Factors influencing pharmacists' clinical decision making in pharmacy practice

BACKGROUND

Pharmacists' clinical decision-making is considered a core process of pharmaceutical care in pharmacy practice, but little is known about the factors influencing this process.

OBJECTIVE

To identify factors influencing clinical decision-making among pharmacists working in pharmacy practice.

METHODS

Semi-structured interviews were conducted with pharmacists working in primary, secondary, and tertiary care settings in the Netherlands between August and December 2021. A thematic analysis was conducted using an inductive approach. The emerged themes were categorized into the Capability-Opportunity-Motivation-Behaviour (COM-B) model domains.

RESULTS

In total, 16 pharmacists working in primary care (n = 7), secondary care (n = 4) or tertiary care (n = 5) were interviewed. Factors influencing pharmacists' capability to make clinical decisions are a broad theoretical knowledge base, clinical experience, and skills, including contextualizing data, clinical reasoning, and clinical judgment. The pharmacy setting, data availability, rules and regulations, intra- and interprofessional collaboration, education, patient perspectives, and time are mentioned as factors influencing their opportunity. Factors influencing pharmacists' motivation are confidence, curiosity, critical thinking, and responsibility.

CONCLUSIONS

The reported factors covered all domains of the COM-B model, implying that clinical decision-making is influenced by a combination of pharmacists' capability, opportunity, and motivation. Addressing these different factors in pharmacy practice and education may improve pharmacists' clinical decision-making, thereby improving patient outcomes.

The mediating effect of psychological empowerment on the relationship between work environment and clinical decision-making among midwives: a multicentre cross-sectional study

BACKGROUND

Clinical decision-making is considered an essential behaviour in clinical practice. However, no research has been done to examine the associations among midwives' clinical decision-making, work environment and psychological empowerment. Thus, this study aimed to determine the influence of work environment on midwives' clinical decision-making and confirm the mediating role of psychological empowerment.

METHOD

This study was designed as a multicentre cross-sectional study, and included 602 registered midwives from 25 public hospitals in China. A sociodemographic questionnaire, Work Environment Scale, Psychological Empowerment Scale and Clinical decision-making Scale were applied. A structural equation model was conducted to estimate the hypothesis model of the clinical decision-making among midwives and explore the potential mediating mechanism of midwives' clinical decision-making. This model was employed maximum likelihood estimation method and bootstrapping to examine the statistical significance.

RESULTS

The mean score of clinical decision-making among midwives was 143.03 ± 14.22, at an intermediate level. The data of this hypothesis model fitted well, and the results showed that work environment positively affected psychological empowerment, which in turn positively affected clinical decision-making; psychological empowerment partly mediated the relationship between work environment and clinical decision-making among midwives.

CONCLUSIONS

Midwives' clinical decision-making could be promoted directly or indirectly by providing a healthy work environment and improving psychological empowerment. It is essential for hospital managers to pay attention to the assessment of the midwives' work environment and actively improve it, such as establishing a supportive, fair and just workplace, and maintaining effective communication with midwives. Furthermore, managers can also promote midwives' clinical decision-making behaviour by enhancing their psychological empowerment via enhancing job autonomy.

The Factors Influencing Nurses' Clinical Decision-Making in Emergency Department

In an emergency, making the correct decision is vital. It is a necessary element of professional nursing care, and the ability of nurses to make successful clinical decisions is the most critical element influencing care quality. The purpose of this study was to assess the factors influencing nurses' clinical decision-making in the emergency department of Palestinan hospitals. A cross-sectional study was targeted at all nurses working in emergency departments at the Palestinian hospitals. The study was completed with 227 nurses, and collecting data was performed with the Clinical Decision Making in Nursing Scale. Results of the study revealed that the average score for the total clinical decision-making score was 3.3 (SD = 0.23). The subscales of clinical decision making were "search for alternatives or options," "canvassing of objectives and values," "evaluation and reevaluation of consequences," and "search for information and unbiased assimilation of new information." Furthermore, multiple linear regression analysis revealed that degree and work hours accounted for 11.7% of the variance in clinical decision-making. The study confirmed the average score for clinical decision-making was slightly higher than the average score. Also, it approved that nursing degree and work hours were predictors of clinical decision-making among nurses in emergency departments.

Do Personal Differences and Organizational Factors Influence Nurses' Decision Making? A Qualitative Study

Decision-making processes (DMPs) can be altered by several factors that might impact patient outcomes. However, nurses’ views and experiences regarding the multitude of personal and organizational factors that may facilitate or inhibit their decision-making abilities have rarely been studied. Purpose: To explore the personal and organizational factors that influence nurse DMPs in clinical settings at Ministry of Health hospitals (MOH). Method: A qualitative research design was conducted. A purposive sample of 52 nurses was recruited from general and critical wards in two major Ministry of Health hospitals in Hail, Saudi Arabia. A total of eight focus groups (semi-structured interviews) were conducted to elicit participant responses. Results: In this study, the personal differences covered nurses’ experience, physical and psychological status, autonomy, communication skills, values, and cultural awareness. Organizational factors included the availability of resources, organizational support, workload, the availability of educational programs, the availability of monitoring programs, and the consistency and unity of policies, rules, and regulation applications. Conclusions: The major contribution of this study is the comprehensive illustration of influential factors at both the personal level and the organizational level that impact DMPs to achieve desired outcomes for patients and health organizations. This study utilizes a framework that could explain the nature of nurse DMPs.

Clinical Decision Making at the Bedside

The complexity and rapidly changing environment of health care places significant pressure on nurses. How nurses make decisions within this environment has been an area of inquiry in the literature. Clinical decision making is the application of distinct thinking patterns and analysis of data at hand used to make judgements about patient care. Models of clinical decision making provide a foundation for understanding how nurses make decisions. Key factors associated with clinical decision making include experience, intuition, use of information and sources, and environment. Further work is needed to increase understanding of the processes by which nurses make clinical decisions.

Developing professional competence among critical care nurses: An integrative review of literature

BACKGROUND

Professional competence is the ability to base clinical decisions on prior experiences with particular clinical situations.

METHODS

An integrative review of the literature using the methodology of Whittemore and Knafl. The guiding question was: What is the extent and nature of the published literature on intensive care nurses developing professional competence?

RESULTS

This review analysed 21 peer-reviewed articles obtained from electronic databases. The three main domains of professional competence were managing situations, decision-making and teamwork. Three instruments, the Critical Care Competency Assessment instrument, the Self-Assessment Competence Tool, and the Intensive and Critical Care Nursing Competence Scale (intensive care unit), measure professional and/or clinical competence. Demographic factors are experience, education, age, figure tow near here certification status, gender and location.

CONCLUSION

Perception of self-competence, seeing beyond the technical aspects of care to the patient, and perceptions of and bonding with intensive care patients and their families are other facets of professional competence that warrant further study.

The Regret Coping Scale for Health-Care Professionals (RCS-HCP): A validation study with Danish social educators

BACKGROUND

Coping with regret has a substantial impact on wellbeing and mental health, but has rarely been investigated in an occupational setting.

OBJECTIVE

To translate the Regret Coping Scale for Health-Care Professionals (RCS-HCP) and explore internal consistency, construct-, criterion- and predictive validity.

METHODS

The instrument was translated using forward- back method. The qualities were evaluated with a sample of 2758 social educators using exploratory and confirmatory factor analysis as well as Cronbach's alpha, Pearson correlation, and multivariable regression.

RESULTS

The translated instrument showed a trend similar to the original instrument. A 10-item version resulted from the research being reported. The reduced RCS-HCP showed improved fit (Full model, 15 items); CFI = 0.91, TLI = 0.89, RMSEA = 0.66, PClose = 0.000 and BIC = 1392 vs. (Reduced instrument, 10 items); CFI = 0.97, TLI = 0.96, RMSEA = 0.05, PClose = 0.499 and BIC 307. This instrument had acceptable internal consistency for short scales (Cronbach's alpha = 0.65, 0.69 and 0.84 respectively). The subscales correlated as expected with measures of health and occupational factors, coefficient ranging from 0.182 to 0.399. Also, the RCS-HCP predicted stress three month later ΔF[3,2747] = 15.1, p < 0.001, but with very small effect ΔR2 = 0.01, p≤0.001.

CONCLUSIONS

The 10-item Danish version of the RCS-HCP is a valid instrument for measuring coping with regret in health related work.