Collaborative Decision Making in Nursing Practice

摘要本研究旨在探讨急症护理医院医护人员对护理合作的态度及认知。本研究的理论基础是护士和病人的态度和感知可能会影响护理决策中的合作，并可能影响病人的护理结果。使用的方法是问卷调查，在1988年至1991年间在挪威、日本、芬兰和美国进行了重复调查。每个国家都采用了相同的研究程序。在每个国家进行了一组护士调查和两组患者调查，第一组在入院时进行，第二组在出院时进行。最初用英语编写的调查问卷被翻译成挪威、日本和芬兰各自的母语。调查结果表明，虽然这些国家的患者和护士在态度上倾向于消费主义，但这些态度在各国之间以及患者和护士之间的文化适应方面存在显著差异。两种不同的模型解释了护理实践中患者和护士对合作决策的态度。然而，对于这两个群体来说，年龄和更普遍的消费主义态度对他们在护理合作方面的态度有影响。由于当代的重点是重视医疗保健中的自我决定论和消费主义，下一步的调查应该检查消费主义态度与存在并影响患者结果的患者和护士行为之间的关系。然而，由于每个国家的保健谈判和护患关系的不同模式可能已纳入护理实践，因此在国际背景下调查这一问题也很重要。

The purpose of this study is to investigate patients' and nurses' attitudes and perceptions regarding collaboration in nursing care in acute care hospitals. This study is based on the theory that nurses' and patients' attitudes and perceptions may affect collaboration in nursing care decision making and may influence patient-care outcomes.The method used was a questionnaire-survey which was replicated in Norway, Japan, Finland, and the U.S., between 1988 and 1991. The same research procedures were used in each country. One set of nurse surveys and two sets of patient surveys, the first given at the admission and the second at the time of discharge, were carried out in each country. The survey questionnaires originally developed in English were translated into the respective native languages in Norway, Japan, and Finland.Findings from the survey indicate that while the patients and the nurses in these countries tend to lean toward the consumerist perspective in their attitudes, there were significant differences in the acculturation of these attitudes among the countries and between the patients and nurses. Two different models for the explanation of attitudes regarding collaborative decision making in nursing practice emerged for the patients and the nurses as groups. For both groups, however, age and the more general consumerist attitude have a bearing on their attitude regarding collaboration in nursing.Since the contemporary thrust is on valuing self-determinism and consumerism in health care, the next investigation should examine the relationships between consumerism attitudes and patients' and nurses' behaviors which exist and affect patient outcomes. However, since different patterns of health care negotiation and nurse-patient relationships may have been integrated into nursing practice in each country, it will also be important to investigate this issue in an international context.