Abstract
This study aimed to identify clues that nurses can use to exercise clinical judgment regarding when/whether to discontinue the observation-only approach for stroke patients in recovery during bed/wheelchair transfer and allow patients to care for themselves. A qualitative and inductive approach was employed to analyze data collected through focus group interviews of 17 proficient nurses on convalescent rehabilitation wards. As a result, clues for deciding whether to cease observation during bed and wheelchair transfer were classified into 4 categories: "cognitive abilities", "abilities to perform transfer activities", "willingness and feelings about transfer", and "the use of sleep medication". These nurses had difficulties with clinical judgment in relation to patients who either "became quite frustrated about being observed", "were likely to independently perform various activities including those other than bed/wheelchair transfer, once the observation had been discontinued", or those for whom "nursing staff were divided over the cessation of observation". These nurses, in principle, "continued with the observation-only approach when having difficulties with judgments", but they also "discontinued the observation-only approach while assuming the occurrence of falls". The findings revealed that nurses exercised clinical judgment from a unique standpoint as a professional providing rehabilitation care and services for real-life situations.
