1
|
Thomas DC, Litherland EF, Masso S, Raymundo G, Keep M. Clinicians' Decision-Making Regarding Telehealth Services: Focus Group Study in Pediatric Allied Health. JMIR Form Res 2024; 8:e46300. [PMID: 38848121 PMCID: PMC11193077 DOI: 10.2196/46300] [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: 02/06/2023] [Revised: 01/16/2024] [Accepted: 02/26/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Many allied health services now provide both telehealth and in-person services following a rapid integration of telehealth as a response to the COVID-19 pandemic. However, little is known about how decisions are made about which clinical appointments to provide via telehealth versus in person. OBJECTIVE The aim of this study is to explore clinicians' decision-making when contemplating telehealth for their clients, including the factors they consider and how they weigh up these different factors, and the clinicians' perceptions of telehealth utility beyond COVID-19 lockdowns. METHODS We used reflexive thematic analysis with data collected from focus groups with 16 pediatric community-based allied health clinicians from the disciplines of speech-language pathology, occupational therapy, social work, psychology, and counseling. RESULTS The findings indicated that decision-making was complex with interactions across 4 broad categories: technology, clients and families, clinical services, and clinicians. Three themes described their perceptions of telehealth use beyond COVID-19 lockdowns: "flexible telehealth use," "telehealth can be superior to in-person therapy," and "fear that in-person services may be replaced." CONCLUSIONS The findings highlight the complexity of decision-making in a community-allied health setting and the challenges experienced by clinicians when reconciling empirical evidence with their own clinical experience.
Collapse
Affiliation(s)
- Donna Claire Thomas
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Eva Frances Litherland
- Integrated and Community Health, Western Sydney Local Health District, Blacktown, Australia
| | - Sarah Masso
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Gianina Raymundo
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Melanie Keep
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| |
Collapse
|
2
|
Delgado D, Meindl JN, Al-Nasser T, Ivy JW. When Cultural Awareness Reveals Conflicting Cultural Values: A Pragmatic Approach. Behav Anal Pract 2024; 17:13-25. [PMID: 38405277 PMCID: PMC10891033 DOI: 10.1007/s40617-023-00826-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 02/27/2024] Open
Abstract
Cultural awareness reminds ABA service providers of the importance of considering the cultural practices of others when programming for behavior change. Decisions about the appropriateness of services may be difficult, however, when the values of the client conflict with the values of the culture(s) to which the client belongs or with the cultural biases of the practitioner. To minimize such conflicts, we propose a decision-making model that integrates client-centered and culture-centered assessments of habilitative validity. Throughout the proposed evaluation process, the behavior analyst and the recipients of services collaborate to refine program goals that will increase access to reinforcers for the client and their cultural groups. Given that cultures arrange reinforcers and punishers for the individual, assessing habilitative and social validity for the cultural groups affected by services is emphasized as an essential component of the model. We illustrate how the proposed model could be used to suggest appropriate courses of action by analyzing a situation that may involve conflicts of values.
Collapse
Affiliation(s)
- Diana Delgado
- University of Memphis, Ball Hall, # 401A, 3798 Walker Ave, Memphis, TN 38111 USA
| | - James N. Meindl
- University of Memphis, Ball Hall, # 401A, 3798 Walker Ave, Memphis, TN 38111 USA
| | - Thouraya Al-Nasser
- University of Memphis, Ball Hall, # 401A, 3798 Walker Ave, Memphis, TN 38111 USA
| | | |
Collapse
|
3
|
Bussard ME, Jessee MA, El-Banna MM, Cantrell MA, Alrimawi I, Marchi NM, Gonzalez LI, Rischer K, Coy ML, Poledna M, Lavoie P. Current practices for assessing clinical judgment in nursing students and new graduates: A scoping review. NURSE EDUCATION TODAY 2024; 134:106078. [PMID: 38184981 DOI: 10.1016/j.nedt.2023.106078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To map current assessment practices for learning outcomes related to nurses' clinical judgment from undergraduate education to entry to practice. DESIGN Scoping review using the Joanna Briggs Institute guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). DATA SOURCES Electronic databases-Cumulative Index of Nursing and Allied Health Literature (CINAHL Complete; EBSCOhost), EMBASE (Ovid), MEDLINE (Ovid), PsycINFO (Ovid), and Web of Science (Social Sciences Citation Index, Citation Index Expanded)-using a combination of descriptors and keywords related to nursing students, newly graduated nurses, clinical judgment and related terms (e.g., critical thinking, clinical reasoning, clinical decision-making, and problem-solving), and assessment. METHODS Two reviewers independently extracted study characteristics and, for each outcome relevant to clinical judgment, the concept, definition and framework, assessment tool, and the number and schedule of assessments. Data were synthesized narratively and using descriptive statistics. RESULTS Most of the 52 reviewed studies examined the outcome of a discrete educational intervention (76.9 %) in academic settings (78.8 %). Only six studies (11.5 %) involved newly graduated nurses. Clinical judgment (34.6 %), critical thinking (26.9 %), and clinical reasoning (9.6 %) were the three most frequent concepts. Three assessment tools were used in more than one study: the Lasater Clinical Judgment Rubric (n = 22, 42.3 %), the California Critical Thinking Skills Test (n = 9, 17.3 %), and the Health Science Reasoning Test (n = 2, 3.8 %). Eleven studies (21.2 %) used assessment tools designed for the study. CONCLUSION In addition to a disparate understanding of underlying concepts, there are minimal published studies on the assessment of nursing students and nurses' clinical judgment, especially for longitudinal assessment from education to clinical practice. Although there is some existing research on this topic, further studies are necessary to establish valid and reliable clinical competency assessment methods that effectively integrate clinical judgment in clinical situations at relevant time points.
Collapse
Affiliation(s)
- Michelle E Bussard
- School of Nursing, Bowling Green State University, 924 Ridge St., Bowling Green, OH 43403, USA.
| | - Mary Ann Jessee
- School of Nursing, Vanderbilt University, 461 21(st) Avenue South, Nashville, TN 37240, USA.
| | - Majeda M El-Banna
- School of Nursing, George Washington University, 45085 University Drive, Innovation Hall, Ashburn, VA 20147, USA.
| | - Mary Ann Cantrell
- College of Nursing, Villanova University, 800 E. Lancaster Ave., Villanova, PA 19085, USA.
| | - Intima Alrimawi
- School of Nursing, Georgetown University, St. Mary's Hall, 3700 Reservoir Rd. NW, Washington, DC 20057, USA.
| | - Nadine M Marchi
- Inova Health System, 3300 Gallows Road, Falls Church, VA 22042-3300, USA.
| | - Lisa I Gonzalez
- College of Southern Maryland, 8730 Mitchell Rd, La Plata, MD 20646, USA.
| | - Keith Rischer
- KeithRN, 6417 Penn Ave S, Ste 8, iPMB 1383, Minneapolis, MN 55423, USA.
| | - Michelle L Coy
- Mayo Clinic College of Medicine and Science, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Mari Poledna
- Arizona State University, 411 North Central Ave, Phoeniz, AZ 85004, USA.
| | - Patrick Lavoie
- Faculty of Nursing, Université de Montréal, 2375 Chemin De la Côte-Sainte-Catherine, Montreal, Quebec H3C 3J7, Canada; Montreal Heart Institute Research Center, 5000 rue Bélanger, Montreal, Quebec H1T 1C8, Canada.
| |
Collapse
|
4
|
Alotaibi AA, Alotaibi KA, Almutairi AN, Alsaab A. Physicians' Perspectives on the Impact of Insurance Status on Clinical Decision-Making in Saudi Arabia. Cureus 2024; 16:e53756. [PMID: 38465027 PMCID: PMC10921445 DOI: 10.7759/cureus.53756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
Background The decision-making process in clinical practice depends heavily on collaboration and information sharing. Physicians' decision-making processes are profoundly influenced by the patient's insurance status, which warrants focused investigation. Hence, this study aimed to investigate how physicians perceive the influence of insurance status on treatment options and medical interventions and to explore the extent to which physicians discuss insurance-related considerations with patients during the shared decision-making process. Methodology This was a cross-sectional exploratory study conducted in various healthcare facilities all over Saudi Arabia. The electronic questionnaire was the primary tool for data collection. Data were then coded, entered, and analyzed using both descriptive and inferential statistical methods. Results The study involved 430 physicians, primarily male (n = 230, 53.5%), aged 31-40 years (n = 215, 50%), and mostly non-Saudi (n = 285, 66.3%). Medical officers constituted the majority of the study population (n = 258, 60%), with one to five years of experience (n = 187, 43.5%), and engaged in private practice (n = 230, 70%). Concerning insurance, 287 (66.7%) physicians considered patient's insurance when discussing treatment options, while 318 (74%) physicians discussed the financial implications of different treatment options with the patients. Regarding outcomes, 373 (86.7%) physicians believed that insurance status affected patient outcomes and treatment modalities. Significant factors, such as age between 31 and 40 years (P < 0.001), over 10 years of clinical experience (P = 0.002), engagement in both governmental and private practice (P = 0.012), and being a medical officer (P = 0.005), demonstrated a high impact on the insurance status influencing clinical decision-making. Overall, recognizing the influence of insurance on decision-making is crucial for equitable healthcare. Conclusions More than half of the physicians demonstrated high scores indicating the impact of insurance status on the clinical decision-making process. This impact was influenced by specific physician parameters such as age, experience, specialty, and type of practice. Moreover, the financial situation and insurance status of the patients significantly affected treatment and patient outcomes.
Collapse
Affiliation(s)
| | | | - Ahmad N Almutairi
- Family Medicine, Medical Services in Saudi Royal Land Forces, Riyadh, SAU
| | - Anas Alsaab
- Family Medicine, King Saud Medical City, Riyadh, SAU
| |
Collapse
|
5
|
Yakob N, Laliberté S, Doyon-Poulin P, Jouvet P, Noumeir R. Data Representation Structure to Support Clinical Decision-Making in the Pediatric Intensive Care Unit: Interview Study and Preliminary Decision Support Interface Design. JMIR Form Res 2024; 8:e49497. [PMID: 38300695 PMCID: PMC10870206 DOI: 10.2196/49497] [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: 05/31/2023] [Revised: 11/11/2023] [Accepted: 11/22/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Clinical decision-making is a complex cognitive process that relies on the interpretation of a large variety of data from different sources and involves the use of knowledge bases and scientific recommendations. The representation of clinical data plays a key role in the speed and efficiency of its interpretation. In addition, the increasing use of clinical decision support systems (CDSSs) provides assistance to clinicians in their practice, allowing them to improve patient outcomes. In the pediatric intensive care unit (PICU), clinicians must process high volumes of data and deal with ever-growing workloads. As they use multiple systems daily to assess patients' status and to adjust the health care plan, including electronic health records (EHR), clinical systems (eg, laboratory, imaging and pharmacy), and connected devices (eg, bedside monitors, mechanical ventilators, intravenous pumps, and syringes), clinicians rely mostly on their judgment and ability to trace relevant data for decision-making. In these circumstances, the lack of optimal data structure and adapted visual representation hinder clinician's cognitive processes and clinical decision-making skills. OBJECTIVE In this study, we designed a prototype to optimize the representation of clinical data collected from existing sources (eg, EHR, clinical systems, and devices) via a structure that supports the integration of a home-developed CDSS in the PICU. This study was based on analyzing end user needs and their clinical workflow. METHODS First, we observed clinical activities in a PICU to secure a better understanding of the workflow in terms of staff tasks and their use of EHR on a typical work shift. Second, we conducted interviews with 11 clinicians from different staff categories (eg, intensivists, fellows, nurses, and nurse practitioners) to compile their needs for decision support. Third, we structured the data to design a prototype that illustrates the proposed representation. We used a brain injury care scenario to validate the relevance of integrated data and the utility of main functionalities in a clinical context. Fourth, we held design meetings with 5 clinicians to present, revise, and adapt the prototype to meet their needs. RESULTS We created a structure with 3 levels of abstraction-unit level, patient level, and system level-to optimize clinical data representation and display for efficient patient assessment and to provide a flexible platform to host the internally developed CDSS. Subsequently, we designed a preliminary prototype based on this structure. CONCLUSIONS The data representation structure allows prioritizing patients via criticality indicators, assessing their conditions using a personalized dashboard, and monitoring their courses based on the evolution of clinical values. Further research is required to define and model the concepts of criticality, problem recognition, and evolution. Furthermore, feasibility tests will be conducted to ensure user satisfaction.
Collapse
Affiliation(s)
- Najia Yakob
- École de technologie supérieure, Montreal, QC, Canada
| | | | | | - Philippe Jouvet
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Montreal, QC, Canada
| | - Rita Noumeir
- École de technologie supérieure, Montreal, QC, Canada
| |
Collapse
|
6
|
Merchant A, Tharani Z, Iqbal S, Mansoor K, Cassum S. Integrated course assessments in an undergraduate nursing program. J Prof Nurs 2024; 50:43-46. [PMID: 38369370 DOI: 10.1016/j.profnurs.2023.10.010] [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: 11/24/2022] [Revised: 07/07/2023] [Accepted: 10/18/2023] [Indexed: 02/20/2024]
Abstract
Curriculum integration is a partnership amongst multidisciplinary members to create a cohesive curriculum and improve education. Basic and clinical science integration helps students learn deeply. Integrated curricula facilitate students to become lifelong learners. It encourages critical thinking and clinical reflection and helps students become active, self-directed learners. A comprehensive integrated exam was conducted at Aga Khan University, School of Nursing and midwifery to establish meaningful learning and enhance theoretical knowledge application in clinical practice, using competencies from four different courses in second year of study. Comprehensive Integrated Exam prepared students to assess a client and design complete nursing care based on health assessment, adult health nursing, pharmacology, and pathophysiology course concepts. This integrated exam was very effective as 97 % of students who took the exam passed on their first attempt. Faculty members involved found the comprehensive integrated exam a successful strategy to evaluate students learning, whereas the students related that this exam helped them to bridge the gap between applying theoretical concepts from different courses to clinical practice.
Collapse
Affiliation(s)
| | - Zahra Tharani
- Aga Khan University School of Nursing and Midwifery, Pakistan.
| | - Shagufta Iqbal
- Aga Khan University School of Nursing and Midwifery, Pakistan.
| | | | - Shanaz Cassum
- Aga Khan University School of Nursing and Midwifery, Pakistan; FHEA, UK; The Haile T. Debas Teachers' Academy, AKU, Pakistan.
| |
Collapse
|
7
|
Collins M, Probst H, Grafton K. Decision-making processes in image guided radiotherapy: A think aloud study. J Med Imaging Radiat Sci 2023; 54:707-718. [PMID: 37852920 DOI: 10.1016/j.jmir.2023.09.025] [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: 03/31/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION 3D Image Guided Radiotherapy (IGRT) using Cone Beam Computer Tomography (CBCT) has been implemented for a range of treatment sites across the UK in the last decade. A paucity of evidence exists to understand how radiation therapists (RTTs) make clinical decisions during image interpretation as part of the IGRT process. The aim of this study was to investigate the decision-making processes used by RTTs during image interpretation of IGRT. METHOD Case study methodology was adopted utilising a think aloud observational method with follow-up interviews. 12 RTTs were observed and interviewed across three UK radiotherapy centres. Participants were observed reviewing and making clinical decisions in a simulated environment using clinical scenarios developed in partnership with each centres' Clinical Imaging Lead. Protocol analysis was used to analyse the observational data and thematic analysis was used to analyse the interview data. RESULTS A range of approaches to decision-making was observed which varied in length from nine phrases to 57 (mean 24) per case. Six themes emerged from the data: Set Sequence, Site Specific Clinical Priorities, Initial Gross Review, Decision to treat, Compromise and experience. In addition, three cognitive decision-making processes were identified: Simple linear, Linear repeating and Intuitive decision-making process. The findings of the study align with general principles of expert performance, whereby experience in a specific scope of practice is more beneficial in developing expertise than overall experience. CONCLUSION This study has provided new and original insight in the decision-making processes of RTTs. The study has highlighted three process models to explain how RTTs make decisions during IGRT: Simple linear, Linear repeating and Intuitive decision-making process. Intuitive processes are widely accepted to be error prone and linked to bias. When using this process, some RTTs followed this with a confirmation phase. This second phase of the process should be encouraged when teaching IGRT. The results of the study support the concept of expert performance, where performance and expertise are only improved by exposing individuals to specific types of experiences. RTTs, managers and Higher Education Institutions are encouraged to review these models and implement them into IGRT training. It is clear from the evidence base that understanding how we make decisions, enables us to develop expertise and reduce errors during the decision-making process.
Collapse
Affiliation(s)
- Mark Collins
- College of Health Wellbeing & Life Sciences, Sheffield Hallam University, Sheffield S10 2BP, UK.
| | - Heidi Probst
- College of Health Wellbeing & Life Sciences, Sheffield Hallam University, Sheffield S10 2BP, UK
| | - Kate Grafton
- School of Health & Social Care, University of Lincoln, Lincoln LN6 7TS, UK
| |
Collapse
|
8
|
Uppor W, Klunklin A, Viseskul N, Skulphan S. A concept analysis of clinical judgment in undergraduate nursing students. Nurs Forum 2022; 57:932-937. [PMID: 35671387 DOI: 10.1111/nuf.12757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/28/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
AIM To offer a clear understanding of the definition, attributes, antecedents, and consequences of undergraduate nursing students' clinical judgment in the nursing education context. BACKGROUND Clinical judgment is a concept with broad uses among healthcare professionals. Its definitions and attributes vary across contexts. There is no established understanding of clinical judgment in nursing students. DESIGN This concept analysis was performed using the eight steps of Walker and Avant's framework. DATA SOURCES A literature search was conducted using search engines and included peer-reviewed articles related to clinical judgment in nursing students. RESULTS Clinical judgment in nursing students was defined as the cognitive process exhibited via a nursing action by observation, patient assessment, interpreting, and prioritizing data that lead to responding using the appropriate nursing practice with the patient. Reflection was used to evaluate nursing students' clinical judgment to revise nursing practice. Antecedents included nursing education curriculum, student's knowledge, previous clinical experience, critical thinking, and clinical reasoning. The consequences of clinical judgment were clinical judgment ability, safe nursing practice, nursing care quality, and patient safety. CONCLUSIONS This concept analysis gives clear insights into the definition, attributes, antecedents, and consequences of undergraduate nursing student's clinical judgment.
Collapse
Affiliation(s)
- Wassana Uppor
- Nursing Science Division, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| | - Areewan Klunklin
- Nursing Science Division, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
- School of Nursing, Panyapiwat Institute of Management, Nonthaburi, Thailand
| | - Nongkran Viseskul
- Nursing Science Division, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| | - Sombat Skulphan
- Nursing Science Division, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
9
|
Martin K, Bickle K, Lok J. Investigating the impact of cognitive bias in nursing documentation on decision-making and judgement. Int J Ment Health Nurs 2022; 31:897-907. [PMID: 35355387 DOI: 10.1111/inm.12997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 02/15/2022] [Accepted: 03/09/2022] [Indexed: 11/30/2022]
Abstract
The clinical documentation of patients' mental status, behaviour and functioning is a fundamental aspect of inpatient mental health care. It is an important source of information-sharing with the interprofessional team and used by other clinicians within the circle of care to guide their decision-making process. Given the body of evidence highlighting concerns about the quality of nursing documentation and the growing literature demonstrating the presence of bias in healthcare, it is critically important that we examine the impact of this bias in nursing practice. The primary objective of this study was to determine whether clinical decisions and judgements change when nurses read documentation that is either biased or neutral. Using a quantitative, observational study that used surveys to collect data, participants were exposed to two patient vignettes and six clinical notes associated with each patient (notes were written with either biased or neutral language) and asked to make clinical decisions and judgements. Results from 199 nurse participants from a tertiary mental health hospital revealed a notable relationship between the type of notes read (biased vs. neutral) and clinical practice, namely, participants reading biased notes were less likely to offer health teaching when administering pro re nata (PRN) medication for sleep. We also found differences in decision-making and judgements based on the type of note read depending on years of experience and type of education. The results indicate that biased language in nursing documentation can influence other clinicians' decisions and judgements about patients, thereby indicating a cascade of bias.
Collapse
Affiliation(s)
- Krystle Martin
- Ontario Shores Centre for Mental Health Services, Whitby, Ontario, Canada.,University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Korri Bickle
- Ontario Shores Centre for Mental Health Services, Whitby, Ontario, Canada
| | - Jessica Lok
- Ontario Shores Centre for Mental Health Services, Whitby, Ontario, Canada
| |
Collapse
|
10
|
Berg GV, Slettebø Å, Johnsen K, Findal Dahl A, Fossum M. Interviews with Community Healthcare Registered Nurses in Norway: Examination Practices and Clinical Evaluation Processes. Nurs Open 2021; 8:3291-3298. [PMID: 34478247 PMCID: PMC8510713 DOI: 10.1002/nop2.1045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 07/12/2021] [Accepted: 08/04/2021] [Indexed: 12/29/2022] Open
Abstract
Aim This study describes the examination practices and clinical evaluation processes that Registered Nurses in Norway perform in the community healthcare sector. Design A qualitative exploratory design. Methods Twenty interviews were conducted with Registered Nurses employed in the community healthcare sector in Norway. The data were analysed using a thematic analysis. Results We found four major themes: (1) evaluations are embedded in nurses’ daily work, (2) significance of a Registered Nurse's clinical competency, (3) different tasks require various roles and (4) access to resources and equipment. Registered Nurses possess several skills in a range of different examination techniques and clinical evaluation processes in the community healthcare sector. They perform complex assessments in their daily work and must rely on other healthcare professionals, facilities and equipment to provide high‐quality care. Ongoing education and training will enable Registered Nurses to complete accurate assessments in their community healthcare practice.
Collapse
Affiliation(s)
- Geir V Berg
- Division Gjøvik and Lillehammer, Faculty of Medicine and Health Sciences (MH), Department of Health Sciences in Gjøvik, NTNU/Innlandet Hospital Trust, Gjøvik, Norway
| | - Åshild Slettebø
- Centre for Caring Research - Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Kjersti Johnsen
- Centre for Caring Research - Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Aud Findal Dahl
- Centre for Caring Research - Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Mariann Fossum
- Centre for Caring Research - Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| |
Collapse
|
11
|
Setia G, Kedan I. Case Series of Bedside Renal Cell Carcinoma Detected by Point-of-Care Ultrasound in the Ambulatory Setting. J Prim Care Community Health 2021; 11:2150132720916279. [PMID: 32340587 PMCID: PMC7232876 DOI: 10.1177/2150132720916279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Kidney and renal pelvic cancer was the sixth most common
cancer in men and 10th most common in women in the United States in 2018. Renal
cell carcinoma (RCC), accounts for 86% of malignancies of the kidney. RCC
patients are often asymptomatic; up to 25-30% have metastases at diagnosis. Few
present with the triad of gross hematuria, flank pain, and abdominal mass. In
RCC patients, 36% had 2 symptoms of the triad, and 60% had gross hematuria as 1
symptom. Point-of-care ultrasound (POCUS) offers a way to identify clinically
meaningful anatomic abnormalities. This case series presents 3 patients in whom
routine POCUS examination performed in an outpatient cardiology clinic found
asymptomatic renal masses, resulting in surgical resection and cure of
early-stage RCCs. Case Presentation: Patient 1: 54-year-old female
with hypertension (HTN). Two solid masses were identified with POCUS in the
right kidney. Patient 2: 63-year-old male with coronary artery disease (CAD) and
HTN was seen at an 8-month follow-up visit. A 6-cm mass was identified in the
left kidney. Patient 3: 69-year-old male with CAD, HTN, and smoking history seen
at 5-month follow-up visit. A 3-cm mass in the right kidney was identified.
Conclusions: Incorporating POCUS into the routine physical
examination in the ambulatory care setting may improve rates of detection and
increase the pretest probability of identifying renal pathology with formal
imaging studies. With minimal clinician training, earlier and increased
detection of asymptomatic RCC may result in improved patient survival.
Collapse
Affiliation(s)
| | - Ilan Kedan
- Cedars Sinai Smidt Heart Institute, Los Angeles, CA, USA
| |
Collapse
|
12
|
Sharma V, Ali I, van der Veer S, Martin G, Ainsworth J, Augustine T. Adoption of clinical risk prediction tools is limited by a lack of integration with electronic health records. BMJ Health Care Inform 2021; 28:bmjhci-2020-100253. [PMID: 33608259 PMCID: PMC7898839 DOI: 10.1136/bmjhci-2020-100253] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/03/2021] [Indexed: 01/06/2023] Open
Affiliation(s)
- Videha Sharma
- Centre for Health Informatics, The University of Manchester, Manchester, UK .,Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Ibrahim Ali
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Glen Martin
- Centre for Health Informatics, The University of Manchester, Manchester, UK
| | - John Ainsworth
- Centre for Health Informatics, The University of Manchester, Manchester, UK
| | - Titus Augustine
- Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| |
Collapse
|
13
|
Adhikari SP, Shrestha N, Shakya R, Phuyal R, Gyawali M, Dev R. A structured workshop enhanced Physiotherapists' skills in clinical decision-making: A pre-post study. J Family Med Prim Care 2021; 9:5658-5664. [PMID: 33532410 PMCID: PMC7842476 DOI: 10.4103/jfmpc.jfmpc_1048_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/19/2020] [Accepted: 09/28/2020] [Indexed: 11/04/2022] Open
Abstract
Context Effective clinical decision-making skills enhance the quality of patient care. Clinical reasoning and decision-making are fundamental aspects of best physiotherapy clinical practice. Aims To evaluate the effectiveness of an evidence-based structured educational workshop in enhancing physiotherapists' clinical decision-making skills. Settings and Designs A pre-post design conducted in a medical college. Methods and Materials A workshop protocol was developed based on the existing evidence and clinical practice guidelines. The workshop was advertised on the social media page of Nepal Physiotherapy association. On the first come first serve method; physiotherapists were selected. Those who met eligibility criteria were recruited for one of two workshops. Discussion was made on clinical scenarios aimed at enhancing clinical decision-making skills. Data were collected before and after the workshop using a self-administered clinical decision-making skills assessment tool to evaluate effectiveness of the workshop. Paired and unpaired t-tests were used to analyze within and between groups respectively. Results Significant improvement in clinical decision-making skills was found for all individual items (P < 0.001 in all items, effect size: 0.6 - 0.9), total EP score (P < 0.001, effect size: 0.8) and total clinical decision-making score (P < 0.001, effect size: 0.9). A significant difference was found between Bachelor and Master level education (P < 0.05). Conclusions An evidence-based structured educational workshop enhanced physiotherapists' clinical decision-making skills. The findings of this study could be relevant to all health care professionals working in clinical practice. Larger studies with a control group are recommended to strengthen the findings of this study.
Collapse
Affiliation(s)
- Shambhu P Adhikari
- Department of Physiotherapy, School of Medical Sciences, Kathmandu University, Nepal
| | - Nistha Shrestha
- Department of Physiotherapy, School of Medical Sciences, Kathmandu University, Nepal
| | - Rishita Shakya
- Department of Physiotherapy, School of Medical Sciences, Kathmandu University, Nepal
| | - Rajani Phuyal
- Department of Physiotherapy, School of Medical Sciences, Kathmandu University, Nepal
| | - Manju Gyawali
- Department of Physiotherapy and Rehabilitation, Nepal Mediciti Hospital, Nepal
| | - Rubee Dev
- Sun Yat-sen University Global Health Institute, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
14
|
Zanin M, Aitya NA, Basilio J, Baumbach J, Benis A, Behera CK, Bucholc M, Castiglione F, Chouvarda I, Comte B, Dao TT, Ding X, Pujos-Guillot E, Filipovic N, Finn DP, Glass DH, Harel N, Iesmantas T, Ivanoska I, Joshi A, Boudjeltia KZ, Kaoui B, Kaur D, Maguire LP, McClean PL, McCombe N, de Miranda JL, Moisescu MA, Pappalardo F, Polster A, Prasad G, Rozman D, Sacala I, Sanchez-Bornot JM, Schmid JA, Sharp T, Solé-Casals J, Spiwok V, Spyrou GM, Stalidzans E, Stres B, Sustersic T, Symeonidis I, Tieri P, Todd S, Van Steen K, Veneva M, Wang DH, Wang H, Wang H, Watterson S, Wong-Lin K, Yang S, Zou X, Schmidt HH. An Early Stage Researcher's Primer on Systems Medicine Terminology. NETWORK AND SYSTEMS MEDICINE 2021; 4:2-50. [PMID: 33659919 PMCID: PMC7919422 DOI: 10.1089/nsm.2020.0003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Systems Medicine is a novel approach to medicine, that is, an interdisciplinary field that considers the human body as a system, composed of multiple parts and of complex relationships at multiple levels, and further integrated into an environment. Exploring Systems Medicine implies understanding and combining concepts coming from diametral different fields, including medicine, biology, statistics, modeling and simulation, and data science. Such heterogeneity leads to semantic issues, which may slow down implementation and fruitful interaction between these highly diverse fields. Methods: In this review, we collect and explain more than100 terms related to Systems Medicine. These include both modeling and data science terms and basic systems medicine terms, along with some synthetic definitions, examples of applications, and lists of relevant references. Results: This glossary aims at being a first aid kit for the Systems Medicine researcher facing an unfamiliar term, where he/she can get a first understanding of them, and, more importantly, examples and references for digging into the topic.
Collapse
Affiliation(s)
- Massimiliano Zanin
- Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Madrid, Spain
| | - Nadim A.A. Aitya
- Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Ulster, United Kingdom
| | - José Basilio
- Center for Physiology and Pharmacology, Institute of Vascular Biology and Thrombosis Research, Medical University of Vienna, Vienna, Austria
| | - Jan Baumbach
- TUM School of Life Sciences Weihenstephan, Technical University of Munich, Freising, Germany
| | - Arriel Benis
- Faculty of Technology Management, Holon Institute of Technology (HIT), Holon, Israel
| | - Chandan K. Behera
- Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Ulster, United Kingdom
| | - Magda Bucholc
- Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Ulster, United Kingdom
| | - Filippo Castiglione
- CNR National Research Council, IAC Institute for Applied Computing, Rome, Italy
| | - Ioanna Chouvarda
- Lab of Computing, Medical Informatics, and Biomedical Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Blandine Comte
- Université Clermont Auvergne, INRAE, UNH, Plateforme d'Exploration du Métabolisme, MetaboHUB Clermont, Clermont-Ferrand, France
| | - Tien-Tuan Dao
- Biomechanics and Bioengineering Laboratory (UMR CNRS 7338), Université de Technologie de Compiègne, Compiègne, France
- Labex MS2T “Control of Technological Systems-of-Systems,” CNRS and Université de Technologie de Compiègne, Compiègne, France
| | - Xuemei Ding
- Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Ulster, United Kingdom
| | - Estelle Pujos-Guillot
- Université Clermont Auvergne, INRAE, UNH, Plateforme d'Exploration du Métabolisme, MetaboHUB Clermont, Clermont-Ferrand, France
| | - Nenad Filipovic
- Faculty of Engineering, University of Kragujevac, Kragujevac, Serbia
- Bioengineering Research and Development Center (BioIRC), Kragujevac, Serbia
- Steinbeis Advanced Risk Technologies Institute doo Kragujevac, Kragujevac, Serbia
| | - David P. Finn
- Pharmacology and Therapeutics, School of Medicine, Galway Neuroscience Centre, National University of Ireland, Galway, Republic of Ireland
| | - David H. Glass
- School of Computing, Ulster University, Ulster, United Kingdom
| | - Nissim Harel
- Faculty of Sciences, Holon Institute of Technology (HIT), Holon, Israel
| | - Tomas Iesmantas
- Department of Mathematics and Natural Sciences, Kaunas University of Technology, Kaunas, Lithuania
| | - Ilinka Ivanoska
- Faculty of Computer Science and Engineering, Ss. Cyril and Methodius University, Skopje, Macedonia
| | - Alok Joshi
- Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Ulster, United Kingdom
| | - Karim Zouaoui Boudjeltia
- Laboratory of Experimental Medicine (ULB 222), Medicine Faculty, Université libre de Bruxelles, CHU de Charleroi, Charleroi, Belgium
| | - Badr Kaoui
- Biomechanics and Bioengineering Laboratory (UMR CNRS 7338), Université de Technologie de Compiègne, Compiègne, France
- Labex MS2T “Control of Technological Systems-of-Systems,” CNRS and Université de Technologie de Compiègne, Compiègne, France
| | - Daman Kaur
- Northern Ireland Centre for Stratified Medicine, Biomedical Sciences Research Institute, Ulster University, Ulster, United Kingdom
| | - Liam P. Maguire
- Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Ulster, United Kingdom
| | - Paula L. McClean
- Northern Ireland Centre for Stratified Medicine, Biomedical Sciences Research Institute, Ulster University, Ulster, United Kingdom
| | - Niamh McCombe
- Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Ulster, United Kingdom
| | - João Luís de Miranda
- Escola Superior de Tecnologia e Gestão, Instituto Politécnico de Portalegre, Portalegre, Portugal
- Centro de Recursos Naturais e Ambiente (CERENA), Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | | | | | - Annikka Polster
- Centre for Molecular Medicine Norway (NCMM), Forskningparken, Oslo, Norway
| | - Girijesh Prasad
- Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Ulster, United Kingdom
| | - Damjana Rozman
- Centre for Functional Genomics and Bio-Chips, Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ioan Sacala
- Faculty of Automatic Control and Computers, University Politehnica of Bucharest, Bucharest, Romania
| | - Jose M. Sanchez-Bornot
- Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Ulster, United Kingdom
| | - Johannes A. Schmid
- Center for Physiology and Pharmacology, Institute of Vascular Biology and Thrombosis Research, Medical University of Vienna, Vienna, Austria
| | - Trevor Sharp
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom
| | - Jordi Solé-Casals
- Data and Signal Processing Research Group, University of Vic–Central University of Catalonia, Vic, Spain
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- College of Artificial Intelligence, Nankai University, Tianjin, China
| | - Vojtěch Spiwok
- Department of Biochemistry and Microbiology, University of Chemistry and Technology, Prague, Czech Republic
| | - George M. Spyrou
- The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Egils Stalidzans
- Computational Systems Biology Group, Institute of Microbiology and Biotechnology, University of Latvia, Riga, Latvia
| | - Blaž Stres
- Department of Animal Science, Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Civil and Geodetic Engineering, University of Ljubljana, Ljubljana, Slovenia
- Department of Automation, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia
| | - Tijana Sustersic
- Faculty of Engineering, University of Kragujevac, Kragujevac, Serbia
- Bioengineering Research and Development Center (BioIRC), Kragujevac, Serbia
- Steinbeis Advanced Risk Technologies Institute doo Kragujevac, Kragujevac, Serbia
| | - Ioannis Symeonidis
- Center for Research and Technology Hellas, Hellenic Institute of Transport, Thessaloniki, Greece
| | - Paolo Tieri
- CNR National Research Council, IAC Institute for Applied Computing, Rome, Italy
| | - Stephen Todd
- Altnagelvin Area Hospital, Western Health and Social Care Trust, Altnagelvin, United Kingdom
| | - Kristel Van Steen
- BIO3-Systems Genetics, GIGA-R, University of Liege, Liege, Belgium
- BIO3-Systems Medicine, Department of Human Genetics, KU Leuven, Leuven, Belgium
| | | | - Da-Hui Wang
- State Key Laboratory of Cognitive Neuroscience and Learning, and School of Systems Science, Beijing Normal University, Beijing, China
| | - Haiying Wang
- School of Computing, Ulster University, Ulster, United Kingdom
| | - Hui Wang
- School of Computing, Ulster University, Ulster, United Kingdom
| | - Steven Watterson
- Northern Ireland Centre for Stratified Medicine, Ulster University, Londonderry, United Kingdom
| | - KongFatt Wong-Lin
- Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Ulster, United Kingdom
| | - Su Yang
- Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Ulster, United Kingdom
| | - Xin Zou
- Shanghai Centre for Systems Biomedicine, Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Jiao Tong University, Shanghai, China
| | - Harald H.H.W. Schmidt
- Faculty of Health, Medicine & Life Science, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
15
|
Tiase VL, Sward KA, Del Fiol G, Staes C, Weir C, Cummins MR. Patient-Generated Health Data in Pediatric Asthma: Exploratory Study of Providers' Information Needs. JMIR Pediatr Parent 2021; 4:e25413. [PMID: 33496674 PMCID: PMC8414476 DOI: 10.2196/25413] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Adolescents are using mobile health apps as a form of self-management to collect data on symptoms, medication adherence, and activity. Adding functionality to an electronic health record (EHR) to accommodate disease-specific patient-generated health data (PGHD) may support clinical care. However, little is known on how to incorporate PGHD in a way that informs care for patients. Pediatric asthma, a prevalent health issue in the United States with 6 million children diagnosed, serves as an exemplar condition to examine information needs related to PGHD. OBJECTIVE In this study we aimed to identify and prioritize asthma care tasks and decisions based on pediatric asthma guidelines and identify types of PGHD that might support the activities associated with the decisions. The purpose of this work is to provide guidance to mobile health app developers and EHR integration. METHODS We searched the literature for exemplar asthma mobile apps and examined the types of PGHD collected. We identified the information needs associated with each decision in accordance with consensus-based guidelines, assessed the suitability of PGHD to meet those needs, and validated our findings with expert asthma providers. RESULTS We mapped guideline-derived information needs to potential PGHD types and found PGHD that may be useful in meeting information needs. Information needs included types of symptoms, symptom triggers, medication adherence, and inhaler technique. Examples of suitable types of PGHD were Asthma Control Test calculations, exposures, and inhaler use. Providers suggested uncontrolled asthma as a place to focus PGHD efforts, indicating that they preferred to review PGHD at the time of the visit. CONCLUSIONS We identified a manageable list of information requirements derived from clinical guidelines that can be used to guide the design and integration of PGHD into EHRs to support pediatric asthma management and advance mobile health app development. Mobile health app developers should examine PGHD information needs to inform EHR integration efforts.
Collapse
Affiliation(s)
- Victoria L Tiase
- The Value Institute, New York-Presbyterian Hospital, New York, NY, United States.,College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Katherine A Sward
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Catherine Staes
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Mollie R Cummins
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| |
Collapse
|
16
|
Numata H, Noguchi-Watanabe M, Mukasa A, Tanaka S, Takayanagi S, Saito N, Yamamoto-Mitani N. Medical Care-Related Decisions among Patients Diagnosed with Early Stage Malignant Brain Tumor: A Qualitative Study. Glob Qual Nurs Res 2020; 7:2333393620960059. [PMID: 33110930 PMCID: PMC7560538 DOI: 10.1177/2333393620960059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 07/30/2020] [Accepted: 08/04/2020] [Indexed: 11/25/2022] Open
Abstract
Medical care-related decision-making among patients with malignant brain tumors has not been sufficiently discussed. This study aimed to develop a framework for understanding patients’ experiences in the decision-making process. Semi-structured interviews with 14 patients were analyzed using a grounded theory approach, focusing on their 48 decision-making points. Additionally, interviews with two family members and seven healthcare providers, and participant observations were used to gain contextual insight into patients’ experiences. Patients faced decisions while they struggled in vulnerability under shock, fear, and anxiety while hoping. Under this context, they showed four decision-making patterns: (1) led by the situation, (2) controlled by others, (3) entrusted someone with the decision, and (4) myself as a decision-making agent. Across these patterns, the patients were generally satisfied with their decisions even when they did not actively participate in the process. Healthcare providers need to understand patients’ contexts and their attitudes toward yielding decision-making to others.
Collapse
|
17
|
RE B, S R, JC B, W J, D S, AP M, M P, S P. Clinicians' views of treatment types for first episode psychosis delivered in a randomised controlled trial (MAPS). EClinicalMedicine 2020; 24:100421. [PMID: 32775968 PMCID: PMC7393656 DOI: 10.1016/j.eclinm.2020.100421] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Clinicians' treatment beliefs could affect the feasibility of delivering different treatments in a randomised controlled trial (RCT). In MAPS (Managing Adolescent first Episode Psychosis: a feasibility Study), adolescents with first episode psychosis (FEP) were randomly allocated to receive either antipsychotic medication (AP), psychological intervention (cognitive behavioural therapy [CBT] and family intervention [FI]), or both. We conducted a nested qualitative study to investigate clinicians' views of these treatments. METHODS Purposive sampling identified seventeen clinicians from CAMHS and Early Intervention services with prescribing responsibilities for 14-18 year olds at three participating MAPS sites. Individual participants were interviewed to examine their views of treatments in the MAPS trial. Interview transcripts were analysed using inductive Thematic Analysis. FINDINGS Clinicians viewed the decision to refer adolescents to the MAPS trial as requiring careful clinical judgement. Assessment complexity and diagnostic uncertainty had to be balanced against the urgency for treatment to reduce risk and distress. Underlying influences including duty of care and treatment beliefs underpinned decisions. Clinicians consistently valued AP as the primary treatment for FEP, with CBT and/or FI seen as helpful secondary treatment options. Nevertheless, the potential harms of prescribing AP, or not, to such a young population were highlighted as being of concern in treatment decision-making, and fostered reluctance to refer into a RCT. INTERPRETATION The design and delivery of RCTs involving young people experiencing FEP should consider the views of responsible clinicians, recognising that perceived treatment urgency, limitations in diagnostic precision, and existing treatment beliefs may influence trial processes. FUNDING NIHR HTA programme (project number 15/31/04).
Collapse
Affiliation(s)
- Byrne RE
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, Manchester, M25 3BL, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, M13 9PL, UK
| | - Reeve S
- Department of Clinical, Educational, and Health Psychology, University College London, WC1E 6BT
| | - Bird JC
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Jones W
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, Manchester, M25 3BL, UK
| | - Shiers D
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, Manchester, M25 3BL, UK
| | - Morrison AP
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, Manchester, M25 3BL, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, M13 9PL, UK
| | - Pyle M
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, Manchester, M25 3BL, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, M13 9PL, UK
| | - Peters S
- Division of Psychology and Mental Health, University of Manchester, Manchester, M13 9PL, UK
| |
Collapse
|
18
|
Farčić N, Barać I, Plužarić J, Ilakovac V, Pačarić S, Gvozdanović Z, Lovrić R. Personality traits of core self-evaluation as predictors on clinical decision-making in nursing profession. PLoS One 2020; 15:e0233435. [PMID: 32421752 PMCID: PMC7233533 DOI: 10.1371/journal.pone.0233435] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 05/05/2020] [Indexed: 11/21/2022] Open
Abstract
Core self-evaluation (CSE) is a theory that includes four personality dimensions: self-esteem, self-efficacy, locus of control and emotional stability. CSE proved to be a significant predictor of the research on cognitive, emotional and behavioral responses across various situations in the workplace. The aim of this study was to examine the relationship between personality traits of the core self-evaluation and clinical decision-making in nurses’ profession. A cross-sectional design was applied. Data was collected with standardized instruments: Core Self-Evaluation Scale and Clinical Decision-Making Nurses Scale, 584 nurses have participated in the study. Correlation and hierarchical regression analysis were used to test the relations and prediction of variables. The findings of the study revealed that there is a significant positive relationship between overall core self-evaluation and nurses’ clinical decision-making, and there is a significant contribution of self-esteem, self-efficacy and locus of control on all dimensions of clinical decision, especially in the area of canvassing of objectives and values. Nurses with high CSE have positive self-views and tend to be confident in their ability and they also feel in control while performing nursing interventions, whereas those with low CSE tend to have fewer accessible positive resources and are more prone to risk aversion.
Collapse
Affiliation(s)
- Nikolina Farčić
- Nursing Institute "Professor Radivoje Radić", Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- University Hospital Centre Osijek, Osijek, Croatia
- * E-mail: (NF); (VI)
| | - Ivana Barać
- Nursing Institute "Professor Radivoje Radić", Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Jadranka Plužarić
- Nursing Institute "Professor Radivoje Radić", Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Vesna Ilakovac
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- * E-mail: (NF); (VI)
| | - Stana Pačarić
- Nursing Institute "Professor Radivoje Radić", Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- University Hospital Centre Osijek, Osijek, Croatia
| | - Zvjezdana Gvozdanović
- Nursing Institute "Professor Radivoje Radić", Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- General County Hospital Našice, Našice, Croatia
| | - Robert Lovrić
- Nursing Institute "Professor Radivoje Radić", Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| |
Collapse
|
19
|
The Influence of Self-Concept on Clinical Decision-Making in Nurses and Nursing Students: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093059. [PMID: 32354029 PMCID: PMC7246852 DOI: 10.3390/ijerph17093059] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/23/2020] [Accepted: 04/26/2020] [Indexed: 11/24/2022]
Abstract
The aim of this study is to examine the influence of nurses’ self-concept (NSC) on clinical decision-making (CDM) among nursing students and hospital nurses. A further aim is to examine whether there is a difference in CDM and NSC between hospital nurses with various levels of experience and nursing students. A cross-sectional study was conducted during 2018 in the Faculty of Dental Medicine and Health and the University Hospital Center, in Osijek, Croatia, EU. The respondents consisted of 568 hospital nurses, and 129 BSc nursing students. Data were collected with the clinical decision-making in nursing scale (CDMNS) and the nurses’ self-concept questionnaire (NSCQ). There was no correlation between CDM and NSC in either students or hospital nurses. Hospital nurses generally had significantly higher scores in CDM than nursing students. On the other hand, students had a significantly higher total NSC level. The results of this study suggest that experience has a positive impact on nurses’ CDM skills. The high NSC estimated by students enables them to easily take up their clinical roles and approach the patient in a holistic manner, which is an attitude that gradually develops during studies and with clinical experience.
Collapse
|
20
|
Gao G, Kerr MJ, Lindquist RA, Chi CL, Mathiason MA, Monsen KA. Discovering Associations Among Older Adults' Characteristics and Planned Nursing Interventions Using Electronic Health Record Data. Res Theory Nurs Pract 2020; 33:58-80. [PMID: 30796148 DOI: 10.1891/1541-6577.33.1.58] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Little is known about how nursing assessments of strengths and signs/symptoms inform intervention planning in assisted living communities. The purpose of this study was to discover associations among older adults' characteristics and their planned nursing interventions. METHODS This study employed a data-driven method, latent class analysis, using existing electronic health record data from a senior living community in the Midwest. A convenience sample comprised de-identified data of well-being assessments and care plans for 243 residents. Latent class analysis, descriptive, and inferential statistics were used to group the sample, summarize strengths and problems attributes, nursing interventions, and Knowledge, Behavior, and Status scores, and detect differences. RESULTS Three groups presented based on patterns of strengths and signs/symptoms combined with problem concepts: Living Well (n = 95) had more strengths and fewer signs/symptoms; Lower Strengths (n = 99) had fewer strengths and more signs/symptoms; and Resilient Survivors (n = 49) had more strengths and more signs/symptoms. Some associations were found among group characteristics and planned interventions. Living Well had the lowest average number of planned interventions per resident (Mean = 2.7; standard deviation [SD] = 1.7) followed by Lower Strengths (Mean = 3.8; SD = 2.6) and Resilient Survivors (Mean = 4.1; SD = 3.4). IMPLICATIONS FOR PRACTICE This study offers new knowledge in the use of a strengths-based ontology to facilitate a nursing discourse that leverages use of older adults' strengths to address their problems and support their living a healthier life. It also offers the potential to complement the problem-based infrastructure in clinical practice and documentation.
Collapse
Affiliation(s)
- Grace Gao
- School of Nursing, University of Minnesota, Minneapolis
| | | | | | - Chih-Lin Chi
- School of Nursing, University of Minnesota, Minneapolis
| | | | | |
Collapse
|
21
|
Graversen DS, Huibers L, Christensen MB, Bro F, Collatz Christensen H, Vestergaard CH, Pedersen AF. Communication quality in telephone triage conducted by general practitioners, nurses or physicians: a quasi-experimental study using the AQTT to assess audio-recorded telephone calls to out-of-hours primary care in Denmark. BMJ Open 2020; 10:e033528. [PMID: 32220912 PMCID: PMC7170599 DOI: 10.1136/bmjopen-2019-033528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To compare the quality of communication in out-of-hours (OOH) telephone triage conducted by general practitioners (GPs), nurses using a computerised decision support system and physicians with different medical specialities, and to explore the association between communication quality and efficiency, length of call and the accuracy of telephone triage. DESIGN Natural quasi-experimental cross-sectional study. SETTING Two Danish OOH services using different telephone triage models: a GP cooperative and the medical helpline 1813. PARTICIPANTS 1294 audio-recorded randomly selected OOH telephone triage calls from 2016 conducted by GPs (n=423), nurses using CDSS (n=430) and physicians with different medical specialities (n=441). MAIN OUTCOME MEASURES Twenty-four physicians assessed the calls. The panel used a validated assessment tool (Assessment of Quality in Telephone Triage, AQTT) to measure nine aspects of communication, overall perceived communication quality, efficiency and length of call. RESULTS The risk of poor quality was significantly higher in calls triaged by GPs compared with calls triaged by nurses regarding 'allowing the caller to describe the situation' (GP: 13.5% nurse: 9.8%), 'mastering questioning techniques' (GP: 27.4% nurse: 21.1%), 'summarising' (GP: 33.0% nurse: 21.0%) and 'paying attention to caller's experience' (GP: 25.7% nurse: 17.0%). The risk of poor quality was significantly higher in calls triaged by physicians compared with calls triaged by GPs in five out of nine items. GP calls were significantly shorter (2 min 57 s) than nurse calls (4 min 44 s) and physician calls (4 min 1 s). Undertriaged calls were rated lower than optimally triaged calls for overall quality of communication (p<0.001) and all specific items. CONCLUSIONS Compared with telephone triage by GPs, the communication quality was higher in calls triaged by nurses and lower in calls triaged by physicians with different medical specialities. However, calls triaged by nurses and physicians were longer and perceived less efficient. Quality of communication was associated with accurate triage.
Collapse
Affiliation(s)
- Dennis Schou Graversen
- Research Unit for General Practice, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Morten Bondo Christensen
- Research Unit for General Practice, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Flemming Bro
- Research Unit for General Practice, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Helle Collatz Christensen
- Emergency Medical Services, Copenhagen, Copenhagen, Denmark
- Danish Clinical Quality Program (RKKP), Copenhagen, Denmark
| | | | - Anette Fischer Pedersen
- Research Unit for General Practice, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
22
|
McDonnell L, Lavoie JG, Healy G, Wong S, Goulet S, Clark W. Non-clinical determinants of Medevacs in Nunavut: perspectives from northern health service providers and decision-makers. Int J Circumpolar Health 2019; 78:1571384. [PMID: 30724715 PMCID: PMC6366434 DOI: 10.1080/22423982.2019.1571384] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/30/2018] [Accepted: 01/10/2019] [Indexed: 11/04/2022] Open
Abstract
A medevac involves the transport of a critically ill patient, usually by plane or helicopter, to access necessary and at times life-saving care, most often only accessible in urban centres. Medevacs are commonly used in resource-limited and geographically isolated areas in Canada. The objective of this study was to explore the determinants of medevac decision-making from the perspective of frontline care providers and decision-makers in Nunavut. For this purpose, we conducted a secondary analysis of 90 in-depth interviews. Findings indicate that medevacs can be the result of a number of intersecting factors, including the referring and receiving provider's experience, insufficient staffing in health centres, lack of access to diagnostic or treatment-related, and challenges related to recruitment and retention. An expanded scope of practice for frontline care providers, and a related lack of training and/or confidence in skills, only add to these challenges. Medevacs play an important role related to managing shifting community nursing workloads, which expands and contracts in response to local needs. Attention to structural issues, putting in place virtual peer support systems, resolving vacancies left by the lag between attrition and recruitment, increasing access to training, and local diagnostic and treatment equipment, might decrease reliance of medevacs.
Collapse
Affiliation(s)
- Leah McDonnell
- a Ongomiizwin Research , University of Manitoba , Winnipeg , Canada
| | - Josée G Lavoie
- a Ongomiizwin Research , University of Manitoba , Winnipeg , Canada
- b Department of Community Health Sciences, Rady Faculty of Health Sciences , University of Manitoba , Winnipeg , Canada
| | - Gwen Healy
- c Qaujigiartiit Health Research Centre , Iqaluit , Canada
| | - Sabrina Wong
- d School of Nursing , University of British Columbia , Vancouver , Canada
| | - Sara Goulet
- b Department of Community Health Sciences, Rady Faculty of Health Sciences , University of Manitoba , Winnipeg , Canada
- e Ongomiizwin Health Services , University of Manitoba , Canada
| | - Wayne Clark
- a Ongomiizwin Research , University of Manitoba , Winnipeg , Canada
| |
Collapse
|
23
|
Oliveira Pitta Lopes R, Caniçali Primo C, Santos de Andrade Martins J, Faria Campos J, Souza Barbosa G, de Abreu Pinto Peixoto M, Antônio Gomes Brandão M. T-NDX Diagram: Educational Technology Used to Teach Diagnostic Reasoning Based on Nursing Theories. Int J Nurs Knowl 2019; 31:94-100. [PMID: 31343122 DOI: 10.1111/2047-3095.12255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To describe an educational technology to be applied to the teaching and learning of diagnostic judgment based on nursing theories. METHODS A methodological study with 10 stages for the development of educational technology. FINDINGS An innovative educational technology is proposed to incorporate theoretical and methodological domains in a V-shaped diagram for the diagnosis judgment. CONCLUSIONS The technology is innovative in integrating theory and method in a more comprehensive and original way, considering the philosophies and world views of students throughout the reasoning process. IMPLICATIONS FOR NURSING PRACTICE T-NDx Diagram may be useful in enhancing the integration of philosophical and theoretical knowledge and diagnostic judgment, especially for nursing undergraduate students.
Collapse
Affiliation(s)
- Rafael Oliveira Pitta Lopes
- Rafael Oliveira Pitta Lopes, RN, MSN, is a PhD student at Anna Nery School of Nursing, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil, and Assistant Professor at Nursing and Midwifery Graduate Course, Federal University of Rio de Janeiro, Macaé, Brazil
| | - Cândida Caniçali Primo
- Cândida Caniçali Primo, RN, MSN, PhD, is Adjunct Professor at Nursing Department, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Jaqueline Santos de Andrade Martins
- Jaqueline Santos de Andrade Martins, RN, MSN, PhD, is Adjunct Professor at Associação Brasileira de Ensino Universitário, Belford Roxo, Rio de Janeiro, Brazil
| | - Juliana Faria Campos
- Juliana Faria Campos, RN, MSN, PhD, is Adjunct Professor at Anna Nery School of Nursing, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Genesis Souza Barbosa
- Genesis Souza Barbosa, RN, MSN, is Assistant Professor at Nursing and Midwifery Graduate Course, Federal University of Rio de Janeiro, Macaé, Brazil
| | - Mauricio de Abreu Pinto Peixoto
- Mauricio de Abreu Pinto Peixoto, MD, PhD, is Associate Professor at Nucleus of Educational Technology for Health, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcos Antônio Gomes Brandão
- Marcos Antônio Gomes Brandão, RN, MSN, PhD, is Associate Professor at Anna Nery School of Nursing, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
24
|
Tower M, Watson B, Bourke A, Tyers E, Tin A. Situation awareness and the decision-making processes of final-year nursing students. J Clin Nurs 2019; 28:3923-3934. [PMID: 31260577 DOI: 10.1111/jocn.14988] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 03/31/2019] [Accepted: 05/03/2019] [Indexed: 12/26/2022]
Abstract
AIMS AND OBJECTIVES To investigate final-year nursing students' use of situation awareness when making clinical decisions about patients' progress postsurgery. BACKGROUND Making clinical decisions about patient care is a generic nursing competence, developed in preregistration nursing programmes and critical to providing safe patient care. Situation awareness is an important precursor to making decisions and is linked to improved clinical outcomes. However, there is evidence to suggest that nursing students feel inadequately prepared to make clinical decisions. DESIGN Endsley's (Situation awareness analysis and measurement. Hillsdale, NJ: Lawrence Erlbaum Associates, 2000) 3-level situation awareness framework was used to guide the study. Level 1 situation awareness is perception of information required to make a decision. Level 2 relates to comprehending the information. Level 3 situation awareness is projecting how this information will inform the future. Twelve final-year nursing students were recruited to participate. Think-aloud research method was used to capture students' decision-making, followed by semi-structured interviews. Data were analysed using an adapted protocol analysis and were encoded inductively. The COREQ checklist has been used in reporting the study. RESULTS Students demonstrated level 1, 2 and 3 situation awareness when making clinical decisions. However, it was not demonstrated consistently and at times subsequent decision-making was inappropriate. Three themes emerged: "systems approach to assessment of postoperative patients"; "policy drives practice"; and "deferring decisions to registered nurses". Within the themes, students demonstrated differing levels of situation awareness. CONCLUSION Making safe clinical decisions is a paramount skill for nurses; however, student nurses are ill-equipped to undertake this skill. Situation awareness is important in informing safe decision-making, but students' use of situation awareness is variable. Cognitive apprenticeship, applied to supporting development of situation awareness, affords the opportunity to develop students' decision-making. RELEVANCE TO CLINICAL PRACTICE Clinical decision-making is a generic competence for all registered nurses and imperative for safe practice. However, student nurses are unprepared to undertake this skill once registered.
Collapse
Affiliation(s)
- Marion Tower
- School of Nursing, Midwifery & Social Work, University of Queensland, Brisbane, Queensland, Australia
| | - Bernadette Watson
- School of Nursing, Midwifery & Social Work, University of Queensland, Brisbane, Queensland, Australia
| | - Alison Bourke
- School of Nursing, Midwifery & Social Work, University of Queensland, Brisbane, Queensland, Australia
| | - Emma Tyers
- School of Nursing, Midwifery & Social Work, University of Queensland, Brisbane, Queensland, Australia
| | - Anne Tin
- School of Nursing, Midwifery & Social Work, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
25
|
Coutts KA. Community service speech language therapists practising in adult dysphagia: Is the healthcare system failing them? SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2019; 66:e1-e5. [PMID: 31368317 PMCID: PMC6676965 DOI: 10.4102/sajcd.v66i1.615] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/18/2019] [Accepted: 05/20/2019] [Indexed: 11/29/2022] Open
Abstract
Performing community service is a necessity prior to practising speech language therapy in South Africa. This system allows for improved access to these specialised services in the more rural areas. The current challenges of practising in complex settings with little access to mentorship can result in these community service therapists feeling underprepared to assess and manage patients presenting with adult dysphagia (swallowing disorders). This paper explores this topic through the theoretical lens of decision-making, from both clinical and academic perspectives. It aims to pose potential solutions on how to better transform the current practices to be contextually responsive to these challenges.
Collapse
Affiliation(s)
- Kim A Coutts
- Department of Speech Pathology, University of the Witwatersrand, Johannesburg.
| |
Collapse
|
26
|
Vatnøy TK, Karlsen TI, Dale B. Exploring nursing competence to care for older patients in municipal in-patient acute care: A qualitative study. J Clin Nurs 2019; 28:3339-3352. [PMID: 31090955 DOI: 10.1111/jocn.14914] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 02/20/2019] [Accepted: 05/03/2019] [Indexed: 11/28/2022]
Abstract
AIM To identify critical aspects of nursing competence to care for older patients in the context of municipal in-patient acute care. BACKGROUND An increasingly complex and advanced primary healthcare system requires attention to the extent of nursing competence in municipal services. However, competence in complex and advanced care settings must be explored using perspectives which acknowledge the complexity of nurses' performance. DESIGN A phenomenological hermeneutic, qualitative approach with individual in-depth interviews was used. COREQ reporting guidelines have been applied. METHODS A sample of eight nurses and two physicians employed in municipal in-patient acute care units (MAUs) were purposively recruited to participate. Data were collected between May and June of 2017. Analysis and interpretation were conducted systematically in three steps: naïve reading, structural analysis and comprehensive understanding. FINDINGS Two main themes were revealed. The first was the following: "The meaning of the individual nursing competence" including the themes "Having competence in clinical assessments, decision-making, and performing interventions"; "Having competence to collaborate, coordinate and facilitate"; and "Being committed." The second was the following: "The meaning of environmental and systemic factors for nursing competence," included the themes "Having professional leadership"; "Having a sufficiently qualified staff"; and "Working in an open, cooperative and professional work environment." CONCLUSION Individual nursing competence in MAUs should include the capability to detect patient deterioration and to care for older patients in a holistic perspective. In addition, the professional environmental culture, supportive leadership and systemic factors seemed to be crucial to success. RELEVANCE TO CLINICAL PRACTICE This study illustrates the nurses' responsibility for older patients' safety and quality of care in the MAUs. These findings can act as a foundation for the development and adaptation of educational programmes to accommodate requirements for nursing competence in MAUs. The broad perspective of nursing competence can give directions for quality improvements in MAUs.
Collapse
Affiliation(s)
- Torunn Kitty Vatnøy
- Centre for Caring Research, Southern Norway and Department of Health and Nursing Science, University of Agder, Grimstad, Norway
| | - Tor-Ivar Karlsen
- Department of Health and Nursing Science, University of Agder, Grimstad, Norway
| | - Bjørg Dale
- Centre for Caring Research, Southern Norway and Department of Health and Nursing Science, University of Agder, Grimstad, Norway
| |
Collapse
|
27
|
Hlaing PH, Sullivan PE, Chaiyawat P. Application of PRECEDE-PROCEED Planning Model in Transforming the Clinical Decision Making Behavior of Physical Therapists in Myanmar. Front Public Health 2019; 7:114. [PMID: 31134176 PMCID: PMC6517479 DOI: 10.3389/fpubh.2019.00114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 04/23/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Physical therapists in Myanmar use a prescriptive model of Clinical Decision Making (CDM). Improving CDM effectiveness is one essential factor in professionalizing practice and enhancing patient outcomes. This study assesses the changes in CDM skills and behaviors using the PRECEDE-PROCEED planning Model (PPM). Methods: In the PRECEDE planning phases, we investigated the current clinical decision making knowledge, and process, clinical practice culture, and contributing factors of CDM among Myanmar physical therapists. A qualitative approach consisted of 18 in-depth interviews and one focus group discussion was used. In the PROCEED evaluation and implementation phases, we developed and presented the CDM educational book at CDM workshop, which was a 4-day intensive program in Yangon, Myanmar with 34 participants. The participant's CDM knowledge and processes were assessed before and after the educational program to explore the potential impact on implementing CDM which can ultimately improve patient care in the health settings of Myanmar. Results: In the PRECEDE phases, we explored the predisposing and reinforcing factors of Myanmar physical therapists' CDM. We found that CDM models and deliberative decision making process that is used internationally were not followed by Myanmar physical therapists who followed the physician's prescriptions. Teaching and learning emphasize a stimulus-response-repeat-outcome cycle without internal processing or application to clinical situations. Using the PROCEED model components, we developed a 14 chapters CDM workbook and a 4-day workshop as a behavioral change intervention. Participants' prior technical CDM behavior was transformed into professional CDM behavior that included an understanding of clinical practice models and improvement in the cognitive process of CDM processes. The workbook coupled with the intensive active-learning, hands-on workshop of examination and intervention procedures were effective in improving CDM. Discussion: The application of PPM provided a through understandings of current CDM process of Myanmar therapists and aided in the development of the tailored CDM educational program to improve participants' CDM. Using the PPM model for developing a set of Physical Therapy educational content and curriculum was new. The application of PPM was beneficial to use accepted clinical practice models, standardized tests and measures, set goals and clinical outcomes, reassessed to determine change and implement evidence-based practice.
Collapse
Affiliation(s)
- Phyu Hnin Hlaing
- Faculty of Physical Therapy, Mahidol University, Bangkok, Thailand
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | | |
Collapse
|
28
|
Campbell K, Massey D, Broadbent M, Clarke KA. Factors influencing clinical decision making used by mental health nurses to provide provisional diagnosis: A scoping review. Int J Ment Health Nurs 2019; 28:407-424. [PMID: 30394000 DOI: 10.1111/inm.12553] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2018] [Indexed: 01/16/2023]
Abstract
Medical diagnosis has traditionally been the role of medical officers. However, mental health nurses working in crisis/emergency settings within Australia are expected to provide a provisional diagnosis postassessment of a consumer. There is limited literature and understanding how mental health nurses develop a provisional diagnosis. In this scoping review, we aimed to first identify and describe the clinical decision-making processes used by mental health nurses across a variety of clinical settings. Second, we sought to explore the factors influencing mental health nurse's diagnostic practice in a variety of settings. Literature was searched using CINAHL (EBSCOhost), PubMed, and ProQuest. Peer-reviewed literature published between 2007 and 2017 was used for this scoping review. Two major themes were identified: clinical decision making (CDM) in mental health nursing and diagnostic practice in nursing. A combination of clinician, environmental, and patient factors were found to have influenced CDM. Furthermore, mental health nurses rely heavily on tacit knowledge when making clinical decisions. Little is known about the use of diagnostic practice in mental health nursing in Australia; however, the limited literature revealed an overlap between the factors which influence CDM and diagnostic practice, respectively. Further research is needed into the use of diagnostic practice in mental health nursing to develop frameworks to assist with CDM pertaining to application of provisional diagnosis by mental health nurses working in assessment environments.
Collapse
Affiliation(s)
- Katrina Campbell
- School of Nursing, Midwifery and Paramedicine, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, Queensland, Australia.,School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Virginia, Queensland, Australia
| | - Deb Massey
- School of Nursing, Midwifery and Paramedicine, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Marc Broadbent
- School of Nursing, Midwifery and Paramedicine, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Karen-Ann Clarke
- School of Nursing, Midwifery and Paramedicine, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| |
Collapse
|
29
|
Graversen DS, Pedersen AF, Carlsen AH, Bro F, Huibers L, Christensen MB. Quality of out-of-hours telephone triage by general practitioners and nurses: development and testing of the AQTT - an assessment tool measuring communication, patient safety and efficiency. Scand J Prim Health Care 2019; 37:18-29. [PMID: 30689490 PMCID: PMC6454404 DOI: 10.1080/02813432.2019.1568712] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To develop a valid and reliable assessment tool able to measure quality of communication, patient safety and efficiency in out-of-hours (OOH) telephone triage conducted by both general practitioners (GP) and nurses. DESIGN The Dutch KERNset tool was translated into Danish and supplemented with items from other existing tools. Face validity, content validity and applicability in OOH telephone triage (OOH-TT) were secured through a two-round Delphi process involving relevant stakeholders. Forty-eight OOH patient contacts were assessed by 24 assessors in test-retest and inter-rater designs. SETTING OOH-TT services in Denmark conducted by GPs, nurses or doctors with varying medical specialisation. PATIENTS Audio-recorded OOH patient contacts. MAIN OUTCOME MEASURES Test-retest and inter-rater reliability were analysed using ICCagreement, Fleiss' kappa and percent agreement. RESULTS Major adaptations during the Delphi process were made. The 24-item assessment tool (Assessment of Quality in Telephone Triage - AQTT) measured communicative quality, health-related quality and four overall quality aspects. The test-retest ICCagreement reliability was good for the overall quality of communication (0.85), health-related quality (0.83), patient safety (0.81) and efficiency (0.77) and satisfactory when assessing specific aspects. Inter-rater reliability revealed reduced reliability in ICCagreement and in Fleiss' kappa. Percent agreement revealed satisfactory agreements when differentiating between 'poor' and 'sufficient' quality). CONCLUSION The AQTT demonstrated high face, content and construct validity, satisfactory test-retest reliability, reduced inter-rater reliability, but satisfactory percent agreement when differentiating between 'poor' and 'sufficient' quality. The AQTT was found feasible and clinically relevant for assessing the quality of GP- and nurse-led OOH-TT. KEYPOINTS Comparative knowledge is sparse regarding quality of out-of-hours telephone triage conducted by general practitioners and nurses. The assessment tool (AQTT) enables assessment of quality in OOH telephone triage conducted by nurses and general practitioners AQTT is feasible and clinically relevant for assessment of communication, patient safety and efficiency. AQTT can be used to identify areas for improvement in telephone triage.
Collapse
Affiliation(s)
- D. S. Graversen
- Research Unit for General Practice, Aarhus, Denmark & Department of Public Health, Aarhus University, Aarhus C, Denmark
- CONTACT Dennis Schou Graversen Research Unit for General Practice, Aarhus, Denmark & Department of Public Health, Aarhus University, Bartholins Allé 2, 8000Aarhus C, Denmark
| | - A. F. Pedersen
- Research Unit for General Practice, Aarhus, Denmark & Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - A. H. Carlsen
- Research Unit for General Practice, Aarhus, Denmark & Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - F. Bro
- Research Unit for General Practice, Aarhus, Denmark & Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - L. Huibers
- Research Unit for General Practice, Aarhus, Denmark & Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - M. B. Christensen
- Research Unit for General Practice, Aarhus, Denmark & Department of Public Health, Aarhus University, Aarhus C, Denmark
| |
Collapse
|
30
|
Sandal S, Charlebois K, Fiore JF, Wright DK, Fortin MC, Feldman LS, Alam A, Weber C. Health Professional-Identified Barriers to Living Donor Kidney Transplantation: A Qualitative Study. Can J Kidney Health Dis 2019; 6:2054358119828389. [PMID: 30792874 PMCID: PMC6376531 DOI: 10.1177/2054358119828389] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/18/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Living donor kidney transplantation (LDKT) has several advantages over deceased donor kidney transplantation. Yet rates of living donation are declining in Canada and there exists significant interprovincial variability. Efforts to improve living donation tend to focus on the patient and barriers identified at their level, such as not knowing how to ask for a kidney or lack of education. These efforts favor those who have the means and the support to find living donors. Thus, a Canadian Institutes of Health Research (CIHR)-organized workshop recommended that education efforts to understand and remove barriers should focus on health professionals (HPs). Despite this, little attention has been paid to what they identify as barriers to discussing LDKT with their patients. OBJECTIVE Our aim was to explore HP-identified barriers to discuss living donation with patients in 3 provinces of Canada with low (Quebec), moderate (Ontario), and high (British Columbia) rates of LDKT. DESIGN This study consists of an interpretive descriptive approach as it enables to move beyond description and inform clinical practice. SETTING Purposive criterion and quota sampling were used to recruit HPs from Quebec, Ontario, and British Columbia who are involved in the care of patients with kidney disease and/or with transplant coordination. PATIENTS Not applicable. MEASUREMENTS Semistructured interviews were conducted. The interview guide was developed based on a preliminary analytical framework and a review of the literature. METHODS Thematic analysis was used to analyze the data stemming from the interviews. The coding process comprised of a deductive and inductive approach, and the use of a qualitative analysis software (NVivo 11). Following this, themes were identified and developed. Interviews were conducted until thematic saturation was obtained. In total, we conducted 16 telephone interviews as thematic saturation was attained. RESULTS Six predominant themes emerged: (1) lack of communication between transplant and dialysis teams, (2) absence of referral guidelines, (3) role perception and lack of multidisciplinary involvement, (4) HP's lack of information and training, (5) negative attitudes of some HP toward LDKT, (6) patient-level barriers as defined by the HP. HPs did mention patients' attitudes and some characteristics as the main barriers to discussions about living donation; this was noted in all provinces. HPs from Ontario and British Columbia indicated multiple strategies being implemented to address some of these barriers. Those from Ontario mentioned strategies that center on the core principles of provincial-level standardization, while those from British Columbia center on engaging the entire multidisciplinary team and improved role perception. We noted a dearth of such efforts in Quebec; however, efforts around education and promotion, while tentative, have emerged. LIMITATIONS Social desirability and selection bias. Our analysis might not be applicable to other provinces. CONCLUSIONS HPs involved with the referral and coordination of transplantation play a major role in access to LDKT. We have identified challenges they face when discussing living donation with their patients that warrant further assessment and research to inform policy change.
Collapse
Affiliation(s)
- Shaifali Sandal
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | | | - Julio F. Fiore
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - David Kenneth Wright
- St. Mary’s Research Center, Montreal, QC, Canada
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Marie-Chantal Fortin
- Division of Nephrology, Department of Medicine, Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Liane S. Feldman
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Ahsan Alam
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Catherine Weber
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| |
Collapse
|
31
|
Roberts R, Neasham A, Lambrinudi C, Khan A. A thematic analysis assessing clinical decision-making in antipsychotic prescribing for schizophrenia. BMC Psychiatry 2018; 18:290. [PMID: 30200923 PMCID: PMC6131851 DOI: 10.1186/s12888-018-1872-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/30/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In recent decades atypical antipsychotics have increased treatment options available for schizophrenia, however there is conflicting evidence concerning the trade-off between clinical efficacy and side effects for the different classes of antipsychotics. There has been a consistent increase in atypical antipsychotic prescribing compared to typical, despite evidence showing that neither class is superior. This leads to the question of whether prescribers are selective in their uptake of research evidence and clinical guidelines and if so, what influences their choice.. This study aims to identify the factors that contribute to the prescribing choice and how these can be used to aid knowledge translation and guideline implementation. METHODS A thematic analysis study was conducted using data from 11 semi-structured interviews with clinicians with experience in prescribing for schizophrenia. RESULTS The analysis identified five themes underpinning prescribing behaviour: (1) ownership and collaboration; (2) compromise; (3) patient involvement; (4) integrating research evidence; and (5) experience. CONCLUSION The themes mapped to various degrees onto current models of evidence-based decision making and suggest that there is scope to re-think the guideline implementation frameworks to incorporate recurring themes salient to clinicians who ultimately use the guidelines. This will further translation of future evidence into clinical practice, accelerating clinical progress.
Collapse
Affiliation(s)
| | - Abigail Neasham
- 0000 0001 0807 5670grid.5600.3Cardiff University, Cardiff, UK
| | | | - Afshan Khan
- grid.440486.aBetsi Cadwaladr University Health Board, Bangor, UK
| |
Collapse
|
32
|
Irani E, Hirschman KB, Cacchione PZ, Bowles KH. Home health nurse decision-making regarding visit intensity planning for newly admitted patients: a qualitative descriptive study. Home Health Care Serv Q 2018; 37:211-231. [PMID: 29578844 DOI: 10.1080/01621424.2018.1456997] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Despite patients referred to home health having diverse and complex needs, it is unknown how nurses develop personalized visit plans. In this qualitative descriptive study, we interviewed 26 nurses from three agencies about their decision-making process to determine visit intensity and analyzed data using directed content analysis. Following a multifactorial assessment of the patient, nurses relied on their experience and their agency's protocols to develop the personalized visit plan. They revised the plan based on changes in the patient's clinical condition, engagement, and caregiver availability. Findings suggest strategies to improve visit planning and positively influence outcomes of home health patients.
Collapse
Affiliation(s)
- Elliane Irani
- a Frances Payne Bolton School of Nursing , Case Western Reserve University , Cleveland , Ohio , USA
| | - Karen B Hirschman
- b School of Nursing , University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Pamela Z Cacchione
- b School of Nursing , University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Kathryn H Bowles
- b School of Nursing , University of Pennsylvania , Philadelphia , Pennsylvania , USA.,c Center for Home Care Policy and Research , Visiting Nurse Service of New York , New York , USA
| |
Collapse
|
33
|
Helfrich CD, Rose AJ, Hartmann CW, van Bodegom-Vos L, Graham ID, Wood SJ, Majerczyk BR, Good CB, Pogach LM, Ball SL, Au DH, Aron DC. How the dual process model of human cognition can inform efforts to de-implement ineffective and harmful clinical practices: A preliminary model of unlearning and substitution. J Eval Clin Pract 2018; 24:198-205. [PMID: 29314508 PMCID: PMC5900912 DOI: 10.1111/jep.12855] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 11/02/2017] [Accepted: 11/03/2017] [Indexed: 11/29/2022]
Abstract
RATIONALE AND OBJECTIVES One way to understand medical overuse at the clinician level is in terms of clinical decision-making processes that are normally adaptive but become maladaptive. In psychology, dual process models of cognition propose 2 decision-making processes. Reflective cognition is a conscious process of evaluating options based on some combination of utility, risk, capabilities, and/or social influences. Automatic cognition is a largely unconscious process occurring in response to environmental or emotive cues based on previously learned, ingrained heuristics. De-implementation strategies directed at clinicians may be conceptualized as corresponding to cognition: (1) a process of unlearning based on reflective cognition and (2) a process of substitution based on automatic cognition. RESULTS We define unlearning as a process in which clinicians consciously change their knowledge, beliefs, and intentions about an ineffective practice and alter their behaviour accordingly. Unlearning has been described as "the questioning of established knowledge, habits, beliefs and assumptions as a prerequisite to identifying inappropriate or obsolete knowledge underpinning and/or embedded in existing practices and routines." We hypothesize that as an unintended consequence of unlearning strategies clinicians may experience "reactance," ie, feel their professional prerogative is being violated and, consequently, increase their commitment to the ineffective practice. We define substitution as replacing the ineffective practice with one or more alternatives. A substitute is a specific alternative action or decision that either precludes the ineffective practice or makes it less likely to occur. Both approaches may work independently, eg, a substitute could displace an ineffective practice without changing clinicians' knowledge, and unlearning could occur even if no alternative exists. For some clinical practice, unlearning and substitution strategies may be most effectively used together. CONCLUSIONS By taking into account the dual process model of cognition, we may be able to design de-implementation strategies matched to clinicians' decision-making processes and avoid unintended consequence.
Collapse
Affiliation(s)
- Christian D Helfrich
- VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, USA.,Department of Health Services, University of Washington School of Public Health, Seattle, USA
| | - Adam J Rose
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, USA
| | - Christine W Hartmann
- Center for Healthcare Organization and Implementation Research (CHOIR) Bedford VA Medical Center, Bedford, USA.,Boston University School of Public Health, Boston, USA
| | - Leti van Bodegom-Vos
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Suzanne J Wood
- Graduate Program in Health Services Administration, Department of Health Sciences, School of Public Health, University of Washington, Seattle, USA
| | - Barbara R Majerczyk
- VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, USA
| | - Chester B Good
- Center for Health Equity Research and Promotion, VA Pittsburgh healthcare System, Department of Veterans Affairs, Pittsburgh, USA.,Medical Advisory Panel for Pharmacy Benefits Management, Department of Veterans Affairs, Washington, USA.,University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Leonard M Pogach
- Office of Specialty Care, Veterans Health Administration, Washington, USA.,VA New Jersey Health Care System, East Orange, USA
| | - Sherry L Ball
- Louis Stokes Cleveland VA Medical Center, Department of Veterans Affairs, Cleveland, USA
| | - David H Au
- VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, USA
| | - David C Aron
- Department of Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, USA.,Division of Clinical and Molecular Endocrinology and Adjunct Professor Dept. of Organizational Behavior, Weatherhead School of Management, Case Western Reserve University, Cleveland, USA
| |
Collapse
|
34
|
Barken TL, Thygesen E, Söderhamn U. Advancing beyond the system: telemedicine nurses' clinical reasoning using a computerised decision support system for patients with COPD - an ethnographic study. BMC Med Inform Decis Mak 2017; 17:181. [PMID: 29282068 PMCID: PMC5745905 DOI: 10.1186/s12911-017-0573-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/11/2017] [Indexed: 12/19/2022] Open
Abstract
Background Telemedicine is changing traditional nursing care, and entails nurses performing advanced and complex care within a new clinical environment, and monitoring patients at a distance. Telemedicine practice requires complex disease management, advocating that the nurses’ reasoning and decision-making processes are supported. Computerised decision support systems are being used increasingly to assist reasoning and decision-making in different situations. However, little research has focused on the clinical reasoning of nurses using a computerised decision support system in a telemedicine setting. Therefore, the objective of the study is to explore the process of telemedicine nurses’ clinical reasoning when using a computerised decision support system for the management of patients with chronic obstructive pulmonary disease. The factors influencing the reasoning and decision-making processes were investigated. Methods In this ethnographic study, a combination of data collection methods, including participatory observations, the think-aloud technique, and a focus group interview was employed. Collected data were analysed using qualitative content analysis. Results When telemedicine nurses used a computerised decision support system for the management of patients with complex, unstable chronic obstructive pulmonary disease, two categories emerged: “the process of telemedicine nurses’ reasoning to assess health change” and “the influence of the telemedicine setting on nurses’ reasoning and decision-making processes”. An overall theme, termed “advancing beyond the system”, represented the connection between the reasoning processes and the telemedicine work and setting, where being familiar with the patient functioned as a foundation for the nurses’ clinical reasoning process. Conclusion In the telemedicine setting, when supported by a computerised decision support system, nurses’ reasoning was enabled by the continuous flow of digital clinical data, regular video-mediated contact and shared decision-making with the patient. These factors fostered an in-depth knowledge of the patients and acted as a foundation for the nurses’ reasoning process. Nurses’ reasoning frequently advanced beyond the computerised decision support system recommendations. Future studies are warranted to develop more accurate algorithms, increase system maturity, and improve the integration of the digital clinical information with clinical experiences, to support telemedicine nurses’ reasoning process.
Collapse
Affiliation(s)
- Tina Lien Barken
- Centre for eHealth, Centre for Care Research, Southern Norway, Department of Health and Nursing Sciences, Faculty of Health and Sport Sciences, University of Agder, Post box 422, 4604, Kristiansand, Norway. .,Centre for Care Research, Southern Norway, Department of Health and Nursing Sciences, Faculty of Health and Sport Sciences, University of Agder, Post box 422, 4604, Kristiansand, Norway.
| | - Elin Thygesen
- Centre for eHealth, Centre for Care Research, Southern Norway, Department of Health and Nursing Sciences, Faculty of Health and Sport Sciences, University of Agder, Post box 422, 4604, Kristiansand, Norway
| | - Ulrika Söderhamn
- Centre for Care Research, Southern Norway, Department of Health and Nursing Sciences, Faculty of Health and Sport Sciences, University of Agder, Post box 422, 4604, Kristiansand, Norway
| |
Collapse
|
35
|
Saini V, Betz AM, Gregory MK, Leon Y, Fernandez N. A Survey-Based Method to Evaluate Optimal Treatment Selection for Escape-Maintained Problem Behavior. Behav Anal Pract 2017; 10:214-227. [PMID: 29021933 DOI: 10.1007/s40617-017-0180-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Geiger, Carr, and LeBlanc (2010) developed a decision-making model for escape-maintained problem behavior that could be used to guide the course of treatment selection. We used a digital survey to evaluate the model's potential usefulness. We presented novice and expert practitioners' written hypothetical scenarios and asked them to determine the optimal treatment in a given situation. Some participants were given the model, whereas others were instructed to use their best clinical judgment. Using logistic regression analyses, the general findings for our scenarios were the following: (a) experts without the aid of a decision model had better odds of selecting the optimal treatment than novices without the decision model, (b) experts with the decision model did not have greater odds of selecting optimal treatment than experts without the model, and
Collapse
Affiliation(s)
| | - Alison M Betz
- Coastal Behavior Analysis' Center for Autism Research and Education, Vero Beach, FL USA
| | | | | | | |
Collapse
|
36
|
Manley KM, Simms RA, Platt S, Patel A, Bahl R. Unsatisfactory colposcopy: clinical decision-making in conditions of uncertainty. BMC Med Inform Decis Mak 2017; 17:125. [PMID: 28830493 PMCID: PMC5567663 DOI: 10.1186/s12911-017-0516-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 08/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unsatisfactory colposcopy, where the cells of interest are not visible in women with a positive cervical screening test, is a common area of clinical uncertainty due to the lack of clear evidence and guidance. Colposcopists' opinions and experiences are likely to have a significant influence on service provision and the development of national policy. The aim of this study was to analyse decision-making when applied to women with unsatisfactory colposcopy. METHODS A multi-centre qualitative study utilizing a series of focus groups in an English healthcare region. Sampling aimed to ensure heterogeneity of experience and healthcare provider demographics. A topic guide covered a range of clinical and cytological variables and was compiled by the researchers and three expert Colposcopists. Using an iterative approach, thematic analysis was selected as the most appropriate method to identify factors affecting decision-making. RESULTS Twenty-three Colposcopists from four units participated. The decision to treat was easier in women with high-grade cytology and high risk women with low-grade cytology such as heavy smokers, poor attenders, older women, those who had completed their families and women opting for treatment. Where decision-making was more complex, intuition and a multi-disciplinary approach were used to guide management. Areas of dissonance, which are affected by paucity of evidence and emotive factors, included cytological collection device, clinical setting and length of conservative follow-up and depth of excision in women at high risk of treatment-related morbidity. CONCLUSIONS Anxiety of missing a cancer deters long-term cytological follow-up, resulting in heterogeneity of care and higher than anticipated excisional treatments in women with low-grade screening and unsatisfactory colposcopy. In areas of clinical uncertainty when decisions are dominated by affect, clinical guidance can reduce the difficulty and anxiety of decision-making.
Collapse
Affiliation(s)
- Kristyn M. Manley
- Department of Women’s Health, University Hospitals Bristol NHS Foundation Trust, St. Michael’s Hospital, Level D, St. Michaels Hospital, Bristol, BS2 8EG UK
- University of Bristol, Bristol, UK
| | - Rebecca A. Simms
- Department of Women’s Health, University Hospitals Bristol NHS Foundation Trust, St. Michael’s Hospital, Level D, St. Michaels Hospital, Bristol, BS2 8EG UK
- University of Bristol, Bristol, UK
| | - Sarah Platt
- Department of Women’s Health, University Hospitals Bristol NHS Foundation Trust, St. Michael’s Hospital, Level D, St. Michaels Hospital, Bristol, BS2 8EG UK
| | - Amit Patel
- Department of Women’s Health, University Hospitals Bristol NHS Foundation Trust, St. Michael’s Hospital, Level D, St. Michaels Hospital, Bristol, BS2 8EG UK
| | - Rachna Bahl
- Department of Women’s Health, University Hospitals Bristol NHS Foundation Trust, St. Michael’s Hospital, Level D, St. Michaels Hospital, Bristol, BS2 8EG UK
- University of Bristol, Bristol, UK
| |
Collapse
|
37
|
Modeling the Construct of an Expert Evidence-Adaptive Knowledge Base for a Pressure Injury Clinical Decision Support System. INFORMATICS 2017. [DOI: 10.3390/informatics4030020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
38
|
Lim AG, Honey ML. New Graduate Nurses' Knowledge and Skills in Medication Management: Implications for Clinical Settings. J Contin Educ Nurs 2017. [DOI: 10.3928/00220124-20170517-09] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
39
|
Taylor D, Ho A, Mâsse LC, Van Borek N, Li N, Patterson M, Ogilvie G, Buxton JA. Assessment of Capacity to Consent by Nurses Who Deliver Health Care to Patients Who Misuse Substances. Glob Qual Nurs Res 2017; 3:2333393616671076. [PMID: 28462344 PMCID: PMC5342852 DOI: 10.1177/2333393616671076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 08/22/2016] [Accepted: 08/31/2016] [Indexed: 11/30/2022] Open
Abstract
This qualitative study explored the current practice that nurses use to assess capacity to consent to health care (CTC-HC) in street outreach settings. Key informant interviews were conducted with a purposive sample of nurses from each of British Columbia’s five regional health authorities, allowing nurses to describe their lived experiences with assessing CTC-HC. Content analysis was used to summarize information captured in the data. A total of 19 nurses participated in the study. Five themes emerged from the data: (a) internal guiding forces that contribute to the nurses’ assessment, (b) external influences that contribute to the nurses’ assessment, (c) measures that are important for assessing CTC-HC, (d) threshold setting, and (e) context (physical and interpersonal) within which assessment of capacity takes place. These elements will be incorporated into a capacity assessment tool that can be used in nursing best practices.
Collapse
Affiliation(s)
- Darlene Taylor
- University of British Columbia, Kelowna, British Columbia, Canada
| | - Anita Ho
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Louise C Mâsse
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Neville Li
- Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Gina Ogilvie
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Jane A Buxton
- University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
40
|
Wilson J, Walker S. Turning a crisis into an interactive drama: An introductory paper of a 'clickers theatre' in nurse education. NURSE EDUCATION TODAY 2017; 51:109-111. [PMID: 27923512 DOI: 10.1016/j.nedt.2016.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 11/24/2016] [Indexed: 06/06/2023]
Affiliation(s)
- James Wilson
- Faculty of Health Sciences, University of Southampton. Southampton, United Kingdom.
| | - Sandra Walker
- Faculty of Health Sciences, University of Southampton. Southampton, United Kingdom.
| |
Collapse
|
41
|
Thrasher AB, Walker SE, Hankemeier DA, Mulvihill T. Graduate-Assistant Athletic Trainers' Perceptions of Professional Socialization in the Collegiate Setting: Part I. J Athl Train 2016; 51:758-770. [PMID: 27831745 DOI: 10.4085/1062-6050-51.11.09] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Many newly credentialed athletic trainers (ATs) pursue graduate assistantships, which allow them to gain experience while being supervised by an experienced AT. The graduate-assistant (GA) ATs' perception of their socialization process into the collegiate setting is unknown. OBJECTIVE To explore the professional socialization of GAs in the collegiate setting. DESIGN Qualitative study. SETTING Phone interviews. PATIENTS OR OTHER PARTICIPANTS A total of 19 collegiate GAs (15 women, 4 men; average age = 23 ± 0.15 years; National Collegiate Athletic Association Division I = 13, II = 3, III = 2; National Association of Intercollegiate Athletics = 2; postprofessional athletic training program = 6) participated. DATA COLLECTION AND ANALYSIS Data were collected via phone interviews and transcribed verbatim. Interviews were conducted until data saturation occurred. Data were analyzed through phenomenologic reduction. Trustworthiness was established via member checks and peer review. RESULTS Four themes emerged: (1) role identity, (2) initial entry into role, (3) maturation, and (4) success. Before beginning their role, participants envisioned the assistantship as a way to gain independent experience while being mentored. They perceived themselves as the primary care providers for their athletic teams. Those who were immediately immersed into clinical practice adapted to their role quickly despite experiencing stress initially. Participants felt that a formal orientation process and a policies and procedures manual would have alleviated some of the initial stress. The GAs matured as they practiced clinically and developed confidence as they gained experience. Personal attributes, experience, and peer and supervisor support contributed to perceived success as GAs. Factors that hindered perceived success were lack of confidence, an unsupportive environment, and long hours. CONCLUSIONS When looking for graduate assistantships, ATs should seek a position that allows them to practice independently and provides didactic educational opportunities while aligning with their athletic training philosophies.
Collapse
Affiliation(s)
- Ashley B Thrasher
- School of Health Sciences, Western Carolina University, Cullowhee, NC
| | | | | | - Thalia Mulvihill
- Department of Educational Studies, Ball State University, Muncie, IN
| |
Collapse
|
42
|
Young SK, Young TK. Assessing clinical support and inter-professional interactions among front-line primary care providers in remote communities in northern Canada: a pilot study. Int J Circumpolar Health 2016; 75:32159. [PMID: 27633080 PMCID: PMC5025523 DOI: 10.3402/ijch.v75.32159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/19/2016] [Accepted: 08/20/2016] [Indexed: 11/14/2022] Open
Abstract
Background Primary care in remote communities in northern Canada is delivered primarily by nurses who receive clinical support from physicians in regional centres and the patient transportation system. To improve continuity, quality and access to care in remote northern communities, it is important to understand the perspectives of front-line providers and the complex challenges they face. Objective To design and implement a survey of primary care providers to identify issues relating to inter-professional communication, clinical support and patient evacuation. Methods In collaboration with the territorial government and regional health authority partners, we developed a 21-item self-administered questionnaire survey, which could be completed online. The survey was sent to 218 physicians and nurses who were employed in the Northwest Territories (NWT) at the time of the survey and were involved in sending patients out of the community and/or receiving patients. The survey also contained an open-ended question at the end seeking comments regarding primary health care. Results The overall low response rate of 39% among nurses and 19% among physicians threatens the validity of the quantitative results. The majority of providers were satisfied with their ability to communicate with other providers in a timely manner, their freedom to make clinical decisions and their overall experience practicing in the NWT. The patient transfer system appears to work from both the sender and receiver perspectives. However, a common theme reported by nurses was that physicians providing clinical advice, especially short-term locums, were not familiar with the local situation, whilst physicians at the receiving end remarked that the clinical information provided to them often lacked clarity. Conclusions Important lessons were learnt from the pilot study, especially in better engagement of providers in planning and dissemination. The questionnaire design and the online method of delivery were acceptable. Although important issues were identified, a larger definitive survey is needed to investigate them in the future.
Collapse
Affiliation(s)
| | - T Kue Young
- School of Public Health, University of Alberta, Edmonton, Canada;
| |
Collapse
|
43
|
Maharmeh M, Alasad J, Salami I, Saleh Z, Darawad M. Clinical Decision-Making among Critical Care Nurses: A Qualitative Study. Health (London) 2016. [DOI: 10.4236/health.2016.815173] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
44
|
Keers RN, Williams SD, Cooke J, Ashcroft DM. Understanding the causes of intravenous medication administration errors in hospitals: a qualitative critical incident study. BMJ Open 2015; 5:e005948. [PMID: 25770226 PMCID: PMC4360808 DOI: 10.1136/bmjopen-2014-005948] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To investigate the underlying causes of intravenous medication administration errors (MAEs) in National Health Service (NHS) hospitals. SETTING Two NHS teaching hospitals in the North West of England. PARTICIPANTS Twenty nurses working in a range of inpatient clinical environments were identified and recruited using purposive sampling at each study site. PRIMARY OUTCOME MEASURES Semistructured interviews were conducted with nurse participants using the critical incident technique, where they were asked to discuss perceived causes of intravenous MAEs that they had been directly involved with. Transcribed interviews were analysed using the Framework approach and emerging themes were categorised according to Reason's model of accident causation. RESULTS In total, 21 intravenous MAEs were discussed containing 23 individual active failures which included slips and lapses (n=11), mistakes (n=8) and deliberate violations of policy (n=4). Each active failure was associated with a range of error and violation provoking conditions. The working environment was implicated when nurses lacked healthcare team support and/or were exposed to a perceived increased workload during ward rounds, shift changes or emergencies. Nurses frequently reported that the quality of intravenous dose-checking activities was compromised due to high perceived workload and working relationships. Nurses described using approaches such as subconscious functioning and prioritising to manage their duties, which at times contributed to errors. CONCLUSIONS Complex interactions between active and latent failures can lead to intravenous MAEs in hospitals. Future interventions may need to be multimodal in design in order to mitigate these risks and reduce the burden of intravenous MAEs.
Collapse
Affiliation(s)
- Richard N Keers
- Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, MAHSC, University of Manchester, Manchester, UK
| | - Steven D Williams
- Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK
- Pharmacy Department, University Hospital of South Manchester NHS Foundation Trust, MAHSC, Manchester, UK
- NHS England, Skipton House, London, UK
| | - Jonathan Cooke
- Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK
- Infectious Diseases and Immunity Section, Division of Infectious Diseases, Department of Medicine, Imperial College London, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, MAHSC, University of Manchester, Manchester, UK
| |
Collapse
|
45
|
Chen HC, Tan J, Dolly S, Kavanaugh J, Anastasio MA, Low DA, Harold Li H, Altman M, Gay H, Thorstad WL, Mutic S, Li H. Automated contouring error detection based on supervised geometric attribute distribution models for radiation therapy: A general strategy. Med Phys 2015; 42:1048-59. [DOI: 10.1118/1.4906197] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
|
46
|
Bae JM. The clinical decision analysis using decision tree. Epidemiol Health 2014; 36:e2014025. [PMID: 25358466 PMCID: PMC4251295 DOI: 10.4178/epih/e2014025] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/29/2014] [Indexed: 11/09/2022] Open
Abstract
The clinical decision analysis (CDA) has used to overcome complexity and uncertainty in medical problems. The CDA is a tool allowing decision-makers to apply evidence-based medicine to make objective clinical decisions when faced with complex situations. The usefulness and limitation including six steps in conducting CDA were reviewed. The application of CDA results should be done under shared decision with patients' value.
Collapse
Affiliation(s)
- Jong-Myon Bae
- Department of Preventive Medicine, Jeju National University School of Medicine, Jeju, Korea
| |
Collapse
|
47
|
Clinical decision making of nurses working in hospital settings. Nurs Res Pract 2011; 2011:524918. [PMID: 21994830 PMCID: PMC3182333 DOI: 10.1155/2011/524918] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 07/28/2011] [Indexed: 11/17/2022] Open
Abstract
This study analyzed nurses' perceptions of clinical decision making (CDM) in their clinical practice and compared differences in decision making related to nurse demographic and contextual variables. A cross-sectional survey was carried out with 2095 nurses in four hospitals in Norway. A 24-item Nursing Decision Making Instrument based on cognitive continuum theory was used to explore how nurses perceived their CDM when meeting an elective patient for the first time. Data were analyzed with descriptive frequencies, t-tests, Chi-Square test, and linear regression. Nurses' decision making was categorized into analytic-systematic, intuitive-interpretive, and quasi-rational models of CDM. Most nurses reported the use of quasi-rational models during CDM thereby supporting the tenet that cognition most often includes properties of both analysis and intuition. Increased use of intuitive-interpretive models of CDM was associated with years in present job, further education, male gender, higher age, and working in predominantly surgical units.
Collapse
|
48
|
Jansson I, Pilhammar E, Forsberg A. Obtaining a foundation for nursing care at the time of patient admission: a grounded theory study. Open Nurs J 2009; 3:56-64. [PMID: 19746207 PMCID: PMC2739902 DOI: 10.2174/1874434600903010056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 07/17/2009] [Accepted: 07/17/2009] [Indexed: 11/22/2022] Open
Abstract
The nursing process can be viewed as a problem-solving model, but we do not know whether use of the whole process including care plans with interventions based on nursing diagnoses improves nurses' ability to carry out assessments. Therefore, the aim of this study was to illuminate and describe the assessment and decision-making process performed by nurses who formulated individual care plans including nursing diagnosis, goals and interventions or who used standardized care plans when a patient was admitted to their ward for care, and those who did not. Data collection and analysis were carried out by means of Grounded theory. Nurses were observed while assessing patients, after which they were interviewed. The main concern of all nurses was to obtain a foundation for nursing care based on four strategies; building pre-understanding, creating a caring environment, collecting information on symptoms and signs and performing an analysis from different perspectives. It appeared that the most important aspect for nurses who did not employ care plans was the medical reason for the patient's admission. The nurses who employed care plans discussed their decisions in terms of nursing problems, needs and risks. The results indicate that nurses who formulated care plans were more aware of their professional role.
Collapse
Affiliation(s)
- Inger Jansson
- School of Social and Health Sciences, Halmstad University, Halmstad, Sweden.
| | | | | |
Collapse
|