‘Mutual intacting’: a grounded theory study of clinical judgement practice issues

AIM: This paper reports a study conducted to explore how nurses working at advanced practice level in chronic and acute care outpatient contexts responded to decision-making concerns in clinical practice. BACKGROUND: Current theoretical explanations of clinical judgement offer insight into how healthcare professionals process information; however, they are incomplete as they do not consider psychosocial issues. Research evidence informing clinical judgement practice is based largely on acute care hospital settings. Consequently, little is known about how practitioners make clinical judgements in outpatient contexts where patients can participate in their own care. METHOD: A grounded theory approach was used to analyse interview data about clinical judgements made in actual clinical practice. Twenty-one nurses working at advanced practice level in mental healthcare clinics and accident and emergency in the Republic of Ireland were recruited. Concurrent data collection and analysis, constant comparative analysis and theoretical sampling were conducted in 2002-2005. FINDINGS: The core category to emerge from the data was 'mutual intacting'. This refers to the main strategies that practitioners used to resolve concerns about eliciting patient information and selecting treatments that were acceptable to patients. It highlights the clinical judgement practices that practitioners find useful to engage patients to facilitate effective decision-making. CONCLUSION: Practitioners could draw from the various strategies identified in this research to develop their clinical judgement practice further in ways that include the development of an effective relationship with their patients. Negotiation and compromise are particularly useful strategies that should be used to facilitate effective treatment delivery that takes account of patients' circumstances.