Exploring Nurses' Decision‐Making Through the Lens of Capability: A Framework for Understanding Autonomy in Complex Care Environments
Notice bibliographique
Résumé
AIM: To apply the capability approach to understand ICU nurses' decision-making autonomy. DESIGN: A qualitative study using Amartya Sen's capability approach as a conceptual framework. METHODS: This study reanalyzed qualitative data from a previous investigation involving semi-structured interviews with 39 experienced Canadian ICU nurses who described their decision-making processes in managing post-cardiac surgery bleeding. The analysis examined how resources (e.g., information, therapeutic and human), conversion factors (personal, social and institutional) and professional agency interact to shape nurses' decision-making capabilities. RESULTS: Nurses' decision-making capabilities encompass: (1) obtaining necessary information, (2) interpreting information to make judgements and (3) making actionable decisions. These capabilities enable nurses to achieve valued outcomes such as clinical effectiveness, patient and family comfort, professional growth and personal fulfilment. However, they are shaped not only by clinical expertise or competency but also by structural and contextual factors, including resource constraints, institutional policies, interprofessional dynamics and hierarchical relationships. These factors influence nurses' autonomy and real opportunities to translate clinical judgements into action. CONCLUSIONS: The capability approach offers a reflective lens for examining the contextual conditions that shape nurses' autonomy. By shifting the focus beyond individual competence, it highlights the broader structural and relational influences on nurses' ability to make and implement clinical decisions. IMPLICATIONS FOR THE PROFESSION: Understanding decision-making as a capability underscores the importance of creating supportive environments where nurses can apply their expertise. The findings call for context-sensitive strategies in education, policy and practice that valorise nurse agency and respond to the systemic factors influencing decision-making in critical care settings. IMPACT: What problem did the study address? This study examined the gap between nurses' clinical expertise and the ability to act on decisions in practice, exploring how contextual factors influence their autonomy in critical care settings. What were the main findings? Decision-making autonomy is shaped by the interaction of individual, organisational and systemic factors-including access to resources, team dynamics and institutional norms-underscoring the need for context-sensitive strategies to support nurses' decision-making. Where and on whom will the research have an impact? These findings can inform educators, policymakers and healthcare leaders seeking to strengthen decision-making, education and support, especially in complex or resource-constrained environments. REPORTING METHOD: This report adheres to the Standards for Reporting Qualitative Research. PATIENT OR PUBLIC CONTRIBUTION: This study did not include patient or public involvement in its design, conduct, or reporting.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,013 | 0,015 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,006 | 0,003 |
| Études des sciences et des technologies | 0,007 | 0,065 |
| Communication savante | 0,014 | 0,014 |
| Science ouverte | 0,002 | 0,010 |
| Intégrité de la recherche | 0,003 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».