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PubMedDate not supplied

The process of ethical decision making in psychiatric nursing practice.

The process by which nurses make ethical decisions in clinical practice has significance for the practitioners, educators, and administrators concerned with professional standards and quality of care. Twenty nurses participated in semistructured interviews during which they discussed ethical problems of their choice that had occurred in their clinical practice. Content analysis of interview transcripts revealed a 10-stage process used in ethical decision making. The process begins with an emotional response on hearing of an event that affects clinical practice and ends in an aftermath that includes feelings, talking with others, reconsiderations, and change or vows to change. The study identifies both affective and cognitive components of the decision-making process. The importance of the emotional aspect of ethical decision making, absent from previous studies, is recognized and evaluated. Implications based on the study suggest that the problems of ethical decision making may be a significant part of the stress in nursing. In addition, there is evidence that the process of ethical decision making affects nurses' views of self and of the profession and may have direct bearing on their leaving nursing for another professional career.

Adult↗
PubMed2000

A study of case managers' decision-making processes.

Decision-making processes were explored in a study of 122 case managers from community-based aging network agencies. Of interest was how often case managers employed a consumer-driven model whereby elders' input is always considered during the assessment and decision-making processes. Approximately 80% always used clients as a source of information during assessment but less than a majority always used client recommendations in decision making. The case managers indicated that safety was more frequently a guiding principle used in decision making than the least restrictive alternative, disruption to lifestyle, and freedom. When clients disagreed with the case managers' decisions, attempting to convince the client was the strategy the greatest proportion of respondents employed. Case manager characteristics (gender and degree) were not found to be associated with consumer-oriented methods of assessment or decision making. The authors concluded that the respondents tended to use a consumer-oriented approach when assessing clients but moved away from the consumer-driven model when making decisions with regard to clients. Safety, rather than freedom, was the prevailing guiding principle.

Adult↗
PubMed1983

Evaluation of operational failures in clinical decision making.

Medical decision analysts are interested in the changes in health benefits from inappropriate ordering of tests, imperfect information from tests, and imperfect results of treatments. Operational failures in the decision-making sequence, caused by human and system factors, may also alter health benefits. An evaluation of operational failures in follow-up of positive urine cultures in pediatric patients is reported. Branching criteria were developed by physician representatives from each of eight pediatric group practices to evaluate the care of patients aged 6 months to 16 years, inclusive. Of 858 cases evaluated, 52 percent failed at one or more nodes in the criteria sequence. Rates of failure at individual nodes among cases reaching these nodes varied from 2 percent to 48 percent. Like those of other researchers, our findings suggest that decision analyses that do not take operational failures into consideration may inaccurately predict the yield of health benefits achieved in actual practice.

Adolescent↗
PubMed2005

Misimagining the unimaginable: the disability paradox and health care decision making.

Good decision making often requires accurate predictions about how potential outcomes will make one feel. However, people often mispredict the emotional impact of unfamiliar circumstances. For example, they often overestimate the emotional impact that chronic illnesses and disability will have on their lives. In the present article, the authors look at possible sources of error in both the happiness reports of patients with chronic illness or disability and the happiness predictions of healthy people asked to imagine the same illnesses and disabilities. On balance, the available evidence suggests that, whereas patients misreport their well-being, healthy people also mispredict the emotional impact that chronic illness and disability will have on their lives.

Adaptation, Psychological↗
PubMed1997

Strategies for promoting ethical decision-making.

The structured controversy as a strategy for helping the non-licensed caregiver make ethical decisions as well as develop critical thinking skills was an innovative teaching technique. Students in the Homecare/Special care aide program are essential providers of care to residents or clients in a special care facility or in a homecare setting. Theory and practice of ethical decision-making is not usually dealt with in the curriculum of the non-licensed caregiver. Implementation of this approach helped students learn theory and skills necessary when dealing with controversial issues in making ethical decisions. Thompson and Thompson's (1985) ten steps of bioethical decision-making were implemented to assist in the process. Structured controversy was defined and the process of implementing structured controversy outlined. A variety of ethical issues were presented based on the ethical principles of beneficence, justice, autonomy, truthfulness, confidentiality, and integrity (Yeo, 1991). Several definitions of critical thinking are presented.

Curriculum↗
PubMed2006

Views of older adults on patient participation in medication-related decision making.

BACKGROUND: Medication decision making is complex, particularly for older patients with multiple conditions for whom benefits may be uncertain and health priorities may be variable. While patient input would seem important in the face of this uncertainty and variability, little is known about older patients' views of involvement in medication decision making. OBJECTIVE: To explore the views of older adults regarding participation in medication decision making. DESIGN: Qualitative study. PARTICIPANTS: Fifty-one persons at least 65 years old who consumed at least one medication were recruited from 3 senior centers and 4 physicians' offices. APPROACH: One-on-one interviews were conducted to uncover participants' perceptions of medication-related decision making through semistructured, open-ended questions. Themes were compared according to the constant comparative method of analysis. RESULTS: The predominant theme that emerged was the variability in perceptions concerning whether it was possible or desirable for patients to participate in prescribing decisions. For some participants, involvement was limited to sharing information. Physician and system factors that were felt to facilitate or impede patient participation included communication skills, the expanding number of medications available, multiple physicians prescribing for the same patient, and a focus on treating numbers. Perceived lack of knowledge, low self-efficacy, and fear were the patient factors mentioned. Both the presence and absence of trust in the prescribing physician were seen as alternatively impeding and enhancing patient participation. Only 1 participant explicitly mentioned patient preference, a cornerstone of shared decision making. CONCLUSIONS: While evolution to greater patient involvement in medication decision making may be possible, and desirable to some older patients, findings suggest that the transition will be challenging.

Age Factors↗
PubMed2005

Critical involvement of dopaminergic neurotransmission in impulsive decision making.

BACKGROUND: Impulsive decision making, apparent as intolerance for reinforcement delay, is prominent in attention-deficit/hyperactivity disorder. Commonly prescribed for this condition, amphetamine (Adderall), reduces impulsive decision making; however, the neuropharmacologic mechanism of this effect of amphetamine is unclear. METHODS: We investigated the involvement of dopaminergic and noradrenergic neurotransmission in impulsive decision making in rats, using a delayed reward task. RESULTS: Amphetamine and methylphenidate decreased impulsive decision making, which was mimicked by the selective dopamine reuptake inhibitor GBR 12909 but not by the noradrenaline reuptake inhibitor desipramine. Impulsive choice was increased by the dopamine D1 receptor antagonist SCH-23390 but not the dopamine D2 receptor antagonist eticlopride. The effect of amphetamine on impulsive choice was attenuated by pretreatment with eticlopride, whereas amphetamine retained its effect on impulsivity in the presence of SCH-23390. The alpha2 adrenoceptor agonist clonidine increased impulsivity, but the alpha1 adrenoceptor agonist phenylephrine did not affect impulsive decision making. CONCLUSIONS: These data demonstrate an important role for dopaminergic neurotransmission in impulsive decision making, whereby tolerance to delay of reinforcement depends on dopamine D1 receptor activation. Activation of dopamine D2 receptors appears to mediate the beneficial effects of amphetamine on impulsive behavior. Noradrenergic neurotransmission may play a minor role in impulsive choice.

Adrenergic Uptake Inhibitors↗
PubMed1998

Interdependence and Controversy in Group Decision Making: Antecedents to Effective Self-Managing Teams.

Self-managing teams have the challenge to make decisions regarding their tasks and to manage their internal affairs. Findings on 60 self-managing teams with 540 employees indicate that the theory of cooperation and competition is useful for identifying the social processes that help these teams grapple with problems and work effectively. Specifically, teams with highly cooperative goals were found to discuss their opposing views open-mindedly and constructively which in turn developed confidence in team dynamics that contributed to effective team performance. Competitive goals appeared to interfere with constructive controversy, confidence, and effectiveness. Findings were interpreted as suggesting that structuring cooperative goals and constructive controversy can help self-managing teams gain confidence and work productively. Copyright 1998 Academic Press.

Journal Article↗
PubMedDate not supplied

Rational decision making based on history: adult sore throats.

Primary care physicians are often required to make preliminary evaluations based only on the patient's history, especially during telephone encounters about sore throats. The authors studied adults with sore throats to determine whether patients can be stratified into higher and lower risks of strep throat by history alone. They first obtained data from 517 patients seen in an emergency room. Providers graded symptoms on a four-point scale (absent, mild, moderate, or severe). Initial analyses showed that prediction based on history should include three variables: fever, difficulty in swallowing, and cough. For ease of computation, these were consolidated into one score, "history" (= fever history + difficulty in swallowing - cough). This score was used to develop a model that predicts the probability of infection with group A beta-hemolytic streptococcus, and the model's performance was tested in two additional patient groups. The predictive accuracy of the "history" score was confirmed in all patient groups, despite differences in providers and disease prevalences. Primary care physicians may use this model to help them make decisions in situations such as telephone encounters without using additional data.

Adult↗
PubMed2005

A comparison of graphical and textual presentations of time series data to support medical decision making in the neonatal intensive care unit.

OBJECTIVE: To compare expert-generated textual summaries of physiological data with trend graphs, in terms of their ability to support neonatal Intensive Care Unit (ICU) staff in making decisions when presented with medical scenarios. METHODS: Forty neonatal ICU staff were recruited for the experiment, eight from each of five groups--junior, intermediate and senior nurses, junior and senior doctors. The participants were presented with medical scenarios on a computer screen, and asked to choose from a list of 18 possible actions those they thought were appropriate. Half of the scenarios were presented as trend graphs, while the other half were presented as passages of text. The textual summaries had been generated by two human experts and were intended to describe the physiological state of the patient over a short period of time (around 40 minutes) but not to interpret it. RESULTS: In terms of the content of responses there was a clear advantage for the Text condition, with participants tending to choose more of the appropriate actions when the information was presented as text rather than as graphs. In terms of the speed of response there was no difference between the Graphs and Text conditions. There was no significant difference between the staff groups in terms of speed or content of responses. In contrast to the objective measures of performance, the majority of participants reported a subjective preference for the Graphs condition. CONCLUSIONS: In this experimental task, participants performed better when presented with a textual summary of the medical scenario than when it was presented as a set of trend graphs. If the necessary algorithms could be developed that would allow computers automatically to generate descriptive summaries of physiological data, this could potentially be a useful feature of decision support tools in the intensive care unit.

Computer Graphics↗
PubMedDate not supplied

Development and decision-making in the mammalian cerebral cortex.

One of the fundamental tasks of neurobiology is to understand how the precision and specificity of the adult nervous system is achieved during development. This paper reviews the progress that has been made toward this end in studies of the developing mammalian cerebral cortex. Particular attention is focused on the problem of how cortical neurons make decisions during development: the correlation between a neuron's 'birthday' and its final laminar destination and projection patterns has raised the possibility that young neurons may be committed to their adult fates very early on in development, perhaps prior to migration. Indeed, several lines of evidence reviewed here suggest that at least some of the decisions made by cortical neurons are intrinsic properties of the cell itself. These studies include experiments on the reeler mouse mutant, and more recent attempts to manipulate developmental fates by pharmacological interventions and transplantation techniques. It is concluded that early commitment events in the cerebral cortex may specify a neuron's laminar position and restrict the range of potential axonal projections that the cell may form, but that local positional cues direct neurons to select (or maintain) only certain of the possible projections.

Animals↗
PubMed1983

Application of risk assessment to food safety decision making.

The purpose of this report is to present the scientific basis of risk assessment and to demonstrate that risk assessment can be used to make decisions about the safety of our food supply. The report has been prepared as as resource for those involved in the current discussions in Congress and elsewhere over the policies b by which the safety of the American food supply is evaluated and assured. The document is not intended to present an argument for any particular food safety policy, but rather to address a key scientific tissue that arises in the review of policy options. It distinguishes risk assessment--the scientific process of identifying and evaluating potential risks--from risk management, the separate policy decision regarding what constitutes "safety" or an acceptable degree of risk.

Animals↗
PubMed2003

Rational choice(s)? Rethinking decision-making on breast cancer risk and screening mammography.

Women who refrain from undergoing breast cancer screening are believed to be uninformed about risks and usually labeled as irrational. Our purpose in writing this paper is to challenge the traditional notion of rational behaviour, illustrating with qualitative data that people's rationality is influenced by their socio-cultural and political identities. We explore three major themes: (1) cultural explanations regarding intention to use screening mammography (2) (dis)trust in science and expert opinion, and (3) self-responsibility and self-surveillance in caring for one's body. Understanding that women rely on different risk discourses to make decisions about their health should aide researchers, health professionals, and the community in better understanding alternative ways of conceptualizing people's health-related behaviours when they do not coincide with health authorities recommendations.

Adult↗
PubMed1988

Decision-making in cases of intrafamilial child sexual abuse.

In intrafamilial sexual abuse, the mother's functioning (her dependency, relationship with the victim, and protectiveness) and the father-offender's functioning (his overall functioning, guilt about victimization, and extent of sexual abuse) can be used to make decisions about removal of children, treatment prognosis, treatment strategies, and juvenile or criminal court action. Guidelines for clinicians are presented.

Adult↗
PubMedDate not supplied

Patient decision making: use of and adherence to telephone-based nurse triage recommendations.

OBJECTIVE: Health plans, employer groups, and medical providers offer telephone-based nurse triage services to provide ready access to medical advice and information to assist patients in making decisions about their medical needs. The purpose of this study is to assess patient adherence to nurse triage recommendations. PATIENTS AND METHODS: The study includes data for members of an HMO located in a large metropolitan area who used the triage service during 1997 (n = 22,998). The nurse triage call data are linked with medical claims and encounter data to assess patient medical service utilization following a call to the triage service to assess triage adherence. The authors consider no use of medical services following a triage call with the recommendation to use self-care advice at home an indicator of adherence to this recommendation. RESULTS: The percentage of callers who adhered to triage recommendations to use hospital emergency services, physician office services, or self-care advice was 79.2%, 57.4%, and 65.8%, respectively. Adherence varies somewhat by age. CONCLUSION: The reported adherence levels are lower than those obtained from self-reported data reported elsewhere. Given the inherent limitations of both types of data, actual telephone-based nurse triage adherence may lie between the 2 levels.

Emergency Service, Hospital↗
PubMed2004

Intraoperative echocardiography: support for decision making in cardiac surgery.

Intraoperative echocardiography (including transesophageal echocardiography, epiaortic ultrasound and epicardial echocardiography) is commonly performed in North American hospitals during cardiac anesthesia. Several authors have reported on the positive impact of intraoperative echocardiography on patients' outcomes. Transesophageal echocardiography is useful in identifying anatomic and functional abnormalities either before or after cardiopulmonary bypass and helps to make decisions in the care of high-risk and unstable patients. In minimally invasive and robotically assisted surgery, transesophageal echocardiography is essential in order to guide cannulation of venous and arterial vessels for cardiopulmonary bypass and in providing immediate assessment of the quality of the performed repair. Intraoperative echocardiography can also detect complications associated with the performed procedure and can be an excellent hemodynamic monitor in unstable patients. In this paper different scenarios where intraoperative echocardiography is useful are reviewed, some clinical cases are shown to illustrate, and a review of related literature is reported.

Aorta, Thoracic↗
PubMedDate not supplied

Residents who make decisions reveal healthier, happier attitudes.

Resident participation implies that all parties see themselves as contributing to decision making and think that their participation will make a difference. A nursing home where residents participate with care providers is a community of openness, information sharing and mutual respect. Having residents participate in their care as well as in care-giving policies and procedures improves quality of care, increases residents' sense of involvement and creates an environment that is more satisfactory for all involved. Health promotion programs are a good method for increasing participation.

Aged↗