Mónica Vázquez, nurse of the Clínica Universidad de NavarraMónica Vázquez, a nurse from the University of Navarra, has defended her doctoral dissertation thesis entitled "Nursing decision-making in protocol-based care: a multiple case study". Directed by the researchers Cristina Oroviogoicoechea and María Jesús Pumar, the study was carried out in three hospitalization services (medical, surgical and medical-surgical), taking as a starting point the variability of the clinical internship , which is one of the main quality problems in the healthcare attendance , negatively affecting its effectiveness, efficiency and accessibility. This variability can be improved through Protocol-Based Care (PBC), a strategy that promotes a mode of standardization of care that eliminates arbitrariness in the clinical internship while respecting the status and individual needs of patients.

During the study, multiple methods were used to collect data, such as documentary analysis, observations of the context, participant observations and interviews. For the data analysis we used employee descriptive statistics for the quantitative data , Burnard content analysis for the qualitative data , and the "following the thread" technique for the integration of data of each case and of the three cases.

The integration of the three cases examined revealed that decision making in PBC varies depending on the organizational context and the subject of protocols. It also revealed that the PBC decision-making process is linear and variable, and that PBC decision-making is made up of multiple interrelated elements, including the perception of risk. 

Conclusions

Vázquez's thesis showed that nursing decision making in PBC is a complex, multifactorial and context-dependent process that can be used to promote PBC. He also showed that strategies aimed at improving PBC decision-making should focus on improving the professionals' perception of risk, and that programs can be developed for this purpose from the academic field and from the professional internship . To ensure the effectiveness of these strategies, an adequate organizational context is required, where there is coaching on the use of protocols, preferably exercised by an advanced profile , and with a favorable organizational climate.