Framework of Decision-Making in Five Expert Home Care Nurses : An Attempt to Reflect Patients' Wishes in Decision-Making

Abstract

This report describes a framework of decision-making in expert home care nurses, in which an attempt to reflect patients' wishes was made. A prospective inductive qualitative study was conducted on five proficient nurses of two home care nursing stations. The purpose of this study was to research structural components in decision-making, which would guide the nurses to successful provision of home care. Data were collected during several home-visit observations, without intervention, and through send-structured interviews after home visits, which interviews were tape-recorded, with the consent of all subjects. All structural components concerned different thinking toward home care between patients and their families, in which home care nurses gave priority to patients' wishes. These components were grouped into 12 core categories. The two core categories were defined as a view-of-life concerning the home care nurses, and the ten were strategies to reach an agreeable compromise with regard to different thinking toward home care between patients and their families. According to the structural components and decision-making in five nursing practitioners, a framework of decision-making in home care nursing, or an approach to patients and their families with different thinking, could be found. This study suggested that expert home care nurses had established thinking of their view-of-life, including their position as home care nurses, giving priority to patients' wishes, and providing satisfying home care nursing as viewed by both patients and their families. This study was approved by the Ethics Committee of St. Luke's College of Nursing