Samenvatting

Aims and objectives:
To explore how excellent nurses in hospitals take into account patient preferences in nursing decision-making in the evidence-based practice towards personalized care.

Background:
In evidence-based practice, nursing decision-making is based on scientific evidence, evidence of best practice, and individual patient preferences. Little is known about how nurses in hospitals take into account patient preferences in nursing decision-making.

Design:
Qualitative grounded theory.

Methods:
Data collection entailed 27 semi-structured interviews with nurses designated by their colleagues as excellent caregivers, followed by 57 hours of participant observation. Data-analysis was conducted using three level coding with constant comparison and theoretical sampling. The COREQ checklist for qualitative research was followed.

Results:
A main finding was that participants used three implicit tools to discover patient preferences: establishing a connection, using antennae and asking empathic questions, thus instantly reassuring patients from the very first contact. Their starting point in care was the patient's perception of quality of life wherein they shifted towards their patient's perspective: “Teach me to provide the best care for you in this situation”. During the observations it was confirmed that the excellent nurses behaved as they had described before.

Conclusion:
Excellent nurses actively turn towards patients’ expectations and experienced quality of life by carefully blending individual sensitive and situation specific patient preferences with scientific evidence and evidence of best practice. In doing so they are able to balancing more equally patient preferences in to the equation called evidence-based practice, thus leading to wise decision-making in personalized nursing care.

Relevance to clinical practice:
Patient preferences become a fully-fledged part of nursing decision-making in EBP when in education and practice the implicit knowledge of excellent nurses about how to take into account patient preferences to provide personalized care is more valued and taught.