收稿日期: 2025-02-22
网络出版日期: 2025-11-04
基金资助
中央高水平医院临床科研专项(2022-PUMCH-B-130);北京协和医学基金会医务管理发展研究公益项目(PUMF01020019-XHYW2405)
Research progress on behavioral economics analysis and optimization strategy of clinical decision-making among ICU nurses
护理临床决策是护士基于理论与实践经验，运用评判性思维，针对临床问题制订并实施最优方案的系统化过程。ICU护士的工作特点是在信息有限且时间紧迫的情况下做出大量快速决策，并对患者病情产生直观影响。该文对ICU护士临床决策的行为经济学进行分析，从有限理性理论、偏差理论和前景理论对ICU护士临床决策的形成进行探讨，从有限理性、有限意志力和动态偏好3个方面对ICU护士临床决策发生偏差的成因进行阐述。该文提出引入大语言模型辅助决策、引入助推策略、鼓励共同决策的发展，为提高重症医疗团队中护理决策的质量奠定根基，以便更好地服务于临床实践。
张帅 , 陈莹莹 , 杨慧 , 夏莹 . ICU护士临床决策的行为经济学分析与优化对策研究进展[J]. 中华急危重症护理杂志, 2025 , 6(11) : 1399 -1403 . DOI: 10.3761/j.issn.2096-7446.2025.11.019
Nursing clinical decision-making is a systematic process in which nurses use critical thinking to formulate and implement the optimal scheme for clinical problems based on theory and practical experience. The characteristics of ICU nurses' work is to make rapid and massive decisions under the condition of limited information and time constraints，which make intuitive impact on patient condition. This paper analyzes ICU nurse clinical decision-making from the perspective of behavioral economics，and discusses the formation of clinical decision-making from the theory of bounded rationality，deviation theory and prospect theory，elaborate on the causes of clinical decision-making bias in ICU nurses from bounded rationality，limited willpower，and dynamic preferences. This paper put forward strategies such as introducing large language model to assist decision making，nudge theory，promoting the development of joint decision-making，so as to lay the foundation for improving the quality of nursing decision-making in critical care teams and better serve clinical practice.
| [1] | Oh S, Gu M, Sok S. A concept analysis of nurses' clinical deci-sion making:implications for Korea[J]. Int J Environ Res Pub-lic Health, 2022, 19(6):3596. |
| [2] | Nibbelink CW, Brewer BB. Decision-making in nursing practice:an integrative literature review[J]. J Clin Nurs, 2018, 27(5/6):917-928. |
| [3] | 王玲, 杨玉洁, 李尊柱, 等. ICU护士护理临床决策意识调查与分析[J]. 中国医刊, 2022, 57(5):538-541. |
| Wang L, Yang YJ, Li ZZ, et al. Investigation and analysis of clinical decision consciousness of ICU nurses[J]. Chin J Med, 2022, 57(5):538-541. | |
| [4] | 陈悦, 徐帅帅, 贺学敏, 等. 护理临床决策能力培训方式研究现状[J]. 中华现代护理杂志, 2020, 26(31):4432-4436. |
| Chen Y, Xu SS, He XM, et al. Research status of nursing clini-cal decision-making training methods[J]. Chin J Mod Nurs, 2020, 26(31):4432-4436. | |
| [5] | 刘超, 焦明丽, 刘伟婧, 等. 医生决策的行为经济学分析与医院工作场所暴力防范研究[J]. 中国医院管理, 2022, 42(12):72-76. |
| Liu C, Jiao ML, Liu WJ, et al. Behavioral economics analysis on doctor decision-making and hospital workplace violence prevention[J]. Chin Hosp Manag, 2022, 42(12):72-76. | |
| [6] | 王爽, 赵雨欣, 陈炜, 等. 三级公立医院高质量发展背景下急危重症医学中心建设及其对护理的启发[J]. 中华急危重症护理杂志, 2024, 5(6):499-505. |
| Wang S, Zhao YX, Chen W, et al. Construction of emergency and intensive care unit medicine centers in the context of high-quality development of tertiary public hospitals and its inspiration for nursing[J]. Chin J Emerg Crit Care Nurs, 2024, 5(6):499-505. | |
| [7] | 戚景琳, 韩正彪. 信息行为研究中的行为经济学理论:应用、贡献和展望[J]. 情报资料工作, 2024, 45(3):31-40. |
| Qi JL, Han ZB. Theory of behavioral economics in information behavior research:application,contribution and prospects[J]. I Inf Doc Serv, 2024, 45(3):31-40. | |
| [8] | 于博. “完全理性”、“有限理性”和“生态理性”:三种决策理论模式的融合与发展[J]. 现代管理科学, 2014(10):54-56. |
| Yu B. “Complete rationality”,“limited rationality” and “ecolo-gical rationality”:integration and development of three decision theory models[J]. Mod Manag Sci, 2014(10):54-56. | |
| [9] | 李梦璐, 刘畅. 神经内科重症监护室患者身体约束使用情况及相关影响因素分析[J]. 中外医学研究, 2024, 22(29):152-156. |
| Li ML, Liu C. Analysis of use of physical restraint and related influencing factors of patients in neurological intensive care unit[J]. Chin Foreign Med Res, 2024, 22(29):152-156. | |
| [10] | 周晓云, 刘程程, 石雅楠, 等. 重症监护病房护士临床警报管理质性研究的Meta整合[J]. 护士进修杂志, 2024, 39(5):510-516. |
| Zhou XY, Liu CC, Shi YN, et al. Meta synthesis of qualitative studies on clinical alarm management of nurses in intensive care unit[J]. J Nurs Train, 2024, 39(5):510-516. | |
| [11] | Zabihzadeh A, Mazaheri MA, Hatami J, et al. Culture as an effective frame of reference in clinical decision-making:a comparison of Iranian,American,and Canadian psychothera-pists[J]. Asian J Psychiatr, 2022,67:102928. |
| [12] | 曹娜, 解硕, 鲁美苏, 等. 患者安全事件中ICU护士作为第二受害者创伤复苏路径的扎根理论研究[J]. 中华急危重症护理杂志, 2025, 6(2):219-225. |
| Cao N, Xie S, Lu MS, et al. The trauma recovery path of ICU nurses as second victims of patient safety incidents:a grounded theory study[J]. Chin J Emerg Crit Care Nurs, 2025, 6(2):219-225. | |
| [13] | Bucknall T, Fossum M, Hutchinson AM, et al. Nurses' decision-making,practices and perceptions of patient involvement in medication administration in an acute hospital setting[J]. J Adv Nurs, 2019, 75(6):1316-1327. |
| [14] | Beadle ES, Walecka A, Sangam AV, et al. Triggers and factors associated with moral distress and moral injury in health and social care workers:a systematic review of qualitative studies[J]. PLoS One, 2024, 19(6):e0303013. |
| [15] | 张耀丹, 杜爱平, 田永明. ICU护士道德勇气现状及影响因素分析[J]. 护理学杂志, 2023, 38(2):51-54,62. |
| Zhang YD, Du AP, Tian YM. Level and determinants of moral courage among ICU nurses[J]. J Nurs Sci, 2023, 38(2):51-54,62. | |
| [16] | Hynes L, Coventry T, Russell K. Intensive care nurse's perce-ptions on barriers impeding the provision of end of life care in the intensive care setting:a quantitative analysis[J]. Aust J Adv Nurs, 2022, 39(1):7-17. |
| [17] | & #x00106;urković M, Brajković L, Jozepović A, et al. End-of-life deci-sions in intensive care units in Croatia-pre COVID-19 pers-pectives and experiences from nurses and physicians[J]. J Bioeth Inq, 2021, 18(4):629-643. |
| [18] | Li BY, Yue LQ, Nie HY, et al. The effect of intelligent mana-gement interventions in intensive care units to reduce false alarms:an integrative review[J]. Int J Nurs Sci, 2023, 11(1):133-142. |
| [19] | 薛瑾, 王清, 蒋玲, 等. ICU患者谵妄管理临床决策支持系统的构建与应用研究[J]. 中华护理杂志, 2023, 58(9):1037-1042. |
| Xue J, Wang Q, Jiang L, et al. Construction and application of a clinical decision support system for delirium management in ICU patients[J]. Chin J Nurs, 2023, 58(9):1037-1042. | |
| [20] | Courtright KR, Dress EM, Singh J, et al. Prognosticating out-comes and nudging decisions with electronic records in the intensive care unit trial protocol[J]. Ann Am Thorac Soc, 2021, 18(2):336-346. |
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