The Characteristics of Judgment by Experienced Visiting Nurses

Abstract

This study was aimed at (1) investigating characteristics of judgment by experienced visiting nurses with regard to various home cares which would arise while on duty and (2) obtaining information that will be useful for improving educational programs for visiting nurses. The study was based on semi-structured interviews with 14 visiting nurses employed at three different visiting nurse stations in F prefecture. These nurses were asked about the decision-making process they use to solve the problems that they face. [Results] We obtained information on 58 incidents (19 cases) that had been managed based on decisions by individual nurses. The information obtained with regard to the respective incidents was analyzed and classified inductively on the basis of both content and process of decision-making. 1. The content of these decisions was classified into four major categories : a. Decisions on the direction of care management. b. Judgment with regard to the knowledge and skills of the nurses as well as the system for home care. c. Judgment on developing ways to care for the patient. d. Decisions on developing ways to care for the family of the patient. 2. As for the decision-making process, visiting nurses were actively carrying out their duties based on independent thinking and decision-making as a result of their observations and experiences. The three characteristics revealed about the decision-making process were : a. The ecological type of decision-making was based on an understanding of the living conditions of their patients. b. The circulatory type of decision-making regarding the home care was based on feelings and opinions of both patient and family. c. The inquiry type of decision-making was based on an effort by the nurses to utilize effectively the limited information that is available on home care. 3. In conclusion, the importance of introducing systematic and continuous educational programs for visiting nurses and the supervisors who could provide leadership for the less experienced visiting nurses in the field of home care has been shown.