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Bouchez T, Cagnon C, Hamouche G, Majdoub M, Charlet J, Schuers M. Interprofessional clinical decision-making process in health: A scoping review. J Adv Nurs 2024; 80:884-907. [PMID: 37705486 DOI: 10.1111/jan.15865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 07/19/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023]
Abstract
AIMS To describe the key elements of the interprofessional decision-making process in health, based on published scientific studies. To describe the authors, reviews and subject matter of those publications. DESIGN Scoping review of the literature. DATA SOURCES MEDLINE, APA Psycinfo OpenGrey, Lissa and Cochrane databases were searched in December 2019 and January 2023. REVIEW METHODS References were considered eligible if they (i) were written in French or English, (ii) concerned health, (iii) studied a clinical decision-making process, (iv) were performed in an interprofessional context. 'PRISMA-scoping review' guidelines were respected. The eligible studies were analysed and classified by an inductive approach RESULTS: We identified 1429 sources of information, 145 of which were retained for the analysis. Based on these studies, we identified five key elements of interprofessional decision-making in health. The process was found to be influenced by group dynamics, the available information and consideration of the unique characteristics of the patient. An organizational framework and specific training favoured improvements in the process. CONCLUSION Decision-making can be based on a willingness of the healthcare organization to promote models based on more shared leadership and to work on professional roles and values. It also requires healthcare professionals trained in the entire continuum of collaborative practices, to meet the unique needs of each patient. Finally, it appears essential to favour the sharing of multiple sources of accessible and structured information. Tools for knowledge formalization should help to optimize interprofessional decision-making in health. IMPACT The quality of a team decision-making is critical to the quality of care. Interprofessional decision-making can be structured and improved through different levels of action. These improvements could benefit to patients and healthcare professionals in every settings of care involving care collaboration. IMPACT STATEMENT Interprofessional decision-making in health is an essential lever of quality of care, especially for the most complex patients which are a contemporary challenge. This scoping review article offers a synthesis of a large corpus of data published to date about the interprofessional clinical decision-making process in healthcare. It has the potential to provide a global vision, practical data and a list of references to facilitate the work of healthcare teams, organizations and teachers ready to initiate a change.
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Affiliation(s)
- Tiphanie Bouchez
- Department of Education and Research in General Practice, University Côte d'Azur, RETINES, HEALTHY, Nice, France
- Sorbonne University, INSERM, University Sorbonne Paris-Nord, LIMICS, Paris, France
| | - Clémence Cagnon
- Department of Education and Research in General Practice, University Côte d'Azur, RETINES, HEALTHY, Nice, France
| | - Gouraya Hamouche
- Department of Education and Research in General Practice, University Côte d'Azur, RETINES, HEALTHY, Nice, France
| | - Marouan Majdoub
- Department of Education and Research in General Practice, University Côte d'Azur, RETINES, HEALTHY, Nice, France
| | - Jean Charlet
- Sorbonne University, INSERM, University Sorbonne Paris-Nord, LIMICS, Paris, France
- Assistance Publique-Hôpitaux de Paris/DRCI, Paris, France
| | - Matthieu Schuers
- Sorbonne University, INSERM, University Sorbonne Paris-Nord, LIMICS, Paris, France
- Department of General Practice, University of Rouen, Rouen, France
- Department of Medical Informatic, Academic Hospital of Rouen, Rouen, France
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Munro S, Cooke D, Holah J, Quinn T. The views, opinions and decision-making of UK-based paramedics on the use of pre-hospital 12-lead electrocardiograms in acute stroke patients: a qualitative interview study. Br Paramed J 2023; 8:1-10. [PMID: 38046793 PMCID: PMC10690491 DOI: 10.29045/14784726.2023.12.8.3.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Introduction A qualitative exploration into the views, opinions and decision-making of paramedics involved in undertaking pre-hospital 12-lead electrocardiograms (PHECGs) for stroke patients was undertaken, in order to gain a deeper understanding of the clinical and occupational context that the paramedics work within, the acceptability of the paramedics in using PHECGs for stroke patients and the consequences and influences of their decision-making. Methods Data were collected via semi-structured interviews and analysed using the framework method, with the underpinning theoretical framework of cognitive continuum theory. A purposive sample of 14 paramedics was recruited and interviewed. Results Five themes were generated from the analysis of the interviews: (1) 'time is brain': minimising delays and rapid transport to definitive care; (2) barriers and facilitators to undertaking PHECGs for stroke patients; (3) recognising and gaining cues; (4) maintaining patient dignity, self-protection and fully informed consent; and (5) education, experience and engagement with evidence. Conclusion The study showed mixed views on the usefulness of PHECGs, but all participants agreed that PHECGs should not cause additional delays. Paramedic decision-making on recording PHECGs relies on intuitive and quasi-rational cognitive modes, and requires a number of clinical, logistical and ethical considerations. The findings suggest careful consideration is needed of the benefits and potential drawbacks of incorporating PHECGs into pre-hospital stroke care.
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Affiliation(s)
- Scott Munro
- South East Coast Ambulance Service NHS Foundation Trust; University of Surrey ORCID iD: https://orcid.org/0000-0002-0228-4102
| | - Debbie Cooke
- University of Surrey ORCID iD: https://orcid.org/0000-0003-1944-7905
| | - Janet Holah
- South East Coast Ambulance Service NHS Foundation Trust
| | - Tom Quinn
- Kingston University ORCID iD: https://orcid.org/0000-0002-5116-0034
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Askelin B, Hind A, Paterson C. Exploring Clinical Decision-Making among the Uro-oncology Multidisciplinary Team: A Qualitative Study. Semin Oncol Nurs 2023; 39:151447. [PMID: 37179175 DOI: 10.1016/j.soncn.2023.151447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 04/05/2023] [Accepted: 04/12/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE The aim of this qualitative study was to understand the clinical decision-making process among the genitourinary oncology (GU) multidisciplinary team (MDT) and how patients are engaged in the process. DATA SOURCES A qualitative descriptive study design was conducted and has been reported according to the Consolidated Criteria for Reporting Qualitative Studies (COREQ). Members of the GU MDT were recruited from a metropolitan tertiary hospital and cancer regional center in Australia serving a population of 550,000. Semistructured interviews were conducted, and the audiorecordings were transcribed; an inductive thematic analysis was used to provide insight from multiple perspectives. CONCLUSION Three themes emerged: (1) the role and scope of the uro-oncology MDT, (2) lack of person-centered clinical decision-making, and (3) the barriers and facilitators. Amid the COVID-19 pandemic, the MDT discussions transitioned to virtual application, which was found to be convenient and efficient and improved attendance. The GU cancer MDT had a prominent biomedical focus that lacked person-centered considerations. Additional research is needed to explore how person-centered outcomes can be incorporated into the clinical decision-making process. IMPLICATION FOR NURSING PRACTICE The GU MDT is increasingly important in the care of uro-oncology patients. There appears to be barriers to the implementation of person-centered discussions in the MDT. The effective delivery of multidisciplinary care is contingent on an appropriate mechanism for collaborative communication between all MDT members and patients given the limited involvement of the patient in the MDT itself.
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Affiliation(s)
- Blake Askelin
- Faculty of Health, and School of Nursing, Midwifery and Public Health, University of Canberra, Bruce ACT, Australia
| | - Alicia Hind
- Faculty of Health; Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group; and School of Nursing, Midwifery and Public Health, University of Canberra, Bruce ACT, Australia
| | - Catherine Paterson
- Faculty of Health; Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group; Professor, School of Nursing, Midwifery and Public Health, University of Canberra, Bruce ACT, Australia; Canberra Health Services & ACT Health, SYNERGY Nursing & Midwifery Research Centre, Canberra Hospital, Australia; and Robert Gordon University, Aberdeen, Scotland, UK.
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Anselmann V, Disque H. Nurses' perspective on team learning in interprofessional teams. Nurs Open 2023; 10:2142-2149. [PMID: 36377695 PMCID: PMC10006656 DOI: 10.1002/nop2.1461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/19/2022] [Accepted: 10/22/2022] [Indexed: 11/16/2022] Open
Abstract
AIM The aim of this study is to find out what learning activities in interprofessional teams and what influencing factors for team learning activities in interprofessional teams can be described by nurses working in interprofessional teams. DESIGN We conducted a descriptive interview study. METHODS We used a semi-structured interview guideline and interviewed 10 nurses (N = 10) working in interprofessional teams. We analyzed our data using a qualitative content analysis. RESULTS Nurses describe team learning activities of knowledge sharing, team reflection, and storing and retrieving. Furthermore, our results show that team stability is important for interprofessional teams. PATIENT OR PUBLIC CONTRIBUTION Our results can be helpful for hospitals to improve organizational structures that help interprofessional teams to work together. Furthermore, vocational education and training for nurses should offer possibilities for nursing students to learn together with students of other fields.
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Affiliation(s)
- Veronika Anselmann
- Institute of Nursing Science, University of Education Schwäbisch Gmünd, Schwäbisch Gmünd, Germany
| | - Hannah Disque
- Institute of Nursing Science, University of Education Schwäbisch Gmünd, Schwäbisch Gmünd, Germany
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Conlon D, Raeburn T, Wand T. Cognitive Continuum Theory: Can it contribute to the examination of confidentiality and risk-actuated disclosure decisions of nurses practising in mental health? Nurs Inq 2022; 30:e12520. [PMID: 36065121 DOI: 10.1111/nin.12520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/19/2022] [Accepted: 08/12/2022] [Indexed: 11/29/2022]
Abstract
Nurses practising in mental health are faced with challenging decisions concerning confidentiality if a patient is deemed a potential risk to self or others, because releasing pertinent information pertaining to the patient may be necessary to circumvent harm. However, decisions to withhold or disclose confidential information that are inappropriately made may lead to adverse outcomes for stakeholders, including nurses and their patients. Nonetheless, there is a dearth of contemporary research literature to advise nurses in these circumstances. Cognitive Continuum Theory presents a single-system intuitive-analytical approach to examining and understanding nurse cognition, analogous to the recommended single-system approach to decision-making in mental health known as structured clinical judgement. Both approaches incorporate cognitive poles of wholly intuition and analysis and a dynamic continuum characterised by a 'common sense' blending of intuitive and analytical cognition, whereby cues presented to a decision-maker for judgement tasks are weighed and assessed for relevance. Furthermore, Cognitive Continuum Theory promotes the importance of determining pattern recognition and functional relations strategies, which can be used to understand the operationalisation of nurse cognition.
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Affiliation(s)
- Darren Conlon
- Sydney Nursing School Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.,School of Nursing & Midwifery (Sydney), Faculty of Medicine, Nursing & Midwifery, and Health Sciences, The University of Notre Dame Australia, Darlinghurst, NSW, Australia
| | - Toby Raeburn
- School of Nursing & Midwifery (Sydney), Faculty of Medicine, Nursing & Midwifery, and Health Sciences, The University of Notre Dame Australia, Darlinghurst, NSW, Australia
| | - Timothy Wand
- Sydney Nursing School Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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Raoust GM, Bergström J, Bolin M, Hansson SR. Decision-making during obstetric emergencies: A narrative approach. PLoS One 2022; 17:e0260277. [PMID: 35081113 PMCID: PMC8791468 DOI: 10.1371/journal.pone.0260277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 11/07/2021] [Indexed: 11/17/2022] Open
Abstract
This study aims to explore how physicians make sense of and give meaning to their decision-making during obstetric emergencies. Childbirth is considered safe in the wealthiest parts of the world. However, variations in both intervention rates and delivery outcomes have been found between countries and between maternity units of the same country. Interventions can prevent neonatal and maternal morbidity but may cause avoidable harm if performed without medical indication. To gain insight into the possible causes of this variation, we turned to first-person perspectives, and particularly physicians’ as they hold a central role in the obstetric team. This study was conducted at four maternity units in the southern region of Sweden. Using a narrative approach, individual in-depth interviews ignited by retelling an event and supported by art images, were performed between Oct. 2018 and Feb. 2020. In total 17 obstetricians and gynecologists participated. An inductive thematic narrative analysis was used for interpreting the data. Eight themes were constructed: (a) feeling lonely, (b) awareness of time, (c) sense of responsibility, (d) keeping calm, (e) work experience, (f) attending midwife, (g) mind-set and setting, and (h) hedging. Three decision-making perspectives were constructed: (I) individual-centered strategy, (II) dialogue-distributed process, and (III) chaotic flow-orientation. This study shows how various psychological and organizational conditions synergize with physicians during decision-making. It also indicates how physicians gave decision-making meaning through individual motivations and rationales, expressed as a perspective. Finally, the study also suggests that decision-making evolves with experience, and over time. The findings have significance for teamwork, team training, patient safety and for education of trainees.
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Affiliation(s)
- Gabriel M. Raoust
- Department of Clinical Sciences Lund, Division of Obstetrics and Gynecology, Faculty of Medicine, Lund University, Lund, Sweden
- Women’s Health Clinic, Ystad Hospital, Ystad, Sweden
- * E-mail:
| | - Johan Bergström
- Division for Risk Management and Societal Safety, Faculty of Engineering, Lund University, Lund, Sweden
| | - Maria Bolin
- Department of Applied Information Technology, University of Gothenburg, Gothenburg, Sweden
| | - Stefan R. Hansson
- Department of Clinical Sciences Lund, Division of Obstetrics and Gynecology, Faculty of Medicine, Lund University, Lund, Sweden
- Women’s Health Clinic, Skåne University Hospital, Lund, Sweden
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Clinical decision making involving prescription drug monitoring programs: A factorial, vignette-based study among student pharmacists. J Am Pharm Assoc (2003) 2021; 61:316-324. [PMID: 33579594 DOI: 10.1016/j.japh.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 12/02/2020] [Accepted: 01/07/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Prescription drug monitoring programs (PDMPs) are state-maintained databases that providers may reference when deciding to prescribe or dispense controlled substances. As more states begin to mandate PDMP use at the point of care, it is imperative to assess how pharmacists use PDMP information when determining whether to fill a controlled substance prescription (CSP). The objective of this study was to evaluate which factors affected fourth-year student pharmacists' decision to fill an opioid prescription, their level of confidence in their decision making, and familiarity with the PDMP. METHODS We used a 24 factorial design to present a series of text-based vignettes to fourth-year student pharmacists. Each participant received 8 vignettes (5 randomly selected, 3 fixed), representing a hypothetical hydrocodone-acetaminophen combination prescription with varying levels of the following dichotomous factors: doctor shopping, dosage, pharmacy shopping, and concurrent benzodiazepine prescription. Participants were asked to decide whether or not they would fill each of the hypothetical prescriptions they received. A multilevel model was used to measure the association between each of the vignette factors, age, race, sex, experience with PDMP, and the decision to refuse to fill a prescription. Each vignette response served as an independent observation. RESULTS A total of 87 participants yielded 696 vignette responses. Participants were significantly more likely to refuse to fill prescriptions with doctor shopping (adjusted odds ratio [aOR] 19.86 [95% CI 10.78-36.58]), pharmacy shopping (6.78 [4.13-11.12]), dosage (1.83 [1.16-2.90]), or if the student pharmacist was of female sex (1.73 [1.02-2.93]). Concomitant benzodiazepine use was not associated with a no-fill decision (1.45 [0.92-2.27]). CONCLUSION This study reveals that student pharmacists' decision to fill a prescription is dependent on both prescription characteristics and a patient's CSP history. The importance of PDMP history cannot be downplayed and suggests that PDMP use may be effective in informing patient care decisions. Still, the variability in filling decision highlights the need to teach a formulaic approach to CSP dispensing in colleges of pharmacy.
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Parker-Tomlin M, Boschen M, Glendon I, Morrissey S. Factors influencing health practitioners' cognitive processing and decision-making style. J Interprof Care 2018; 33:546-557. [PMID: 30497308 DOI: 10.1080/13561820.2018.1551866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Successful interventions, healthcare planning, and patient-centered care require explanation, justification, and collaboration through interprofessional clinical decision-making (CDM). Understanding health practitioners' decision-making styles and influencing factors can enhance CDM capabilities. Health professionals and students (N = 229) completed an online survey on their decision-making styles, interprofessional education, interprofessional practice, discipline education, clinical experience, processing styles, personality, interpersonal motivational factors, and age. To assess the influence of task structure, participants answered CDM questions on a high- and a low-structured case study. Age demonstrated an effect on the level of clinical experience, while clinical experience also mediated the effect of age on rational processing styles. While personality results were mixed, consistent with previous findings, conscientiousness predicted rational processing style. Effects of interpersonal motivation on personality were also mixed, insofar as results indicated an association between conscientiousness and both experiential and rational processing styles. Interpersonal motivation also predicted rational processing styles. The complexity of CDM and factors influencing healthcare practitioners' processing and decision-making styles was highlighted. To optimize CDM processes by addressing errors and biases, CDM, and practice complexity, healthcare practitioner education should include theory-driven CDM orientation frameworks.
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Affiliation(s)
| | - Mark Boschen
- School of Applied Psychology, Griffith University , Gold Coast, Queensland , Australia
| | - Ian Glendon
- School of Applied Psychology, Griffith University , Gold Coast, Queensland , Australia
| | - Shirley Morrissey
- School of Applied Psychology, Griffith University , Gold Coast, Queensland , Australia
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Seidi J, Alhani F, Ardalan F. Exploring nurses' experience about facilitating factors in medication administration based on clinical judgment of nurses: A content analysis. Electron Physician 2017; 9:6063-6071. [PMID: 29560161 PMCID: PMC5843435 DOI: 10.19082/6063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 09/24/2017] [Indexed: 11/20/2022] Open
Abstract
Background Clinical judgment of nurses to conduct medication orders is based on patient assessment, medication knowledge, observation, and interpretation of the data collected. This process is influenced by many factors. Objective This study aims to explore nurses’ experience about facilitating factors in medication administration based on clinical judgment of nurses. Methods This qualitative study was part of an approved project research of the Iranian National Institute of Health Research, which was conducted in Kurdistan University of Medical Sciences in 2015. Based on purposive sampling of 18 participants, 26 open and semistructured interviews were conducted. Based on conventional content analysis method and using MAXQDA2010, coding and categorizing the data were applied. During the analysis, data collection continued until saturation. Results Analysis of the data led to the emergence of five themes, including the implementation of evidence-based medication orders, situational-based medication orders, medication orders in critical condition, educational interventions in medication orders, and supporting the nurses as facilitator of the implementation of medicinal orders based on clinical judgment of nurses. Conclusion In response to constraints such as the routines, clinical crisis and lack of evidence in medicinal orders, nurses used following ways to fix these barriers and facilitators. Combining evidence such as clinical guidelines, physician’s views based on patients, and clinical conditions proved the best facilitator. It is recommended that, using these results, a perfect background for the proper administration of medication orders by nurses should be provided.
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Affiliation(s)
- Jamal Seidi
- Ph.D. of Nursing, Assistant Professor, Clinical Care Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Fatemeh Alhani
- Ph.D. of Health Education, Associate Professor, Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Farasat Ardalan
- M.Sc. of Nursing, Faculty Member, Department of Community Health Nursing, Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran
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