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PubMedDate not supplied

Acquisition and integration of low vision assistive devices: understanding the decision-making process of older adults with low vision.

The purpose of this study was to describe how older adults with low vision make decisions to use low vision assistive devices (LVADs). Analysis of participants' narratives, from both group and individual interviews, revealed three topic areas affecting device use. Two are discussed in this paper: Experiences and Characteristics Leading to Successful LVAD Use Decision Making and Challenges to Successful LVAD Use Decision Making. The third, Adjustment to Low Vision Disability, is briefly discussed. Of particular importance to occupational therapy practitioners in the growing field of low vision rehabilitation was the value placed on low vision rehabilitation services to assist with acquiring devices and integrating them into daily routines. Occupational therapy services were highly regarded. Participants demonstrated the importance of becoming a part of a supportive network of people with low vision to gain access to information about resources. They emphasized the need for systems and policy changes to reduce barriers to making informed decisions about LVAD use. Results indicate that occupational therapists working in low vision can support clients by facilitating development of a support network, acting as liaisons between clients and other health practitioners, especially ophthalmologists, and encouraging policy development that supports barrier-free LVAD acquisition and use. These topics should be incorporated into continuing and entry-level education to prepare practitioners for leadership in the field of low vision rehabilitation.

Aged↗

PubMed2002

The decision-making process when starting terminal care as assessed by nursing staff.

This article deals with making decisions about starting terminal care. The results are part of a larger survey on nurses' conceptions of terminal care in community health centres in Finland. The importance, frequency and timing of decision making as well as communication and the number of investigations and procedures carried out are examined. The relationship between decision making and the size of a health centre's catchment population is also discussed. The results make it possible to compare the current situation in Finland with the national law on patients' rights. The sample consisted of 328 nurses who worked on the wards of 32 community health centres. The data were collected by means of a structured questionnaire and processed with the Statistical Package for Social Sciences software. The nurses agreed that explicit decision making and documentation about starting terminal care were necessary, but it was highlighted that the practice had many shortcomings. Decisions were often made too late and the patients were not always aware of their situation; family members and the nursing staff were mostly better informed. It was noted that many investigations and other procedures were carried out on terminally ill patients, often at the request of family members. Decision making was found to have some relationship to the size of a health centre's catchment area.

Adult↗

PubMed1994

Family decision making about living related kidney donation.

Little information is available on how families make decisions about living related kidney donation. The purpose of this study, therefore, was to explore the family decision making process in identifying and selecting a living related kidney donor, to identify factors that assist or inhibit the decision making, and to explore issues and concerns raised by families about the experience. The qualitative method of grounded theory was used. Ten recipients, their living related donors, and their family members were interviewed individually and as a group prior to and after the transplant. Four decisions were required of most families. Three decision-making patterns--straightforward, moderately straightforward, and complex were identified as well as the factors that influenced the process.

Adult↗

PubMed2003

Observations, confirmations and strategies - useful tools in decision-making process for nurses in practice?

The aim of the study was to describe how nurses make decisions on measures in clinical practice. The data-collection method consisted of audio-taped interviews with six nurses. The interviews were then transcribed verbatim. The questions in the interviews were based on nursing situations observed earlier when the nurses initiated and implemented patient-related measures and the focus was on the nurses' experience of decision making. A content analysis was performed. The results show that the nurses' decisions on measures were based on three themes: observation of cues related to the patient's situation, confirmation of information gathered and implementation of action strategies. The results are discussed in relation to earlier empirical research on decision-making activities in the nurse's clinical practice and the nurse's utilization of knowledge during the decision-making process. It is concluded that the nurse's awareness of the patient's situation, together with a well-founded basis for decisions, can have positive effects on the nursing care provided by the nurse.

Cues↗

PubMed2004

Making decisions with families at the end of life.

Because advance directives are not yet the norm, end-of-life decisions for patients without medical decision-making capacity are made regularly within discussions between the patient's physician and family. Communication and decision making in these situations require a complex integration of relevant conceptual knowledge of ethical implications, the principle of surrogate decision making, and legal considerations; and communication skills that address the highly charged emotional issues under discussion. The most common pitfalls in establishing plans of care for patients who lack decision-making capacity include failure to reach a shared appreciation of the patient's condition and prognosis; failure to apply the principle of substituted judgment; offering the choice between care and no care, rather than offering the choice between prolonging life and quality of life; too literal an interpretation of an isolated, out-of-context, patient statement made earlier in life; and failure to address the full range of end-of-life decisions from do-not-resuscitate orders to exclusive palliative care.

Decision Making↗

PubMed2005

What do patients consider when making decisions about treatment for hepatitis C?

PURPOSE: There are few data describing decision-making in chronic hepatitis C infection from the patient's perspective. In this study, we sought to investigate the factors that influence patients' decisions as they consider treatment for hepatitis C infection. SUBJECTS: Consecutive patients attending outpatient liver clinics were recruited. Purposeful sampling was employed to include patients who were currently being treated or had recently been treated for chronic hepatitis C infection with pegylated-interferon and ribavirin as well as patients who had refused therapy. METHODS: We conducted focus groups until thematic saturation was reached. All focus groups were facilitated by the same PhD-level senior research scientist, and constant comparative methods were used to analyze the data. RESULTS: A total of 40 patients (80% male) participated in 8 focus groups. The factors influencing patients' decision-making that emerged most frequently during the focus groups were consideration of risk benefit tradeoffs, protected values, heuristics, participants' conceptualization of hepatitis C infection, social issues, and physicians' recommendations. CONCLUSION: Ideally, complex decision-making is based on careful consideration of the tradeoffs related to available options. Our findings suggest that patients' treatment decisions are influenced by multiple factors besides the risks and benefits of interferon and ribavirin. By being aware of these factors physicians can improve decision-making in hepatitis C infection by 1) determining whether patients' decisions are biased by heuristics or protect values, 2) understanding how patients' conceptualization of their illness influences their attitudes toward therapy, and by 3) ensuring that patients understand that social responsibilities need not necessarily preclude treatment because therapy can be discontinued if adverse effects become intolerable.

Adult↗

PubMed2006

Claiming health: mammography screening decision making of African American women.

PURPOSE/OBJECTIVES: To develop a substantive theory that explains how African American women aged 50 years and older of different socioeconomic status (SES) make decisions about mammography screening. DESIGN: Qualitative, grounded theory. SETTING: Churches, places of employment, or women's homes in a large city in Ohio. SAMPLE: 30 women aged 52-72 years; 16 in the initial sample and 14 in the theoretical sample. METHODS: Audiotaped interviews and extensive written field notes; interviews were transcribed verbatim and analyzed using the constant comparison method, resulting in saturation of data. MAIN RESEARCH VARIABLES: Decision-making processes explaining mammography screening. FINDINGS: "Claiming health" emerged as the substantive theory explaining decisions that affect mammography screening and was embedded in the social contexts of cultural heritage and learned kinship values, religious beliefs and supports, and prior negative experiences with healthcare professionals and the healthcare system. Claiming health involved sisterhood and fellowship relationships fostered in the church. Claiming health was differentiated by age and SES, with older women of lower SES reporting greater reliance on cultural heritage and negative recollections of the healthcare system when making decisions regarding mammography. Each subconcept of claiming health was equally important and influenced decision making. CONCLUSIONS: Oncology nurses can benefit from the information presented by assisting older women of lower SES who may have encountered negative experiences in the healthcare system to develop effective assertiveness and communication skills when interacting with healthcare professionals. IMPLICATIONS FOR NURSING: Further research is needed to determine whether claiming health is a way of thinking about health generally or is used solely to explain experiences with mammography screening.

Black or African American↗

PubMed2004

Dealing with doubt: making decisions in a neonatal ward in The Netherlands.

Neonatology provides intensive care for newborns. Most of the patients in a neonatal ward have been born prematurely. In this article decision-making concerning children born very prematurely (at fewer than 28 weeks, 12 or more weeks too early) is described. Three phases of daily practice are discussed: birth, treatment and referral or death. The article is based on ethnographic research conducted in the neonatal ward of the Amsterdam University Hospital. This ward's policy is to refrain from starting life-prolonging treatment for some children. This is done when staff members consider their chances too small. When life-prolonging treatment is started it is done provisionally and with trial-like features. Staff members want to judge the acceptability of the child's future quality of life. If they think it is unacceptable, they want to stop life-prolonging treatment. Parents play an important role in decision-making because their consent is needed for such decisions. More importantly, staff members need parental input about what, for that particular child and those parents, is seen as a good, bad or acceptable quality of future life. Decision-making shows a specific characteristic. Parents are informed about their child in sober terms and because they have considerable opportunities to influence decision-making it is argued that the processes taking place in the ward reflect the Dutch 'negotiation culture'.

Anthropology, Cultural↗

PubMed2004

A guide to assessing decision-making capacity.

Many patients have uncertain capacity to make decisions about their care. Determining whether a patient possesses decision-making capacity challenges even the most seasoned of physicians. We illustrate an algorithm devised by Miller and Marin (Emerg Med Clin North Am 2000; 18:233-241) that assesses the patient's understanding of his or her condition, ability to process information, and stability of decision-making to determine whether he or she possesses adequate decision-making capacity. Although this algorithm is better than previous approaches, it has limitations and potential problems with its implementation.

Algorithms↗

PubMed1991

Decision-making competence and self-esteem: a comparison of parents and adolescents.

This study examined the relationship between parents' and adolescents' confidence and competence in making decisions. Data were obtained from a survey sample of 584 adolescents, aged 12-18 years living in Adelaide, South Australia. Data were obtained from a sample of 352 parents of the adolescents by means of a mail survey. Parents' decision-making self-esteem was related to the self-esteem of young adolescents. The relationship was stronger for males than females. There was a relationship between mothers' decision-making competence and the competence of young female adolescents. Thus, partial support was provided for modelling theory in regard to the role of parents in the socialization of decision-making skills and confidence.

Adolescent↗

PubMed2001

Philosophy for managers? An exploration of what the great philosophers can do to assist ethical decision making.

Ethics is attracting increasing attention in management of both public- and private-sector organisations. For managers within health-care systems, ethical issues can be most acute, especially given the human nights issues involved in new legislation. This paper explores some of the ways in which philosophy may potentially offer guidelines to managers faced with the need to make decisions ethically. It draws on a small number of philosophical perspectives to demonstrate how they can assist in informing ethical decision making, and illustrates its arguments through one topic, suicide prevention, an area of relevance to health managers but one that is beset by some of the most profound ethical dilemmas. The ways in which philosophy may assist in decision making in this one example are, it is argued, generalisable to many other health issues where complicated decisions have to be made. The paper develops a philosophical framework consisting of the ethical considerations of "self-love", "humanity", "the value of human life" and "duty to others" and demonstrates, through the use of two hypothetical case studies, how these can be applied to a decision-making process so as to reduce inconsistencies in attitudes and practice.

Decision Making↗

PubMed2005

Reimbursement and clinical guidance for pharmaceuticals in Sweden: do health-economic evaluations support decision making?

Introduction of the new Pharmaceutical Benefits Board (LFN; 1 October 2002) has markedly changed the principles of pricing and reimbursement of drugs in Sweden. The Board is required to make decisions based on information on cost-effectiveness, and pharmaceutical companies must submit economic evaluations when relevant as part of their applications for reimbursement. This study examined experience to date regarding the use of health-economic evaluations and cost-effectiveness information by the LFN. We also describe activities and the use of cost-effectiveness analysis by Swedish local formulary committees organized by the 21 county councils. It is concluded that economic evaluations have supported decision making by LFN, although cost-effectiveness seems to be of varying importance in different situations. While the use of health-economic evaluations and the outcome of decision making by LFN are similar to comparable committees in other countries, there is presently a gap in this sense between the LFN and Swedish local formulary committees. Coordinated decision making is much needed but may be difficult to implement as the perspective, expertise, and objectives of the two public authorities differ.

Cost Control↗

PubMedDate not supplied

Patient roles in decision-making.

Participation by patients in making decisions about treatment is widely encouraged. However, there is little evidence from patients about their preferences with respect to this. This study used a card-sort approach to explore the actual and preferred participation in making decisions about treatment among a sample of 405 patients with renal disease. The study identified that the majority preferred to adopt a passive role in decision-making. The findings highlight the need for nurses to identify individual patient preferences with respect to participation and to explore why a person may choose to adopt a particular decision-making role.

Adolescent↗

PubMedDate not supplied

Low-income women with early-stage breast cancer: physician and patient decision-making styles.

BACKGROUND: Poor women have low rates of breast conservation therapy not explained by differences in insurance status or treatment preferences. The purpose of this study was to explore how low-income women make decisions about breast cancer treatment. METHODS: Twenty-five women diagnosed with early-stage breast cancer through the Nebraska Every Woman Matters program were interviewed about their experiences selecting treatment options. These interviews were transcribed and then analysed using established qualitative techniques. RESULTS: More than half of the women (n=16) described playing a passive role in decision making. Choice was determined by medical factors or not offered by their physicians. Intense emotional distress affected some women's ability to compare options. The women who did engage in a rational decision-making process (n=9) based their choices on concerns about body image and fear of recurrence. CONCLUSIONS: When presented with a choice, and when able to objectively weigh treatment options, low-income women base their treatment decisions on the same issues as those of higher income. Whether differences in income strata alter the doctor-patient power dynamic in favor of physician control over decision making, or whether low-income women are less prepared to engage in a rational deliberative process warrants further study.

Adult↗

PubMed2001

A study of the use of past experiences in clinical decision making in emergency situations.

Making decisions to call emergency assistance to patients is an important dimension of nursing practice. Most usually these decision making situations are uncertain and it is expected nurses rely on past clinical experiences. This study, approved by the ethics committees of both a university and an area health service, aimed to describe nurses' reliance on past experiences and identify associated judgement strategies (heuristics). Thirty-two registered nurses with five or more years experience were interviewed. Main findings were: nurses did use their past experiences and these experiences were used in the form of the three "classic" heuristics, representativeness, availability and anchoring and adjustment. It can be concluded past experiences are intrinsic to decision making and this has implications for both the clinical components of nursing educational programs and staffing allocations made by administrators. Some nurses, however, did not include referral to past experiences in their decision-making accounts which may be a limitation of the study design.

Adaptation, Psychological↗

PubMed1979

The overburdened manager and decision making.

This article discusses three methods managers can use to make decisions: intuition, management analysis, and Type 1 and Type 2 error analysis. Olson identifies studies that have shown that top managers work at an unrelenting pace and jump from one activity to another. He claims that managers do not have time to plan in a reflective, systematic manner. In fact, in his view, decision makers usually react intuitively to situations that can no longer be ignored. The author presents evidence that top managers prefer verbal media such as telephone calls and meeting for decision making because of their timeliness. He points out that the strategic data bank of the organization is largely in the mind of the manager. As a consequence, he states, an effective analysis requires that the manager communicate to the analyst the relevant data stored in his head. This process often makes it easier for the manager to solve the problem himself rather than delegate it to others. Olson identifies five organizational conditions that enable a top manager to effectively delegate problem solving tasks to management analysts: (1) the analyst must have the confidence of the same people who influence the manager; (2) the analyst must be able to adapt the techniques to the specific needs of the manager; (3) there must be sufficient time for the analyst to structure the problem and evaluate the alternatives; (4) the analyst must share in information gathered by the manager from verbal contacts; and (5) the manager must be part of an organization large enough to make it profitable for him to seek assistance from an analyst. When the above organizational conditions are not met, the author suggests Type 1 and Type 2 error analysis. He promotes this form of analysis as a method for using logic and intuition to consider various forms of information. This management tool is named for Type 1 error (accepting a proposal that should have been rejected) and Type 2 error (rejecting a proposal that should have been accepted). The author advocates the use of this methodology because, in his view, it focuses the attention of the manager on the facts when a decision needs to be made. In this process, the manager must identify and evaluate the likelihood and consequences of each alternative strategy. Olson sees Type 1 and Type 2 error analysis as providing explicit logic to strengthen the intuitive decision making process.

Administrative Personnel↗

PubMedDate not supplied

The process of decision-making by emergency nurses.

The manner in which emergency nurses make decisions is a fundamental component of their practice but has not been widely researched. A review of nursing literature revealed that the decision model used by nurses in other clinical areas was a hypothetico-deductive method of clinical reasoning. It appeared cogent to determine whether the hypothetico-deductive decision-making theory held true for emergency nursing. Accordingly, the overall objective in this study was to establish the method of decision-making used by emergency nurses. A modified grounded theory framework was chosen to validate the model put forward by White et al. Three participants, all clinical nurse specialists, were given five clinical situations to respond to and asked to describe and discuss their thoughts when arriving at a diagnostic conclusion. The results demonstrated that the use of the hypothetico-deductive model of clinical reasoning, utilising verbal, non-verbal and other sources of information, was used by clinical nurse specialists in the emergency setting.

Decision Making↗

PubMed1993

Do clinical and formal assessments of the capacity of patients in the intensive care unit to make decisions agree?

BACKGROUND: The complex environment and technology of intensive care unit (ICU) care may impair the ability of patients to participate in medical decision making or give informed consent. We studied the agreement of the intuitive assessments of residents and nurses of ICU patients' cognition, judgment, and decision-making capacity, and whether those assessments agreed with abbreviated formal mental status testing. METHODS: Using a prospective survey case study, we assessed 200 English-speaking patients within 24 hours of their ICU admission. Formal assessment of cognition, judgment, and insight was performed by a research assistant. We obtained independent intuitive ratings by nurses and residents of patient cognition, judgment, and ability to participate in medical decision making or give informed consent. RESULTS: Residents' and nurses' assessment of cognition and judgment showed a high degree of agreement with weighted ks of greater than 0.76. Assessments of cognition by residents and nurses agreed with Folstein Mini-Mental State Examination in 70% and 73.6% of cases, respectively. Forty percent of the population had an unimpaired Mini-Mental State Examination score of greater than 23, and an additional 12% of the subjects were mildly impaired with scores of 20 to 23. When asked whether they would approach patient or family for consent for an invasive procedure, nurses and physicians said they would request informed consent from 66% and 62% of the patients, respectively. CONCLUSIONS: Residents and nurses caring for patients newly admitted to the ICU agree in their assessment of cognition, judgment, and capacity to participate in medical decision making, and are not unduly influenced by ventilator status. Their assessments correlate highly with abbreviated formal mental status testing.

Cognition↗