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Results for “Decision Making”

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PubMed2003

Participation by clients and nurse midwives in family planning decision making in Indonesia.

In order to enhance understanding of the quality of decision making during family planning consultations in developing countries, provider competencies and client behaviors during 179 randomly selected consultations in Indonesia were assessed. Results show that family planning clients make a significant contribution to the quality of the decision-making process, most notably by identifying the problem requiring a decision, expressing their feelings about using a method, and asking questions. Client involvement may compensate for provider weaknesses, which tend to be in areas calling for interpersonal rather than technical skills. However, the programmatic ideal of informed choice has not yet been realized. Supervisors, trainers, communicators, and program managers can improve the quality of decision making by: creating opportunities for client involvement during consultations, strengthening providers' ability to fully inform clients about their options, and making providers aware of the opportunities for decision making in consultations with continuing clients.

Adolescent↗

PubMed2006

Second-year baccalaureate nursing Students' decision making in the clinical setting.

This qualitative, intrinsic case study explored the decision-making activities of baccalaureate nursing students in the second year of a 4-year program. It sought to discover how second-year students determine the need to make a clinical decision, how they respond to a pending clinical decision, the types of decisions made in the clinical setting, and the factors that enhance or impede decision making. The study involved 12 students, all of whom were enrolled in their first clinical rotation on an inpatient unit and completed journals and interviews. Inductive analysis revealed three key encounters that demonstrated students' decision making: encounters with the patient, nursing staff, and clinical tutor. Each encounter revealed an emotion-based and knowledge-based response to various clinical situations. Decisions were evident within each of the three encounters. Implications for curriculum development and clinical tutors are described.

Attitude of Health Personnel↗

PubMed1979

Sociologic influences on decision-making by clinicians.

Recent articles on clinical decision-making have proposed sophisticated quantitative methods for improving the physician's clinical judgment. Actual clinical decisions, however, are influenced by interactions between the clinician, the patient, and the sociocultural milieu as well as by biomedical considerations. This paper explores these sociologic influences on the decision-making process. Four types of sociologic factors influence the clinician's judgment: the characteristics of the patient; the characteristics of the clinician; the clinician's interaction with his profession and the health care system; and the clinician's relationship with the patient. To illustrate sociologic influences on clinical decision-making, this paper presents observations from the literature of sociology, clinical psychology, psychiatry, and medicine. Further studies are needed to provide additional empirical information.

Attitude of Health Personnel↗

PubMed1999

Clinical capital equipment acquisition: decision-making at the executive level.

Capital investment in the United States health care industry is one of the components of the system that has historically fueled cost increases and complicated the quality/cost/access conundrum. This article is concerned with capital development focused on clinical equipment acquisition in acute care hospitals. The research findings suggest that decision-makers are abandoning two approaches to decision-making known as Quantitative Decision-Making and Mixed Scanning in favor of two models known as Rational Decision-Making and Political Decision-Making. While this is the case, a method of decision-making known as Idea Sets (developed and labeled by James March as Garbage Can Decision-Making) is the most widely used approach. Equipment acquisition criteria used by the decision-makers are shifting away from concerns of enhancing existing clinical programs and/or adding new clinical programs. Acquisition criteria are shifting toward procuring equipment which will decrease institutional expense, improve organizational efficiency, and galvanize operational effectiveness. In addition to the technical findings of the research, further insights about ourselves and our colleagues are gleaned. Accordingly, we understand more completely the human dynamics surrounding decisions and thus are able to dialogue more richly about issues. Meaningful dialogue such as this will have the dual benefit of advancing teamwork and facilitating decision-making.

Capital Expenditures↗

PubMed1988

An ethical model for decision-making.

The increasing social and technological complexity of health care is requiring health care providers to make many ethical decisions. This article presents a brief overview of selected ethical principles and theories, as well as several decision-making models. A 10-question model to assist the practitioner in assessing the moral aspects of an ethical dilemma is described and this model is applied to a clinical situation which involves the principles of confidentiality, autonomy, and prevention of harm.

Aged↗

PubMed1995

Information and decision-making preferences of men with prostate cancer.

PURPOSE/OBJECTIVES: To determine whether a relationship exists between preferences for involvement in decision making and type of information in patients with cancer. DESIGN: Survey, correlational. SETTING: Community urology clinic in Winnipeg, Manitoba, Canada. SAMPLE: Convenience sample of 57 men (mean age of 71 years). METHODS: Subjects completed a card sort to elicit their preferred role in treatment decision making. A two-part questionnaire measured the type and amount of information preferred. FINDINGS: The majority (57.9%) of men preferred a passive decision-making role. Information on disease advancement, likelihood of cure, and types of treatment available were the three preferred categories of information. Men in the collaborative group and those who wanted their physician to make treatment decisions-only after seriously considering their opinions-also wanted significantly more information in these three categories. Married men ranked self-care information as significantly less important than did single men. Information preferences were similar regardless of preferred decision-making role. CONCLUSIONS: Although the majority of men in this sample wanted their physician to make final treatment decisions, they did want to be informed. Information preferences were similar to other groups of patients with cancer. Future clinical studies are required to determine if providing these men with more information will enable them to assume a more active decision-making role. IMPLICATIONS FOR NURSING PRACTICE: Given the small variance in decision-making and information preferences accounted for by sociodemographic and treatment/disease-related factors, individual assessment of these preferences remains the best clinical approach.

Aged↗

PubMed1993

Lay participation in health care decision making: a conceptual framework.

Lay participation in health care decision making has attracted increasing interest in Canada, with numerous provincial government reports advocating this initiative. Interest stems from a number of factors. Among them is a growing recognition that patient preferences ought to be incorporated into decision making that involves individual treatment choices. Another factor is the desire to increase public accountability for decisions on the allocation of health care resources, in order to make providers more accountable to the communities they serve. There is, however, still considerable confusion over what lay participation really means. In addition, little consideration has been given to whether and how lay participation can lead to better decision making and the criteria by which it should be judged. This article presents a framework based on decision-making domains, role perspectives, and levels of participation and is intended as an initial step toward providing greater conceptual clarity regarding the key dimensions and goals of lay participation in health care decision making.

Canada↗

PubMed2006

Parents' reactions to participating in interviews about end-of-life decision making.

BACKGROUND: Although in-depth interviewing is well suited to studying the sensitive topic of end-of-life decision making, no reports have been published assessing the effects on parents of participating in interviews regarding end-of-life decision making for critically ill children. OBJECTIVE: To examine the reactions of pediatric intensive care unit (PICU) patients' parents to interviews on end-of-life decision making for their child. METHODS: We conducted semistructured interviews on end-of-life decision making with PICU patients' parents from two tertiary care PICUs. We approached 117 parents of 102 patients. Seventy-four parents (63%) of 69 patients participated. RESULTS: Forty-three parents (61%) described the interview as "a good experience," 20 (29%) as "a neutral experience," and 1 (1%) as "a bad experience." The parent who judged the interview negatively stated that, "It bothers me a little bit because my son is [out] there having difficulties and I'm in here and not out there." Fifty-four of 59 parents (92%) said they would participate in another similar interview. Most parents (92%) felt the medical community should continue research on end-of-life decision making. Themes identified from the responses included: emotional reaction to the interviews; exposure to end-of-life decision-making issues; impact on parents' views; and impact on future end-of-life decision making. Parents' comments suggested that many perceived the interviews as beneficial. CONCLUSIONS: This study demonstrates the willingness of many parents of critically ill children to participate in study interviews regarding end-of-life decision making, a topic that most parents felt was important and warranted more research.

Adult↗

PubMed1998

Education for clinical decision making in midwifery practice.

OBJECTIVE: To present an approach to developing clinical decision-making skills in midwifery students. DESCRIPTION: Use of simulations, 'thinking aloud' technique, reflection and the decision rules of experienced midwives are proposed for developing clinical-reasoning skills and acquiring skilled clinical knowledge. IMPLICATIONS: Educators are encouraged to recognise that skill acquisition in clinical decision making requires practise before students engage fully in the clinical setting. The process of decision making is emphasised as essential for students to experience so they develop an understanding of the clinical information attended to, the sequence in which the information is processed and the rules used to combine information to reach clinical judgements. By using clinical simulations developed from 'real cases' the process of decision making is able to be experienced by students. Further, if these simulations are accompanied by the collection of verbal protocols, students have opportunities to retrospectively explore their decision making with reflection. In addition, the presentation and use of decision rules of experienced midwives has the potential to enhance the development of skills in students.

Clinical Competence↗

PubMedDate not supplied

The quality and coping patterns of women's decision-making regarding breast cancer surgery.

This study addressed issues regarding the decision-making process used by women who had mastectomy as their surgical treatment for breast cancer. The seven criteria for quality decision-making and the conflict model proposed by Janis and Mann (1977) were used as the study's conceptual framework along with the notion by Simon (1957) of 'bounded rationality'. Four coping patterns emerged: vigilance (actively searches for information and advice), satisficing (being satisfied, chooses first solution that meets the desired objectives), complacency (accepts advice without questions or fully comprehending), and defensive avoidance (rationalises and avoids discussion and consideration of the problem). The participants primarily left the decision for surgical treatment of breast cancer to their surgeons using satisficing, complacency and defensive avoidance. When the option of lumpectomy was offered to some of the participants (34%), they rejected this treatment alternative using the coping patterns of satisfying and defensive avoidance. Those women who were not offered lumpectomy (66%) did not seek a rationale for not being given this alternative. The findings indicated that the women's decision-making process was halted in Stage 2 of the criteria for quality decision-making actively searched for and viewed a number of alternatives. The study's findings are discussed in relation to improving the quality of the decision-making process for women regarding their breast cancer surgical treatment.

Adaptation, Psychological↗

PubMed2005

The process of decision making in reproductive medicine.

The decision-making process regarding the optimal infertility treatment strategy is influenced by several factors. In addition to the underlying cause of infertility, the process of decision making is also influenced by other factors. These factors are mainly (1) the duration of infertility, (2) patient's age, and (3) the number of previously performed treatment cycles of intrauterine insemination (IUI) or in vitro fertilization (IVF). The duration of infertility influences diagnostic steps as well as therapeutic options. With an infertility of at least 5 years the benefit of intrauterine insemination is limited and couples should be counseled to go forward with IVF. Patients age >or= 40 years should be treated with IVF, whereas patients age >or= 43 years should be counseled about their very limited chance to conceive even through IVF. The number of insemination cycles should be limited to four. Couples who have undergone at least six IVF cycles should be counseled to discontinue therapy. The treatment program should be as individualized as possible, with individual counseling that is adapted after each single treatment cycle.

Decision Making↗

PubMed2006

Shared decision-making and evidence-based practice.

Shared decision-making refers to a process of health care delivery in which practitioners and clients seeking help for problems or disorders collaborate to access relevant information and to enable client-centered selection of health care resources. Though nearly all clients express a desire for more information, preferences for participation in health care decisions vary by individual and by illness. Two common strategies to promote shared decision-making are communication training for clients and clinicians, and decision aids to provide targeted information and values clarification. Research in several areas of medicine shows that active client participation results in a variety of benefits, from increased satisfaction to decreased symptom burden. Many current mental health interventions promote client-centered care, client choice, and self-directed care, but research on shared decision-making in mental health for clients with severe and persistent mental illness is just beginning.

Cooperative Behavior↗

PubMed1998

Decision-making models in different fields of nursing.

The purpose of this study was to identify the decision-making models used by nurses in different fields of nursing and to find out which variables explain the use of those models. The instrument for the project was developed on the basis of existing decision-making theories and earlier studies on nurses' decision making. The sample consisted of 483 Finnish nurses from five fields of nursing: long-term care, short-term medical-surgical care, critical care, health care, and psychiatric care. The statistical analyses consisted of factor analysis, factor scores, and correspondence analysis. Five different models of nursing decision making were identified. The nature of the nursing task and the nursing context showed associations with decision making on all models. The structure of knowledge and nurses' practical experience did not provide an explanation for nurses' decision making on any model.

Critical Care↗

PubMed1997

Complexity of ethical decision making in psychiatry.

Psychiatric residents and psychiatrists have little difficulty in making judgments about a clinical course of action to take with patients. However, making ethical clinical decisions is more challenging, because psychiatric residents are usually provided little formal training in ethics. Further, many ethical dilemmas are complex, requiring knowledge of the psychiatric profession's ethics code, moral principles, law, and practice standards and of how they should be weighed in the decision-making process. The purpose of this article is to demonstrate this complexity in regard to the identification of potential ethical dilemmas, understanding the issues that these dilemmas raise, and formulating potential solutions to them. Two common but important areas of treatment in which ethical dilemmas arise (informed consent and competence of care) are used as examples for our presentation. The article demonstrates that to successfully engage in ethical analysis in psychiatry is impossible without substantial formal training in the process.

Altruism↗

PubMed2003

Speed versus accuracy in collective decision making.

We demonstrate a speed versus accuracy trade-off in collective decision making. House-hunting ant colonies choose a new nest more quickly in harsh conditions than in benign ones and are less discriminating. The errors that occur in a harsh environment are errors of judgement not errors of omission because the colonies have discovered all of the alternative nests before they initiate an emigration. Leptothorax albipennis ants use quorum sensing in their house hunting. They only accept a nest, and begin rapidly recruiting members of their colony, when they find within it a sufficient number of their nest-mates. Here we show that these ants can lower their quorum thresholds between benign and harsh conditions to adjust their speed-accuracy trade-off. Indeed, in harsh conditions these ants rely much more on individual decision making than collective decision making. Our findings show that these ants actively choose to take their time over judgements and employ collective decision making in benign conditions when accuracy is more important than speed.

Animal Communication↗

PubMed2006

Neuropsychological predictors of decision-making capacity over 9 months in mild-to-moderate dementia.

BACKGROUND: Older adults with dementia may have diminished capacity to make medical treatment decisions. OBJECTIVE: To examine rates and neuropsychological predictors of treatment decision making, or consent capacity, among older adults with dementia over 9 months. DESIGN: Consent capacity was assessed initially and 9 months later in subjects with and without dementia using a longitudinal repeated measures design. PARTICIPANTS: Fifty-three older adults with dementia and 53 similarly aged adults without dementia. MEASUREMENTS: A standardized measure MacArthur Competence Assessment Tool-Treatment of 4 legal standards for capacity (Understanding, Appreciation, Reasoning, and Expressing a Choice) and a neuropsychological battery. RESULTS: In the dementia group, 9.4% had impaired capacity initially, and 26.4% had impaired capacity at 9 months. Mean scores in the dementia group were impaired relative to controls initially and at 9 months for Understanding (initial t=2.49, P=.01; 9-month t=3.22, P<.01) and Reasoning (initial t=2.18, P=.03; 9-month t=4.77, P<.01). Declining capacity over 9 months was attributable to a further reduction in Reasoning (group x time F=9.44, P=.003). Discriminant function analysis revealed that initial scores on naming, delayed Logical Memory, and Trails B were associated with impaired capacity at 9 months. CONCLUSIONS: Some patients with mild-to-moderate dementia develop a clinically relevant impairment of consent capacity within a year. Consent capacity in adults with mild-to-moderate dementia should be reassessed periodically to ensure that it is adequate for each specific informed consent situation. Interventions that maximize Understanding and Reasoning by supporting naming, memory, and flexibility may help to optimize capacity in this patient group.

Aged↗

PubMed2005

Shared decision making: empowering the bedside nurse.

Shared decision making is a process that has empowered specialty nurses at the Mayo Clinic in Rochester, MN, to solve a practice concern. Staff nurses recognized a lack of concise, collated information available that described what nurses need to know when caring for patients receiving chemotherapy. Many aspects of the administration process were knowledge and experience based and not easily retrievable. The Hematology/Oncology/Blood and Marrow Transplant Clinical Practice Committee identified this as a significant practice issue. Ideas were brainstormed regarding how to make the information available to nursing colleagues. The Chemotherapy Yellow Pages is a resource that was developed to facilitate the rapid retrieval of pertinent information for bedside nurses. The content of this article outlines a'model of shared decision making and the processes used to address and resolve the practice concern.

Decision Making↗

PubMed1998

Role of written advance directives in decision making: insights from qualitative and quantitative data.

OBJECTIVE: To understand the role of written advance directives (ADs) in medical decision making through examination of qualitative and quantitative data sources. We specifically wanted to address whether physicians unilaterally disregard advance directives. DESIGN: Block randomized controlled trial to improve decision making and outcomes of seriously ill patients. SETTING: Five academic medical centers. PATIENTS: Fourteen hospitalized, seriously ill adults were randomized to receive an intervention of patient-specific information on prognoses and specially trained nurse to facilitate decision making. To be included in this analysis, patients reported having an AD and also met one of these criteria of severity: were comatose, had objective estimate of prognosis for surviving 2 months of 40% or less, or died during this hospital admission. MEASUREMENTS AND MAIN RESULTS: Quantitative data sources consisted of medical record review and interviews with the patient (when possible), surrogate, and responsible physician about prognosis, symptoms, preferences, and decision making. Qualitative data consisted of narratives by the nurse responsible for counseling and facilitating decision making. Each element of the quantitative database was reviewed, and a timeline of communication and decision making was constructed. Qualitative data were analyzed using grounded theory and narrative summary analysis. We compared and contrasted qualitative and quantitative data to better understand the role of ADs in decision making. In each case, the patient had a period of diminished capacity in which ADs should have been invoked. Advance directives played an important role in decision making of 5 of 14 cases, but even in those cases, life-sustaining treatment was stopped only when the patient was "absolutely, hopelessly ill." In two of these cases, the family member wrongly reported that the patient had an AD, and in the remaining seven cases, ADs had a limited role. The limited role could not be traced to a single explanation. Rather, a complex interaction of several factors was identified: patients were not considered hopelessly ill, so the directive was never seen as applicable and a transition in the goals of care did not occur; family members or the designated surrogate were not available, were ineffectual, or were overwhelmed; or the content of the AD was vague, or not applicable to the clinical situation, and the intent in completing the AD was never clarified. A physician did not unilaterally disregard a patient's preference in any of the cases. Two factors that enhanced the role of the AD were an available surrogate who was able to advocate for the patient and open communication between the physician and the surrogate in which the patient's prognosis was reconsidered. CONCLUSIONS: Our findings indicate that physicians are not unilaterally disregarding patients' ADs. Despite the patients' serious illnesses, family members and physicians did not see them as "absolutely, hopelessly ill." Hence, ADs were not considered applicable to the majority of these cases. Cases in which ADs had an impact evidenced open negotiation with a surrogate that yielded a transition in the goals of care.

Adult↗