Health professionals’ decision‐making in wound management: a grounded theory

Aim To develop a conceptual understanding of the decision‐making processes used by healthcare professionals in wound care practice. Background With the global move towards using an evidence‐base in standardizing wound care practices and the need to reduce hospital wound care costs, it is important to understand health professionals’ decision‐making in this important yet under‐researched area. Design A grounded theory approach was used to explore clinical decision‐making of healthcare professionals in wound care practice. Methods Interviews were conducted with 20 multi‐disciplinary participants from nursing, surgery, infection control and wound care who worked at a metropolitan hospital in Australia. Data were collected during 2012–2013. Constant comparative analysis underpinned by Strauss and Corbin's framework was used to identify clinical decision‐making processes. Findings The core category was ‘balancing practice‐based knowledge with evidence‐based knowledge’. Participants’ clinical practice and actions embedded the following processes: ‘utilizing the best available information’, ‘using a consistent approach in wound assessment’ and ‘using a multidisciplinary approach’. The substantive theory explains how practice and evidence knowledge was balanced and the variation in use of intuitive practice‐based knowledge versus evidence‐based knowledge. Participants considered patients’ needs and preferences, costs, outcomes, technologies, others’ expertise and established practices. Participants’ decision‐making tended to be more heavily weighted towards intuitive practice‐based processes. Conclusion These findings offer a better understanding of the processes used by health professionals’ in their decision‐making in wound care. Such an understanding may inform the development of evidence‐based interventions that lead to better patient outcomes.