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PubMed1983

Diagnosing organizational decision making through responsibility charting.

Decision making within many organizations is becoming increasingly complex and difficult to manage. This article describes a technique called "Responsibility Charting" which can be used as a basis for understanding and improving decision making, and for enhancing the quality of communication within an organization. The authors present a case study to illustrate the types of analyses possible with this technique.

Administrative Personnel↗
PubMed2003

Impulsive decision making and working memory.

Decision making that favors short-term over long-term consequences of action, defined as impulsive or temporally myopic, may be related to individual differences in the executive functions of working memory (WM). In the first 2 experiments, participants made delay discounting (DD) judgments under different WM load conditions. In a 3rd experiment, participants high or low on standardized measures of imupulsiveness and dysexecutive function were asked to make DD judgments. A final experiment examined WM load effects on DD when monetary rewards were real rather than hypothetical. The results showed that higher WM load led to greater discounting of delayed monetary rewards. Further, a strong direct relation was found between measures of impulsiveness, dysexecutive function,and discounting of delayed rewards. Thus, limits on WM function, either intrinsic or extrinsic, are predictive of a more impulsive decision-making style.

Adolescent↗
PubMedDate not supplied

Quality of decision making by registered nurses.

This study investigated quality of decision making in a convenience sample of 26 registered nurses. Instruments used were the Joseph Decision Making Tool, Actual Decision Making instrument, and computer-assisted clinical simulations. Results were correlated with educational preparation, age, experience, practice area, and specialty certification. No differences among basic educational preparation with frequency of actual decision-making practices and willingness to make decisions were found. A positive correlation was found between practice area and frequency of actual decision making (r = 0.639, P < 0.001), and practice area and communication (r = 0.439, P < 0.05).

Adult↗
PubMed1990

Decision-making processes of youth.

Research supports the theory that after administrators make a decision, feedback, both positive and negative, and also the administrators' perceived security vis-à-vis their position affect their level of commitment to a course of action. However, this research fails to recognize that subjects of college age playing administrators in the simulated, experimental treatments which have been presented in the research had nothing personally to lose if they made a bad decision--an orientation contradictory to the reality of most actual administrative positions. Additionally, the research ignores the interactional effects of the personality of decision makers in terms of their anxiety levels and the judgments they make. This study took both of these considerations into account by creating a decision-making situation within which prospective administrators made monetary commitments to long-term goals while their anxiety level, both as a basic personality attribute and an index of the reality of the decision-making process, was monitored under conditions of varying levels of job insecurity and resistance to their policies in relation to their decisions. Analyses revealed that contrary to the results of past research which used college students as subjects: (1) there is a significant negative correlation between levels of anxiety and commitments to previously chosen courses of action; (2) there are no significant effects of job security on commitment; and, most importantly, (3) high resistance to a policy decision leads to significantly less monetary commitments to long-term goals. The findings suggest that the basis for the contradictory results lies with the anxiety level of decision makers and the realism of experiencing a loss by making poor decisions.

Achievement↗
PubMed2006

Patient participation in decision making in nursing.

Patient participation in decision making concerning nursing needs is an important aspect of high quality care, of interest for both planning and implementing care. However, patients' perspective on participation in clinical decision making has not been studied extensively and the literature is inconclusive of what roles patients prefer to adopt. The aim was to investigate associations between patient demographics and preferences for participation in clinical decision making and to compare patients and RNs perceptions of the patients' preferences for participation. A cross sectional study including 80 nurse-patient dyads was adopted. The Control Preference scale was used to collect data. The findings showed that younger and more educated patients preferred to be more active in some aspects of decision making than older and less educated patients did. Further, in comparison with RNs inference of patient preferences for participation, patients preferred to be more passive in decision making in relation to nursing needs in general, as well as for physical and psychosocial needs. Differences in perceptions between patients and RNs concerning patient participation could hamper high quality care and need to be addressed.

Adult↗
PubMedDate not supplied

Does audit improve DNR decision making?

The use of 'do not resuscitate' (DNR) orders in hospitals has been the subject of considerable comment in both the medical and the lay press. Guidelines have been produced to help make DNR decisions but, as yet, there have been no published accounts of these in practice. We have used audit to accounts of these in practice. We have used audit to develop DNR policy in our hospital, and have reviewed practice after the introduction of guidelines. This led to early consultant involvement in making decisions in 55 of 80 patients (69%) who were assessed as DNR at the time of death or discharge, documentation of reasons for DNR in all 55 of these and documentation of discussion with nurses in 49 (89%). Consultants agreed with DNR decisions made by their juniors in 31 of 34 cases (91%) and changed 'for CPR' decisions to DNR in 24 of 108 (22%). We have demonstrated that audit is an appropriate way to change and develop practice in sensitive areas such as this.

Adolescent↗
PubMed1992

Attempts to use computers as diagnostic aids in medical decision making: a thirty-year experience.

For more than 30 years our group of physicians, statisticians, and computer scientists has worked toward developing a computer program with the capability of a trained physician to make diagnostic decisions in the relatively broad medical subspecialty of hematology. We devised and tested many programs, none of which have been sufficiently useful to warrant carrying beyond the pilot-study stage. We analyzed the reasons for this failure. Our experience confirms the great difficulty, and even the impossibility, of incorporating the complexity of human thought into a system that can be handled by a computer. We concluded that we should stop trying to make a computer act like a diagnostician and concentrate instead on ways of making computer-generated relevant information available to physicians as they make decisions.

Algorithms↗
PubMed1996

Event-related potentials as indices of subclinical neurological differences in HIV patients during rapid decision making.

The authors examined decision making in HIV patients under slow and rapid information deliveries. Thirteen asymptomatic, HIV-infected (HIV+) subjects with known seroconversion dates and 13 healthy control subjects were instructed to detect the "oddball" target tones among nontarget tones during single-channel (slow) and dual-channel (rapid) deliveries. Event-related potentials (ERPs) from midline scalp sites, reaction time, and "hits" were recorded. Behaviorally, the two groups performed similarly, and during single-channel delivery they produced similar ERPs indexing target detection. However, during dual-channel delivery the HIV+ group showed atypical morphology in the region of the P300 cognitive decision-making component compared with the control group. Auditory ERPs elicited by rapid, dichotic stimulus presentations appeared sensitive to subclinical effects of HIV-related neuropathology in individuals who had been HIV-positive for 3 months to 8 years.

Acoustic Stimulation↗
PubMed2005

Organ donation: key factors influencing families' decision-making.

AIM: To clarify the decision-making and bereavement needs of family members who had organ donation discussed with them; to provide a rationale for further preparation of professionals involved in this sensitive work. METHODS: This work used a 3-year longitudinal design. A sample of 49 family members who had donation discussed with them, were recruited. At 3 to 5, 13 to 15, and 18 to 26 months postbereavement, face-to-face interviews and two, self-completed; psychometric measures, the Beck Depression Inventory II and the Grief Experience Inventory, were used with participants who chose to donate. Single interviews were carried out with participants who declined donation. Data were analyzed using a comparative, thematic approach and multivariate statistics, focusing on detection of important similarities and differences between cases. FINDINGS: Four main categories were identified that illustrated the issues that influenced families' ability to agree or decline donation and their perception of the decision-making process. The categories were concerns about knowledge of the deceased's donation wish, views held by the extended family about donation, giving meaning to the death and events that occurred in the hospital that were perceived as positive or negative. The role of children in the decision-making about organ donation was highlighted. In conclusion, hospital care affected participants' donation decision-making and appeared to impact on subsequent grief. To facilitate decision-making and bereavement that is uncomplicated by questions about brain injury and subsequent death, families needed time to understand the information given, care in the way and context that information was shared and attention to their emotional needs.

Attitude to Death↗
PubMed2000

Preferences for life-sustaining treatments in advance care planning and surrogate decision making.

BACKGROUND: Surrogates and clinicians often make treatment decisions for decisionally incapacitated patients with limited knowledge of their preferences. This study examined patients' life-sustaining treatment preferences to facilitate advance care planning discussions and surrogate decision making. METHODS: We interviewed 342 participants from 7 groups: younger and older well adults; persons with chronic illness, terminal cancer, and acquired immunodeficiency syndrome (AIDS); stroke survivors; and nursing home residents. Preferences for antibiotics, short- and long-term mechanical ventilation, hemodialysis, tube feeding, and cardiopulmonary resuscitation (CPR) were elicited for each participant's current health state and three hypothetical health states representing severe dementia, coma, and severe stroke. RESULTS: Participants chose to forego more invasive or long-term treatments at a higher rate than less invasive, short-term treatments in all health states. Participants were much more willing to forego treatments in coma than in their current health state, with stroke and dementia somewhere in between. Participants who were older, female, had worse functional status, had more depressive symptoms, or lived in a nursing home were more inclined to forego treatment in their current health state. In contrast, treatment preferences in hypothetical health states showed either no associations or much weaker associations with these factors. Participants who were willing to accept more invasive treatments were highly likely to accept less invasive treatments and participants who preferred to forego a less invasive treatment were highly likely to forego more invasive treatments. Participants who preferred to receive a treatment in a health state with severe impairments were highly likely to want the same treatment in a less impaired health state. Similarly, participants who preferred to forego a treatment in a less impaired health state were highly likely to forego the same treatment in a more impaired state. CONCLUSIONS: In advance care planning discussions, clinicians might explore with patients their preferences about short- and long-term treatments with variability in their invasiveness (including CPR) in both their current health state and hypothetical situations representing different levels of functional impairment. When surrogates have no knowledge about the wishes of formerly competent patients, clinicians may help them with medical decisions by discussing what other people commonly want in similar circumstances.

Journal Article↗
PubMed2002

Emerging paradigms of cognition in medical decision-making.

The limitations of the classical or traditional paradigm of decision research are increasingly apparent, even though there has been a substantial body of empirical research on medical decision-making over the past 40 years. As decision-support technology continues to proliferate in medical settings, it is imperative that "basic science" decision research develop a broader-based and more valid foundation for the study of medical decision-making as it occurs in the natural setting. This paper critically reviews both traditional and recent approaches to medical decision making, considering the integration of problem-solving and decision-making research paradigms, the role of conceptual knowledge in decision-making, and the emerging paradigm of naturalistic decision-making. We also provide an examination of technology-mediated decision-making. Expanding the scope of decision research will better enable us to understand optimal decision processes, suitable coping mechanisms under suboptimal conditions, the development of expertise in decision-making, and ways in which decision-support technology can successfully mediate decision processes.

Cognitive Science↗
PubMedDate not supplied

Decision making. Stability of clinical decisions.

Clinical decisions of 101 medical-surgical nurses were examined for stability. Results indicate that slightly more than 50% of the subjects made stable clinical decisions or decisions not likely to be reversed with minor changes in the clinical data. The findings also reveal that stability was related to hospital setting and country in which the nurses received their education. The authors provide possible explanations for these observations, and recommendations for nursing education and practice.

Clinical Competence↗
PubMed1988

Surgical decision making for residual limb deformities following traumatic brain injury.

When neurologic recovery has plateaued following traumatic brain injury, careful assessment is needed prior to making surgical decisions to correct residual limb deformities. Sufficient cognition to follow simple commands, cooperate with postoperative therapy, and benefit from improved function is essential. Sensation must also be intact. Motor control of the extremity can be evaluated by clinical examination supplemented by nerve blocks to relieve spasticity in antagonistic muscle groups. Dynamic electromyography is frequently required for surgical decision making. Hand placement may be deterred by spasticity of the brachioradialis, biceps, and brachialis muscles. Active finger extension may be masked by spastic flexors. In the lower extremity, knee flexion may be blocked during the preswing period by inappropriate firing of one or more components of the quadriceps. The equinovarus deformity of the foot is the result of spasticity of the gastrocsoleus muscles, the toe flexors, and the tibialis anterior.

Arm↗
PubMed2006

Chest pain: physician perceptions and decision-making in a London emergency department.

STUDY OBJECTIVE: We describe physician perceptions of decision-making for acute coronary syndromes in the emergency department (ED) and the ways in which patient characteristics influence diagnosis. METHODS: This is a qualitative analysis of semistructured interview data from physicians practicing at an ethnically diverse and lower-income London ED. All physicians working more than 3 shifts in the department during a 1-month period were approached for interview. RESULTS: Four themes emerged from the interviews: (1) physicians emphasized the medical history when diagnosing acute coronary syndrome; (2) physicians reported communication barriers as an impediment to diagnosis; (3) physicians cited both epidemiologic data and cultural beliefs when explaining presentation differences between patient groups; (4) physicians interpreted patient complaints by comparing their clinical impressions to a "classic" or "textbook" norm. CONCLUSION: In most cases, physicians relied on the clinical history when making decisions for patients with suspected acute coronary syndromes. In reaching judgments, physicians elicited features of the presentation they thought were salient, interpreted those features in light of epidemiologic knowledge and cultural beliefs, and compared their overall impression of the patient to a "classic" or "textbook" norm. At each step, physicians' perceptions about patients influenced the data gathered and the interpretation of that data. In addition, the expected features of acute coronary syndrome were thought to differ for some patient groups. These results highlight the need for further research into the role of provider beliefs in medical decision-making.

Age Factors↗