La toma de decisiones como competencia enfermera para cuidar a pacientes crónicos con necesidades complejas

Abstract

Nurses need to adapt to their dynamic professional context and to have make-decisions skills. Those skills are more difficult to meet when caring for complex patients with chronic diseases. Among the main skills to be developed during the bachelor, decision-making is one of the most complex. This may be because decision-making skills is a broad concept hard to be transferred with those patients. Its learning outcomes are not previously defined or framed in the work context. This research responds to three aims: (i) to define and agree on the learning outcomes of the competencies associated with nursing practice in decision-making for the care of chronic patients with complex needs. (ii) To develop these competences through training based on reflective practice and critical thinking and (iii) evaluate the effectiveness of that training. The purpose of this investigation is to promote the reflection of nurses to understand the phenomenon of decision-making. This is a mixed research involving qualitative and quantitative methods so that the methods are complemented. A qualitative exploratory study was carried out using nominal group with experts in chronicity and gerontology to attain the first objective. A concurrent multi-level embedded design was performed to attain the second and third objectives. In this way, was possible to address the complexity of the concept of nursing decision-making in chronic patients with complex needs. The results showed the need to define learning outcomes to clarify competences related to decision making. 139 results were obtained from the 6 proposed competencies. All the results were associated with the identified competences dimensions. Results were easily associated to knowledge and skills dimensions. Attitude was more difficult to associate by the lack of objectivity of this dimension. At the same time, the degree of implementation of the 35 items of the IEMACH / ARCHO instrument as a management model of the two study hospitals was agreed in the training sessions. It also was agreed 25 of the most maked-decisions nurses have to take. 20 purposes were agreed to be implemented in their units. The Health Consensus teaching strategy proved its effectiveness and its pedagogical value because it enhances reflection and critical thinking. Regarding, Feeling valued, the high degree of involvement, security, motivation and receiving feedback are some of the main elements that facilitates transferring learning and purposed improvements to professional workplaces. 22 improvement proposals were implemented in different services. The participants highlighted its usefulness and relevance, although they questioned its permanence through time. As a conclusion, results obtained in this study answered the research questions and allow to achieve the objectives set to advance in the subject of study. It would be interesting to further research to determine if the training based on reflexive practice allow develop others transversal competences in nursing daily practice.

Date of Award	1 Oct 2021
Original language	Spanish
Supervisor	Pilar Pineda Herrero (Tutor)