Nurses are pivotal in averting patient falls through their assessment of cues presented by patients and their environments, rendering clinical judgments regarding the risk of falling, and implementing tailored interventions. Despite the intricate cognitive processes entailed in nurses' judgment, no prior studies have explored their approach to assessing the risk of falling. This study aimed to examine how nurses judge the risk of falling among patients with different conditions, whether there are differences in the importance of risk factors as judged by nurses, how they justify their judgments, and what attributes of the nurses influence their judgments. A mixed method approach using the Q Methodology was employed. Three public and private hospitals in Japan. Eighteen nurses participated in the study. Participants were tasked with ranking 36 patient scenarios, each featuring a distinct set of fall risk factors. Subsequently, post-sorting interviews were conducted to gather insights into their typical approach to assessing fall risk and the rationale behind their ranking decisions. A by-person principal component factor extraction was employed to examine differences in the rankings of the scenarios. The interview data were analyzed descriptively to elucidate the reasons behind these discrepancies. Nurses engage in complex cognitive manipulations when evaluating the risk of patient falls, drawing extensively from their wealth of experience while utilizing assessment tools to support their judgments. In essence, nurses identify patients' tendency to act alone without calling a nurse, impaired gait and cognition, sedative use, drains, and limited information sharing among healthcare professionals as key fall risks. In addition, nurses vary in the importance they attribute to certain risk factors, leading to the discrimination of three distinct judgment profiles. One group of nurses judges patients with cognitive impairment and acting alone as high risk. Another group of nurses considers patients with unstable gait and acting alone as high risk. The last group of nurses sees patients wearing slippers as high risk. The post-sorting interviews revealed that their judgments are closely related to the healthcare context and patient population. Nurses operate within diverse contexts, wherein they interact with patients of varying characteristics, collaborate with professionals from diverse disciplines, and have access to varying levels of human and physical resources. This nuanced understanding empowers the formulation of judgments that are finely attuned to the specific context at hand. Not registered.

中文翻译：

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探索护士对跌倒风险因素相对重要性的临床判断：使用 Q 方法的混合方法


护士通过评估患者及其环境给出的线索、对跌倒风险做出临床判断并实施量身定制的干预措施，在避免患者跌倒方面发挥着关键作用。尽管护士的判断涉及复杂的认知过程，但之前没有研究探索他们评估跌倒风险的方法。本研究旨在探讨护士如何判断不同病情患者的跌倒风险，护士判断的危险因素的重要性是否存在差异，他们如何证明自己的判断，以及护士的哪些属性影响他们的判断。采用了使用 Q 方法的混合方法。日本三所公立和私立医院。十八名护士参与了这项研究。参与者的任务是对 36 个患者场景进行排名，每个场景都有一组不同的跌倒风险因素。随后，进行了排序后访谈，以深入了解他们评估跌倒风险的典型方法以及排名决策背后的基本原理。采用逐人主成分因子提取来检查场景排名的差异。对访谈数据进行描述性分析，以阐明这些差异背后的原因。在评估患者跌倒风险时，护士会进行复杂的认知操作，广泛汲取丰富的经验，同时利用评估工具来支持他们的判断。从本质上讲，护士认为患者倾向于单独行动而不呼叫护士、步态和认知受损、镇静剂的使用、引流以及医疗保健专业人员之间的信息共享有限都是跌倒的主要风险。 此外，护士对某些风险因素的重视程度也有所不同，从而导致三种不同判断特征的区分。一组护士将患有认知障碍且单独行动的患者判断为高风险。另一组护士认为步态不稳定且单独行动的患者风险较高。最后一组护士将穿拖鞋的患者视为高风险。筛选后的访谈显示，他们的判断与医疗保健环境和患者群体密切相关。护士在不同的环境中工作，他们与不同特征的患者互动，与不同学科的专业人员合作，并获得不同水平的人力和物力资源。这种细致入微的理解有助于制定与当前具体情况完美契合的判断。未注册。