关于“临床决策”的一篇护理SCI文献，
似乎大家都知道了“临床决策”主题的热度和重要性，但是很多老师是不知道如何发挥护士的作用，直白的说就是不知道如何从护士的角度去设置方案。
之前，小班长就提示过：①把研究问题分阶段，即进一步细化主题。②从护士角度，或护士工作角度，发挥“领导”或“指导”的作用。今天给大家分享《Journal of Advanced Nursing》上的一篇文献，希望能给大家一点提示。
Sullivan, SS, Mann, C, Mullen, S, Chang, Y‐P. Homecare nurses guide goals for care and care transitions in serious illness: A grounded theory of relationship‐based care. J Adv Nurs. 2021; 77: 1888– 1898.
https://doi.org/10.1111/jan.14739
家庭护士指导患有严重疾病患者的护理目标和过渡目标：基于关系的护理理论
引言部分：
全球每年大约有4000万的患者需要姑息治疗；然而大约只有14%的患有危及生命疾病的患者将从“以治疗为中心”的护理过渡到“以舒适护理为中心”的护理。
家庭护士对于如何让患有严重疾病的患者及其家人参与到讨论“临床关怀目标”至关重要。但是，目前尚未有研究来描述家庭护士是如何识别严重疾病的，或者是否了解患者、家庭、家庭护士以及医疗机构等在临终关怀过渡期间的交接等。
因此，本研究主要是：了解家庭护士在护理患有严重疾病的患者时的过程，以及他们如何和何时讨论启动护理目标的讨论、如何参与等，以便更好的向舒适护理过渡。
Abstract摘要
Aims To identify the process that homecare nurses use when recognizing serious illness, engaging patients and families in goals‐for‐care discussions and guiding transitions to comfort‐focused care.
研究目的：探讨家庭护士在以下情境下的作用或过程：①认识到疾病的严重性；②如何和何时让患者及家庭参与到关于护理目标的讨论；③如何向以舒适护理为中心的过渡护理。
Design Constructivist grounded theory.
研究设计：扎根理论
Methods Semi‐structured focus group interviews of 31 homecare Registered Nurses were recorded and transcribed (June–August 2019). Line‐by‐line coding using the constant comparative method until saturation was achieved and a grounded theory was identified. Credibility, transferability, and confirmability establish study rigor.
研究方法：对3名家庭护士进行半结构访谈；编码，提取主题。
Results A grounded theory of relationship‐based care. Nurses cogitate and act when recognizing serious illness. They have difficult conversations and support care transitions with wisdom and knowing, by identifying changes in illness trajectories and being informed and alert to diminishing quality of life. Nurses are skilled at engaging patients, families, and the team and accommodate care in the home for as long as possible, while manoeuvring through complex systems of care; ultimately relinquishing and guiding care to other providers and settings. However, nurses feel inadequately prepared and frustrated with a fragmented healthcare system and lack of collaboration among the team.
研究结果：①构建了基于关系的护理理论（解释：家庭护士不仅要照护患者，还要为患者、家庭等提供支持）。②家庭护士在识别和判断患者疾病严重程度时，会借鉴他们以前的经验，深入思考和反思，进而做出行动。③家庭护士在识别“何时”做出积极行动时往往比较尴尬。要么就是不管疾病的严重程度而做出舒适护理的行动；要么就是寻找何时的机会，来识别“合适的时间”。（他们通过识别疾病轨迹的变化，了解和警惕生活质量的下降，以智慧和了解的方式支持护理过渡。）④家庭护士擅长吸引病人、家属和团队的注意，并尽可能长时间地在家中照顾病人，同时操纵复杂的护理系统；最终放弃和指导护理到其他提供者和环境。⑤然而，护士们感到准备不足，对支离破碎的医疗系统和团队之间缺乏协作感到沮丧。
Conclusion This study identifies a grounded theory to support clinical decision‐making and position homecare nurses as leaders in guiding goal care discussions and transitions to comfort‐focused care. These findings reinforce the importance of developing health policy that ensures care continuity in serious illness. Further research is needed to improve relationships across care settings and enhance training for the delivery of comfort‐focused care in the home as changing needs emerge during serious illness management.
研究结论：本研究确定了一个支持临床决策的基础理论，并将家庭护理护士定位为引导目标护理讨论和转向以舒适为中心的护理的领导者。这些发现加强了制定卫生政策以确保重症患者护理连续性的重要性。需要进一步的研究来改善护理环境中的关系，并在严重疾病管理过程中不断变化的需求中，加强提供以舒适为重点的家庭护理的培训。
备注：如果正在做临床决策的老师，可以去看一下原文。原文的内容要比这个摘要丰富的多。这个摘要看起来是比较空洞的，不完全代表全文所能展示出的“提示”。