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首页> 外文期刊>Sociology of health & illness >Beyond guidelines: discretionary practice in face-to-face triage nursing
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Beyond guidelines: discretionary practice in face-to-face triage nursing

机译：超越指导方针：面对面的分类护理中的自由裁量裁定行为

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摘要

This article draws on ethnographic data from a Norwegian emergency primary care clinic (EPCC) to explore nurses' discretionary application of guidelines. Specifically, it analyses nurses' discretionary use of the Manchester Triage System (MTS) when performing face-to-face triage, that is, assessing the urgency of patients' complaints. The analysis shows how nurses assessed patients at odds with MTS prescriptions by collecting supplementary data, engaging in differential diagnostic and holistic reasoning, relying on emotion and intuition, and allowing colleagues and patients to influence their reasoning. The findings also show how nurses' reasoning led them to override guidelines both overtly and covertly. Based on this evidence, it is argued that nurses' assessments relied more on internalised triage mindlines' than on codified triage guidelines, although the MTS did function as a support system, checklist and system for supervisory control. The study complements existing research on standardisation in nursing by providing an in-depth analysis of nurses' methods for navigating guidelines and by detailing how deviations from those guidelines spring from their clinical reasoning. The challenges of imposing a managerial logic on professional labour are also highlighted, which is of particular relevance in light of the drive towards standardisation in modern healthcare.
机译：本文从挪威紧急初级保健诊所（EPCC）的民族志数据库中借鉴了护士自由裁量权的准则。具体而言，在进行面对面分类时，分析护士的自由裁量使用，即评估患者投诉的紧迫性。该分析显示护士通过收集补充数据，从事差异诊断和整体推理，依靠情感和直觉，并允许同事和患者允许同事和患者影响他们的推理。调查结果还显示了护士推理如何导致它们过度和隐蔽的指南覆盖。基于这一证据，认为护士的评估更多地依赖于内化分类思维数，而不是编纂的分类指南，尽管MTS作为支持系统，清单和监督控制系统。该研究通过对护士进行深入分析，对护理方法进行了深入分析，并通过详细说明如何从他们的临床推理中详细说明这些指南的偏差如何。还强调了对职业劳动力施加管理逻辑的挑战，这鉴于现代医疗保健的标准化的推动力是特别的相关性。

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