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Martini N, Choong JW, Dela Cruz PD, Lau H, Lim H, Liu R, Lim AG, Marshall D. Assessing antibiotic prescribing in nurse practitioners: Applied cognitive task analysis. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100101. [PMID: 38745626 PMCID: PMC11080434 DOI: 10.1016/j.ijnsa.2022.100101] [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: 04/11/2022] [Revised: 09/12/2022] [Accepted: 09/23/2022] [Indexed: 10/14/2022] Open
Abstract
Background Prescribing antibiotics is a demanding and complex task where decision-making skills are of critical importance to minimize the risk of antimicrobial resistance. Despite its importance, little is known about the decision-making skills and cognitive strategies new Nurse Practitioners (NPs) use when prescribing antibiotics. Objective To identify the cognitive demands of antibiotic prescribing complexity and to explore the cognitive strategies that new NPs in New Zealand use when prescribing antibiotics. Design A qualitative approach using Applied Cognitive Task Analysis (ACTA) methodology. Participants A purposive sample was recruited consisting of five NPs who had been registered within the last five years and were prescribing antibiotics as part of their scope of practice. Methods In-depth face-to-face interviews consisting of a task diagram interview and a knowledge audit were conducted and analyzed following the ACTA protocol. Results Four cognitive elements were identified from the data which showed the cognitive demands of prescribing antibiotics, and the cues and strategies NPs use for safe practice. These were: 1 prescribing in the face of uncertainty (complex patients and diagnostic uncertainty); 2 making clinical decisions with insufficient/poor guidance (lack of guidelines, conflicting information); 3 producing an individualized treatment plan in view of clinical and non-clinical patient factors (patient demand/expectation, inadequate patient education, risks versus benefits of antibiotic treatment); 4 ensuring treatment efficacy and continuity of care (ineffective treatment, patient care follow up). Conclusion The ACTA framework has given insight into the current antibiotic prescribing practice of new NPs, identifying areas where professional development courses and treatment resources can be targeted to support antibiotic prescribing. NPs are likely to benefit from resources that are freely available and reflect national or local antimicrobial data. Further work is also warranted to determine whether targeted education resources and clinical pathways will help with diagnostic uncertainty, and how this could be embedded into existing curricula.
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Affiliation(s)
- Nataly Martini
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Je Wei Choong
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Paula Donamae Dela Cruz
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Helen Lau
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Hanna Lim
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Roger Liu
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Anecita Gigi Lim
- School of Nursing, Faculty of Medical and Health Sciences, School of Pharmacy, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Dianne Marshall
- School of Nursing, Faculty of Medical and Health Sciences, School of Pharmacy, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
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Educators’ Perceptions of the Development of Clinical Judgment of Direct-Entry Students and Experienced RNs Enrolled in NP Programs. JOURNAL OF NURSING REGULATION 2022. [DOI: 10.1016/s2155-8256(22)00011-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Oliveira IV, Nascimento YDA, Ramalho-de-Oliveira D. Decision-Making Process in Comprehensive Medication Management Services: From the Understanding to the Development of a Theoretical Model. PHARMACY 2020; 8:E180. [PMID: 33022919 PMCID: PMC7712991 DOI: 10.3390/pharmacy8040180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 11/22/2022] Open
Abstract
In Comprehensive medication management (CMM), the practitioner applies a decision-making method to assess patients' pharmacotherapy in order to identify and solve drug therapy problems. Grounded theory was used to understand how pharmacists make clinical decisions when providing CMM service. Data collection included individual semi structured interviews with 11 pharmacists, observation of clinical case discussions and CMM consultations provided by the participating pharmacists. Two main categories emerged: 1. Understanding the rational method of decision-making: the foundation of the patient care process. 2. Balancing the care equation: the objective and the subjective, which includes a theoretical proposal explaining the pharmacists' decision-making process and the factors that can modify this process. The pharmacotherapy knowledge should guide the anamnesis. Thus, the professional can evaluate the indication, effectiveness, safety and convenience of medications used by the patient. After exploring patients' medication experiences, pharmacists can follow two courses of action: helping the patient overcome barriers to medication use; or matching the pharmacotherapy to the patient's routine. Professional autonomy and absence of the patient at the time of the decision were some factors that influenced the pharmacist's decision. Findings provide a broad understanding of pharmacists' decision-making process during the care of patients using medications. It can be applied as a basis for educational interventions to train professionals on decision-making.
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Affiliation(s)
- Isabela Viana Oliveira
- College of Pharmacy, Center for Pharmaceutical Care Studies, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil;
| | | | - Djenane Ramalho-de-Oliveira
- College of Pharmacy, Center for Pharmaceutical Care Studies, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil;
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Veinot TC, Senteio CR, Hanauer D, Lowery JC. Comprehensive process model of clinical information interaction in primary care: results of a "best-fit" framework synthesis. J Am Med Inform Assoc 2018; 25:746-758. [PMID: 29025114 PMCID: PMC7646963 DOI: 10.1093/jamia/ocx085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 07/18/2017] [Accepted: 08/01/2017] [Indexed: 01/04/2023] Open
Abstract
Objective To describe a new, comprehensive process model of clinical information interaction in primary care (Clinical Information Interaction Model, or CIIM) based on a systematic synthesis of published research. Materials and Methods We used the "best fit" framework synthesis approach. Searches were performed in PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Library and Information Science Abstracts, Library, Information Science and Technology Abstracts, and Engineering Village. Two authors reviewed articles according to inclusion and exclusion criteria. Data abstraction and content analysis of 443 published papers were used to create a model in which every element was supported by empirical research. Results The CIIM documents how primary care clinicians interact with information as they make point-of-care clinical decisions. The model highlights 3 major process components: (1) context, (2) activity (usual and contingent), and (3) influence. Usual activities include information processing, source-user interaction, information evaluation, selection of information, information use, clinical reasoning, and clinical decisions. Clinician characteristics, patient behaviors, and other professionals influence the process. Discussion The CIIM depicts the complete process of information interaction, enabling a grasp of relationships previously difficult to discern. The CIIM suggests potentially helpful functionality for clinical decision support systems (CDSSs) to support primary care, including a greater focus on information processing and use. The CIIM also documents the role of influence in clinical information interaction; influencers may affect the success of CDSS implementations. Conclusion The CIIM offers a new framework for achieving CDSS workflow integration and new directions for CDSS design that can support the work of diverse primary care clinicians.
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Affiliation(s)
- Tiffany C Veinot
- School of Information and School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Charles R Senteio
- Department of Library and Information Science, School of Communication and Information, Rutgers University, New Brunswick, NJ, USA
| | - David Hanauer
- Department of Pediatrics, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Julie C Lowery
- Center for Clinical Management, Research, VA Ann Arbor Healthcare System, University of Michigan, Ann Arbor, MI, USA
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O'Rourke J, Zerwic J. Measure of Clinical Decision-Making Abilities of Nurse Practitioner Students. J Nurs Educ 2016; 55:18-23. [DOI: 10.3928/01484834-20151214-06] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 09/01/2015] [Indexed: 11/20/2022]
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Wisur-Hokkanen C, Glasberg AL, Mäkelä C, Fagerström L. Experiences of working as an advanced practice nurse in Finland--the substance of advanced nursing practice and promoting and inhibiting factors. Scand J Caring Sci 2015; 29:793-802. [PMID: 25656095 DOI: 10.1111/scs.12211] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 11/19/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evaluation of new advanced practice nursing roles, from different angles, is strongly recommended in the literature. New nurses' experiences of working in an advanced role may highlight problems and/or factors that promote or inhibit a successful implementation of new advanced nursing roles. AIM To explore advanced practice nurses' experiences of the content of their nursing care and to describe promoting or inhibiting factors for working with a full scope of advanced nursing practice. METHODS The study design was explorative and descriptive. A total of 24 advanced practice nurses participated in focus group interviews (two were interviewed individually) about the processes, structure and outcome of working as advanced practice nurses. Qualitative manifest content analysis was used for data analysis. FINDINGS The substance of advanced practice nursing can be described with three main themes: a broader and deeper holistic view of patients' state of health, an independent and responsible manner of working and knowing own limits. Promoting factors were an identity as a nurse with advanced competency, feedback from satisfied patients and fruitful teamwork is a necessity. Inhibiting factors were a lack of organisational understanding for advanced nursing practice, poor planning leads to unsatisfactory advanced practice nursing models and advanced practice nurses' lack of courage in adopting new advanced roles. CONCLUSION The participants experienced both a personal inner transition and a role transition that were either supported or opposed. Vague or nonexistent definitions and concepts, insufficient knowledge, insufficient support and undefined roles hindered participants' role transition. Two main strategies should be employed. The first is the realisation of more strategic leadership and support from organisations on all management levels, including nursing organisations/unions, while the second is to more realistically prepare future advanced practice nurses for the challenges they will face, through mentorship programmes and continuous further training.
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Affiliation(s)
| | | | | | - Lisbeth Fagerström
- Buskerud and Vestfold University College, Drammen, Norway.,Åbo Akademi University, Vaasa, Finland
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Durham CO, Fowler T, Kennedy S. Teaching Dual-Process Diagnostic Reasoning to Doctor of Nursing Practice Students: Problem-Based Learning and the Illness Script. J Nurs Educ 2014; 53:646-50. [DOI: 10.3928/01484834-20141023-05] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 07/15/2014] [Indexed: 11/20/2022]
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Exploring Factors Affecting Emergency Medical Services Staffs' Decision about Transporting Medical Patients to Medical Facilities. Emerg Med Int 2014; 2014:215329. [PMID: 24891953 PMCID: PMC4033513 DOI: 10.1155/2014/215329] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 04/09/2014] [Indexed: 11/17/2022] Open
Abstract
Transfer of patients in medical emergency situations is one of the most important missions of emergency medical service (EMS) staffs. So this study was performed to explore affecting factors in EMS staffs' decision during transporting of patients in medical situations to medical facilities. The participants in this qualitative study consisted of 18 EMS staffs working in prehospital care facilities in Tehran, Iran. Data were gathered through semistructured interviews. The data were analyzed using a content analysis approach. The data analysis revealed the following theme: "degree of perceived risk in EMS staffs and their patients." This theme consisted of two main categories: (1) patient's condition' and (2) the context of the EMS mission'. The patent's condition category emerged from "physical health statuses," "socioeconomic statuses," and "cultural background" subcategories. The context of the EMS mission also emerged from two subcategories of "characteristics of the mission" and EMS staffs characteristics'. EMS system managers can consider adequate technical, informational, financial, educational, and emotional supports to facilitate the decision making of their staffs. Also, development of an effective and user-friendly checklist and scoring system was recommended for quick and easy recognition of patients' needs for transportation in a prehospital situation.
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Stamp KD. How nurse practitioners make decisions regarding coronary heart disease risk: a social judgment analysis. Int J Nurs Knowl 2012; 23:29-40. [PMID: 22613752 DOI: 10.1111/j.2047-3095.2011.01196.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Understanding how nurse practitioners use clinical decision skills in practice has the potential to guide education programs to ensure safe, competent, and high quality advanced nursing practice. This study used the lens of social judgment theory to examine the clinical decision making of 60 nurse practitioners. METHODS A three-group pretest-posttest comparison design was used to evaluate how much insight nurse practitioners had into their clinical decision-making process. FINDINGS Nurse practitioners had modest insight into their clinical decision-making process. CONCLUSION Self-insight has implications for enhancing nurses' decision making, improving education, and fostering agreement among advanced practice nurses. IMPLICATIONS FOR NURSING PRACTICE Self-insight has implications for developing professional decision making and promoting appropriate educational opportunities for advanced practice nurses.
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Affiliation(s)
- Kelly D Stamp
- Boston College, William F. Connell School of Nursing, Chestnut Hill, Massachusetts, USA.
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Nyirati CM, Denham SA, Raffle H, Ware L. Where is family in the family nurse practitioner program? Results of a U.S. family nurse practitioner program survey. JOURNAL OF FAMILY NURSING 2012; 18:378-408. [PMID: 22529244 DOI: 10.1177/1074840712443872] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Though recent progress in family nursing science can serve the family nurse practitioner (FNP) to intervene in the regulation of family health, whether those advances are taught to FNP students has been unclear. All 266 FNP programs in the United States were invited to participate in a survey to assess the content and clinical application of family nursing theories in the curriculum. The majority of FNP programs frame family as the context of care for the individual. Though FNP students receive a foundation in family nursing theory in core courses, they are not usually expected to use family assessment methods in clinical practicum courses or to plan interventions for the family as the unit of care. The authors challenge educators to consider family nursing science as an essential component of the FNP program as the Doctor of Nursing Practice (DNP) evolves and becomes requisite for entry into advanced practice.
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Affiliation(s)
- Christina M Nyirati
- School of Nursing, College of Health Sciences and Professions, Ohio University, Athens, OH 45701, USA.
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Kilpatrick K. Understanding acute care nurse practitioner communication and decision-making in healthcare teams. J Clin Nurs 2012; 22:168-79. [DOI: 10.1111/j.1365-2702.2012.04119.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Brykczynski K. Clarifying, affirming, and preserving the nurse in nurse practitioner education and practice. ACTA ACUST UNITED AC 2012; 24:554-64. [DOI: 10.1111/j.1745-7599.2012.00738.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wang Y, Chien WT, Twinn S. An exploratory study on baccalaureate-prepared nurses’ perceptions regarding clinical decision-making in mainland China. J Clin Nurs 2011; 21:1706-15. [DOI: 10.1111/j.1365-2702.2011.03925.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Stamp KD. How Nurse Practitioners Make Decisions Regarding Coronary Heart Disease Risk: A Social Judgment Analysis. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.1744-618x.2011.01196.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Advanced Practice Nursing, Health Care Teams, and Perceptions of Team Effectiveness. Health Care Manag (Frederick) 2011; 30:215-26. [DOI: 10.1097/hcm.0b013e318225e03a] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ramezani-Badr F, Nasrabadi AN, Yekta ZP, Taleghani F. Strategies and Criteria for Clinical Decision Making in Critical Care Nurses: A Qualitative Study. J Nurs Scholarsh 2009; 41:351-8. [DOI: 10.1111/j.1547-5069.2009.01303.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Burman ME, Hart AM, Conley V, Brown J, Sherard P, Clarke PN. Reconceptualizing the core of nurse practitioner education and practice. ACTA ACUST UNITED AC 2009; 21:11-7. [PMID: 19125890 DOI: 10.1111/j.1745-7599.2008.00365.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The movement to the doctor of nursing practice (DNP) is progressing rapidly with new programs emerging and curricular documents being developed. We argue that the implementation of the DNP is a good move for nursing, provided that we use the opportunity to reconceptualize the core of advanced practice nursing, especially nurse practitioner (NP) practice. DATA SOURCES Theory and research articles from nursing focused on advanced practice nursing, NPs, and doctoral education. CONCLUSIONS The foundation of NP education is currently based essentially on borrowed or shared content in assessment, pharmacology, and pathophysiology. We argue that the heart and soul of nursing is in health promotion, both in healthy persons and in those dealing with chronic illness. Current master's programs do not prepare NPs to assume high-level practice focused on health promotion and disease management using the latest theoretical developments in health behavior change, behavioral sciences, exercise physiology, nutrition, and medical anthropology. Although these are touched upon in most NP programs, they do not represent the core science of NP education and need to be a critical part of any DNP program. IMPLICATIONS FOR PRACTICE Ultimately, our vision is for NP care to be consistently "different," yet just as essential as physician care, leading to positive outcomes in health promotion and disease management.
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Affiliation(s)
- Mary E Burman
- Fay W. Whitney School of Nursing, University of Wyoming, Laramie, WY 82071, USA.
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Abstract
PURPOSE The purpose of this descriptive study was to determine the level of autonomy of nurse practitioners (NPs) providing care to an adult patient population in an acute care setting. DATA SOURCES Data were collected from 54 NPs in different specialty areas currently working in a large metropolitan hospital. The Dempster Practice Behaviors Scale was used to measure the autonomy of the NPs. CONCLUSIONS The overall mean autonomy score of 117.37 (SD = 14.55) indicates a high level of autonomy of the NPs in this study. Forty-one percent of the participants had very high levels of autonomy, 31.5% had extremely high levels of autonomy, and 19% had moderate levels of autonomy. Demographic variables of age; years worked as an NP, as an RN, and at current job; highest educational level; basic nursing preparation; NP certification; and specialty had no statistically significant relationship with autonomy scores. IMPLICATIONS FOR PRACTICE The results of this study provided preliminary evidence of the level of autonomy of NPs providing inpatient care to adult patients in an acute care setting. The findings could lead to future research on the impact of NP services on patient outcomes and clinical productivity in acute care settings.
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Affiliation(s)
- Corazon B Cajulis
- Department of Nursing/Medical Services, Mount Sinai Hospital, New York, New York, USA.
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The level of knowledge of respiratory physiology articulated by intensive care nurses to provide rationale for their clinical decision-making. Intensive Crit Care Nurs 2007; 23:145-55. [PMID: 17419057 DOI: 10.1016/j.iccn.2006.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Revised: 11/08/2006] [Accepted: 11/15/2006] [Indexed: 12/01/2022]
Abstract
The combination of intensive care knowledge, and the ability to articulate analytical decision-making processes to the interdisciplinary team, enhances the clinical credibility of the intensive care unit (ICU) nurse. The objective of this paper is to outline a study firstly, assessing ICU nurses' ability in articulating respiratory physiology to provide rationale for their clinical decision-making and secondly, the barriers that limit the articulation of this knowledge. Using an evaluation methodology, multiple methods were employed to collect data from 27 ICU nurses who had completed an ICU education programme and were working in one of two tertiary ICUs in New Zealand. Quantitative analysis showed that nurses articulated a low to medium level of knowledge of respiratory physiology. Thematic analysis identified the barriers limiting this use of respiratory physiology as being inadequate coverage of concepts in some ICU programmes; limited discussion of concepts in clinical practice; lack of clinical support; lack of individual professional responsibility; nurses' high reliance on intuitive knowledge; lack of collaborative practice; availability of medical expertise; and the limitations of clinical guidelines and protocols. These issues need to be addressed if nurses' articulation of respiratory physiology to provide rationale for their clinical decision-making is to be improved.
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Abstract
There has been little research on what beginning yet competent clinical judgment "looks like" to preceptors, those individuals charged with evaluating the performance of new graduate nurses during the orientation/training process. This phenomenological study explicates how preceptors interpret clinical judgment in new nurses during their orientation to labor and delivery.
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Affiliation(s)
- Susan McNiesh
- School of Nursing, San Jose State University, One Washington Square, San Jose, CA 95192, USA.
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Abstract
BACKGROUND Clinical reasoning is employed to develop solutions to health needs. The impact of the clinical environment on the organization of knowledge-guiding practice has received limited attention. This gap in the clinical landscape restricts the sharing of decision-making processes. AIMS Focusing on the community, and specifically the patient's home as a context for nursing, this paper describes the creation of a collective conceptual map for a group of community nurses. There is a twofold aim of exploring the process of exposing and articulating the clinical framework and enhancing and sharing understanding of the clinical paradigm in this context. DESIGN An interpretive research approach was utilized. Hermeneutic phenomenology guided the level of meaning accessed and constructivism was used to build an educational picture. METHODS Multiple methods including focus groups, observation and narrative recordings were utilized to collect and analyse research data. RESULTS All nurses may engage with the same concepts--health, need, care and partnerships--but organized into particular frames by the guiding practice philosophy and service organization. A four-stage framework for understanding clinical reasoning in the community setting is presented. This acknowledges the multi-faceted nature of health, the lived experience of health deficits, and is located in a participation and negotiated model of care. Practice examples are presented to expose the construction of need and response which often occurs in a triadic decision-making process. CONCLUSIONS Environment of care has significant implications on need identification and response. RELEVANCE TO CLINICAL PRACTICE Mechanisms to enhance the sharing of clinical reasoning and decision-making transparency are essential to aid inter- and intra-professional communication. Presentation of a clinical reasoning framework exposes the breath of 'signals' encountered in practice and the range of knowledge employed in understanding and responding to patient need.
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Affiliation(s)
- Susan M Carr
- Research Fellow, Nursing, Midwifery & Allied Health Professions Research & Development Unit, Northumbria University, Benton, Newcastle upon Tyne, UK.
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Cumbie SA, Conley VM, Burman ME. Advanced practice nursing model for comprehensive care with chronic illness: model for promoting process engagement. ANS Adv Nurs Sci 2004; 27:70-80. [PMID: 15027663 DOI: 10.1097/00012272-200401000-00008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
New models of providing care to chronically ill persons are needed that can facilitate a more integrative approach to patient care. The purposes of this article are to describe the utilization of a theory synthesis process for development of a client-focused approach for advanced practice nurse (APN) management of chronic illness and to present the Model for Promoting Process Engagement. The model was developed as a theory-driven intervention to address complexities of chronic illness care. This APN practice model is the direct result of the synthesis of a number of differing theoretical models developed by the authors in previous individual research endeavors.
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Affiliation(s)
- Sharon A Cumbie
- Fay W. Whitney School of Nursing, University of Wyoming, Dept 3065, 1000 E University Ave, Laramie, WY 82071, USA.
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