shows a renewed interest in the concept of practical wisdom or phronesis to fill the void left by the sole interest in propositional knowledge in training and practice. Further research is recommended to specify the concept of finetuning knowledge as practical knowledge in nursing, and its connection with practical wisdom to increase the understanding of how patient preferences can be included in nursing decision making to provide good nursing care.
