Health professionals' decision-making in wound management: a grounded theory

Gillespie, Brigid M. PhD RN FACORN
Chaboyer, Wendy PhD RN
St John, Winsome PhD RN
Morley, Nicola NP RN
Nieuwenhoven, Paul BN RN

¹Associate Professor, Professor and Director, NHMRC Research Centre for Clinical Excellence in Nursing Interventions (NCREN) & Centre for Healthcare Practice Innovation (HPI), Griffith Health Institute, Griffith University, Gold Coast Campus, Queensland, Australia
² Associate Professor, School of Nursing & Midwifery, Griffith University, Gold Coast Campus, Queensland, Australia
³ Vascular Nurse Practitioner, Gold Coast Health Services District, Vascular Services, Gold Coast Campus, Queensland, Australia
⁴ Director of Nursing, Division of Surgery Services GCH, Gold Coast Health Service District, Southport, Queensland, Australia

Accepted for publication 4 November 2014

Correspondence to B.M. Gillespie:

Journal of Advanced Nursing 71(6):p 1238-1248, June 2015. | DOI: 10.1111/jan.12598

Abstract

Aim.

To develop a conceptual understanding of the decision-making processes used by healthcare professionals in wound care practice.

Background.

With the global move towards using an evidence-base in standardizing wound care practices and the need to reduce hospital wound care costs, it is important to understand health professionals' decision-making in this important yet under-researched area.

Design.

A grounded theory approach was used to explore clinical decision-making of healthcare professionals in wound care practice.

Methods.

Interviews were conducted with 20 multi-disciplinary participants from nursing, surgery, infection control and wound care who worked at a metropolitan hospital in Australia. Data were collected during 2012–2013. Constant comparative analysis underpinned by Strauss and Corbin's framework was used to identify clinical decision-making processes.

Findings.

The core category was ‘balancing practice-based knowledge with evidence-based knowledge’. Participants' clinical practice and actions embedded the following processes: ‘utilizing the best available information’, ‘using a consistent approach in wound assessment’ and ‘using a multidisciplinary approach’. The substantive theory explains how practice and evidence knowledge was balanced and the variation in use of intuitive practice-based knowledge versus evidence-based knowledge. Participants considered patients' needs and preferences, costs, outcomes, technologies, others' expertise and established practices. Participants' decision-making tended to be more heavily weighted towards intuitive practice-based processes.

Conclusion.

These findings offer a better understanding of the processes used by health professionals' in their decision-making in wound care. Such an understanding may inform the development of evidence-based interventions that lead to better patient outcomes.