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Results for “Decision Making”

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PubMed1985

Improving clinical decision making in nursing.

This article describes the need for effective clinical decision making among nurses. The author believes that responses to the need should begin at the educational level, and offers some thoughts to nurse educators for improvement. Exploring the theory base for decision making with students and coordinating teaching-learning strategies with real opportunities in clinical settings are some of the suggestions made. Nurse educators are urged to encourage competency in decision making and to become role models for others.

Clinical Competence↗

PubMed1998

Judgment and decision making.

For many decades, research in judgment and decision making has examined behavioral violations of rational choice theory. In that framework, rationality is expressed as a single correct decision shared by experimenters and subjects that satisfies internal coherence within a set of preferences and beliefs. Outside of psychology, social scientists are now debating the need to modify rational choice theory with behavioral assumptions. Within psychology, researchers are debating assumptions about errors for many different definitions of rationality. Alternative frameworks are being proposed. These frameworks view decisions as more reasonable and adaptive that previously thought. For example, "rule following." Rule following, which occurs when a rule or norm is applied to a situation, often minimizes effort and provides satisfying solutions that are "good enough," though not necessarily the best. When rules are ambiguous, people look for reasons to guide their decisions. They may also let their emotions take charge. This chapter presents recent research on judgment and decision making from traditional and alternative frameworks.

Choice Behavior↗

PubMed2000

End-of-life decision making: a qualitative study of elderly individuals.

OBJECTIVE: To identify the desired features of end-of-life medical decision making from the perspective of elderly individuals. DESIGN: Qualitative study using in-depth interviews and analysis from a phenomenologic perspective. SETTING: A senior center and a multilevel retirement community in Los Angeles. PARTICIPANTS: Twenty-one elderly informants (mean age 83 years) representing a spectrum of functional status and prior experiences with end-of-life decision making. MAIN RESULTS: Informants were concerned primarily with the outcomes of serious illness rather than the medical interventions that might be used, and defined treatments as desirable to the extent they could return the patient to his or her valued life activities. Advanced age was a relevant consideration in decision making, guided by concerns about personal losses and the meaning of having lived a "full life." Decision-making authority was granted both to physicians (for their technical expertise) and family members (for their concern for the patient's interests), and shifted from physician to family as the patient's prognosis for functional recovery became grim. Expressions of care, both by patients and family members, were often important contributors to end-of-life treatment decisions. CONCLUSIONS: These findings suggest that advance directives and physician-patient discussions that focus on acceptable health states and valued life activities may be better suited to patients' end-of-life care goals than those that focus on specific medical interventions, such as cardiopulmonary resuscitation. We propose a model of collaborative surrogate decision making by families and physicians that encourages physicians to assume responsibility for recommending treatment plans, including the provision or withholding of specific life-sustaining treatments, when such recommendations are consistent with patients' and families' goals for care.

Aged↗

PubMed2004

Social and emotional decision-making following frontal lobe injury.

Neuropsychological, psychophysiological and functional imaging research has begun to offer insights into the everyday difficulties in decision-making experienced by some patients with frontal lobe damage. It is widely accepted that the ventral prefrontal cortex plays a pivotal role in social and emotional decision-making. This article will review experimental findings using the Iowa Gambling Task and the Cambridge Gamble Task that explore the brain mechanisms of decision-making. Convergent evidence from the two tasks confirms the importance of ventral PFC, but also highlights the relevance of lesion laterality, lesion aetiology, and the contribution of other brain regions (including the dorsal prefrontal cortex and amygdala) to decision-making abilities. The extent to which disrupted decision-making can be separated from the broader domain of executive function is discussed.

Brain Injuries↗

PubMed1994

Pediatric clinical decision making.

BACKGROUND: Clinicians systematically gather information and data, generate hypotheses, and using clinical judgment arrive at a diagnosis and treatment plan. This process may be difficult and time consuming. Analysis using decision-making algorithms provides the clinician with a model to simplify complex clinical situations. This decision-making strategy is particularly effective in the pediatric population because of the variability in the patient's responses. METHODS: This clinical strategy is presented for two clinical scenarios in pediatric patients, nystagmus and esotropia. Two clinical decision-making trees are presented with possible clinical approaches to problem solving. CONCLUSIONS: Decision analysis in the care of pediatric patients may be simplified by the development of decision-making algorithms. This explanation of the decision-making strategy will allow clinicians to develop a personal approach to problem solving in their clinical care.

Algorithms↗

PubMed2006

Medical decision-making of the patient in the context of the family: results of a survey.

GOALS OF THE STUDY: From the perspective of patient autonomy, the family is often looked upon as a troublemaker in medical decision-making. The question remains open as to whether it is possible to do justice to the autonomy of the individual patient and to the claims of his family at the same time. PATIENTS AND METHODS: A clinical study was undertaken when both patients and dependents were interviewed. One hundred people (50 pairs) participated in this study and could be analyzed. A questionnaire consisting of 15 items was used and was evaluated to see if and how the attitudes concerning medical decision-making differ between patient and dependent. RESULTS: The majority of the interviewees (89%) agreed with the opinion that medical decisions should be made jointly by the patient, the family, and the doctor. Ninety-three percent approved of the claim to inform not only the patient, but also the family. Seventy percent of the patients and 54% of the dependents think that the family is entitled to have a say in matters concerning medical decision-making, only 30% of the patients, but 42% of the dependents argued against this view. Eighty-four percent of the patients argued against a change in this right at the end of life, which was approved by 32% of the family members. CONCLUSIONS: The family plays a central role in medical decision-making. This could be shown by a survey among patients with malignant diseases and their dependents. These initial findings must be verified in a larger population. The increased inclusion of the family in the process of medical decision-making corresponds in general to the expressed will of the patients. The model of shared decision-making is favored by values which both the family and the patient have in common. Thus, a family-based decision-making theory needs to be formulated in the future.

Adolescent↗

PubMed2001

Minority dissent and team innovation: the importance of participation in decision making.

This study integrates research on minority dissent and individual creativity, as well as team diversity and the quality of group decision making, with research on team participation in decision making. From these lines of research, it was proposed that minority dissent would predict innovation in teams but only when teams have high levels of participation in decision making. This hypothesis was tested in 2 studies, 1 involving a homogeneous sample of self-managed teams and 1 involving a heterogeneous sample of cross-functional teams. Study 1 suggested that a newly developed scale to measure minority dissent has discriminant validity. Both Study 1 and Study 2 showed more innovations under high rather than low levels of minority dissent but only when there was a high degree of participation in team decision making. It is concluded that minority dissent stimulates creativity and divergent thought, which, through participation, manifest as innovation.

Adult↗

PubMed2005

Health practitioners' and health planners' information needs and seeking behavior for decision making in Uganda.

BACKGROUND: Access to reliable information is the most cost-effective and achievable strategy for sustainable improvement in health care. While several studies have described practitioners' information seeking behavior in developed countries, literature from developing countries is lacking. The aims of the study were: (i) to determine the most influential type of information for health workers' and planners' decision making; (ii) to establish the practitioners' evaluation of the availability and quality of this important information; and (iii) to establish the most commonly used/accessible sources of the information relevant for decision making in Uganda. METHODS: Self-administered questionnaires were sent to 610 health workers, planners, and administrators at the national, district and health facility levels in four districts in Uganda. Respondents were reminded three times, after which non-response was registered. Data were entered, cleaned and analysed using SPSS version 12.0. Logistic regression analysis was used to test for differences in responses. RESULTS: The response rate was 67.7% (413). The respondents indicated that personal experience (79%), discussion with colleagues (76%) and national policy and treatment guidelines (75%) were most influential when making decisions in health care and planning. They reported that most of the epidemiological information was available and of relatively good quality but there was lack of information about distribution of benefit, segregated demographic data, and social values. The most often used sources of information included; discussions with colleagues (89%), doctors' statements (85%) and text books (77%). The least frequently used sources were the internet and the library. This varied with respondents' designation and region of origin. CONCLUSIONS: Health planners and practitioners lack some of the information relevant for decision making. They tend to rely on the national policy and treatment guidelines, discussion with colleagues, and personal experience. Most frequently used sources of information are similar to previous studies. The variation in the frequency of use of the different sources of research information necessitates research to understand the barriers and careful planning of health information delivery to ensure equitable access.

Access to Information↗

PubMed2004

The cerebellum and decision making under uncertainty.

This study aimed to identify the neural basis of probabilistic reasoning, a type of inductive inference that aids decision making under conditions of uncertainty. Eight normal subjects performed two separate two-alternative-choice tasks (the balls in a bottle and personality survey tasks) while undergoing functional magnetic resonance imaging (fMRI). The experimental conditions within each task were chosen so that they differed only in their requirement to make a decision under conditions of uncertainty (probabilistic reasoning and frequency determination required) or under conditions of certainty (frequency determination required). The same visual stimuli and motor responses were used in the experimental conditions. We provide evidence that the neo-cerebellum, in conjunction with the premotor cortex, inferior parietal lobule and medial occipital cortex, mediates the probabilistic inferences that guide decision making under uncertainty. We hypothesise that the neo-cerebellum constructs internal working models of uncertain events in the external world, and that such probabilistic models subserve the predictive capacity central to induction.

Adolescent↗

PubMed2004

Family surrogate decision making at the end of life: seeing them through with care and respect.

Family surrogate decision makers are pivotal in end-of-life decision-making processes. The author investigated decision-making experiences of 20 surrogates who assisted terminally ill family members for this grounded theory study. Findings describe a basic social process of Seeing Them Through With Care and Respect, during which surrogates continuously synthesized the core values of caring for their family member and respecting their family member's autonomy. Surrogate narratives began with Learning the Diagnosis. The major categories of surrogate decision makers' activities during the process were Standing With and Acting For the ill family member. Events reported in two gating categories, Brokering Information and Working With Family, facilitated or impeded decision making. A final category, Outcomes, reports consequences for the surrogate of having been a decision maker.

Decision Making↗

PubMed1999

Introducing "evidence" into board decision-making.

The purpose of this article is to report on the results of a workshop that introduced evidence-based decision-making techniques to Board members of regional health authorities in Alberta. results and conclusions: The workshop demonstrated that it is possible to design a process for the incorporation of evidence in administrative decision-making. The participants demonstrated that they were able to apply scientific evidence in administrative decision making and that the decisions taken were reasonably consistent. Also, in the absence of evidence, values took precedence in the decision-making process and the decisions taken were less consistent.

Alberta↗

PubMed2005

Treatment decision-making strategies and influences in patients with localized prostate carcinoma.

BACKGROUND: Patients diagnosed with localized prostate carcinoma need to interpret complicated medical information to make an informed treatment selection from among treatments that have comparable efficacy but differing side effects. The authors reported initial results for treatment decision-making strategies among men receiving definitive treatment for localized prostate carcinoma. METHODS: One hundred nineteen men treated with radical prostatectomy (44%) or brachytherapy (56%) consented to participate. Guided by a cognitive-affective theoretic framework, the authors assessed differences in decision-making strategies, and treatment and disease-relevant beliefs and affects, in addition to demographic and clinical variables. RESULTS: Approximately half of patients reported difficulty (49%) and distress (45%) while making treatment decisions, but no regrets (74%) regarding the treatment choice they made. Patients who underwent prostatectomy were younger, were more likely to be employed, had worse tumor grade, and had a shorter time since diagnosis (P < 0.01) compared with patients who did not undergo prostatectomy. In multivariate analyses, compared with patients who received radical prostatectomy, patients who received brachytherapy were more likely to say that they chose this treatment because it was "the least invasive" and they "wanted to avoid surgery" (P < 0.0001). CONCLUSIONS: In general, patients who received brachytherapy chose this treatment because of quality of life considerations, whereas "cure" and complete removal of the tumor were the main motivations for patients selecting radical prostatectomy. Long-term data are needed to evaluate distress and decisional regret as patients experience treatment-related chronic side effects and efficacy outcomes. Decision-making aids or other interventions to reduce decisional difficulty and emotional distress during decision making were indicated.

Adult↗

PubMed2005

Nurses' roles in discharge decision making in an adult high dependency unit.

An ethnographic approach was used to investigate the roles which nurses take in the discharge decision making process in an adult High Dependency Unit (HDU). Participant observation and unstructured interviews were the data collection methods used. Four themes were identified. The first theme encompassed the relationship of nurses with medical staff. Tension was felt between nursing and medical staff, although this was not demonstrated in direct communication between the two professions. Nurses took a submissive role in order to avoid conflict, but this also enabled them to manipulate doctors. Another theme was the unique value of the nurse which was defined as the 'holistic' view which nurses took towards patients which was different to that taken by other health care professionals. Nurses undertook an important administrative role. They had substantial responsibility for bed management and became more proactive in decision-making when there was pressure on HDU beds. Issues associated with decision making were highlighted, as although nurses wanted to contribute to discharge decision making, they were often uncomfortable with this role. There is scope for further investigation into the working relationship of nurses and medical staff, how administrative roles of nurses influence their ability to provide patient care and whether the opinions expressed with regard to decision making are widespread within the nursing community.

Adult↗

PubMed2006

The role of emotion in decision-making: a cognitive neuroeconomic approach towards understanding sexual risk behavior.

Models of decision-making usually focus on cognitive, situational, and socio-cultural variables in accounting for human performance. However, the emotional component is rarely addressed within these models. This paper reviews evidence for the emotional aspect of decision-making and its role within a new framework of investigation, called neuroeconomics. The new approach aims to build a comprehensive theory of decision-making, through the unification of theories and methods from economics, psychology, and neuroscience. In this paper, we review these integrative research methods and their applications to issues of public health, with illustrative examples from our research on young adults' safe sex practices. This approach promises to be valuable as a comprehensively descriptive and possibly, better predictive model for construction and customization of decision support tools for health professionals and consumers.

Adolescent↗

PubMed1992

Decision-making autonomy in nursing.

Current nursing literature has suggested that nurses may have low needs or preferences for decision-making autonomy. In this study, the authors found that nurses differed in their preferences for decision-making autonomy in three types of work-related decisions. Employed nurses with a greater preference for autonomy were more satisfied with their jobs, and those with little or no such preference were less satisfied, as they gained decision-making influence over patient care and unit management. The authors discuss implications for designing and implementing decision-making programs.

Adult↗

PubMed2003

Peer referencing in adolescent decision making as a function of perceived parenting style.

This study examined the relationship between parenting style and adolescent decision making. Two hundred sixty-two college students completed a decision-making scale as well as a parenting scale in an effort to determine if the child-rearing style of their parents was related to the tendency of these late adolescents to reference peers rather than parents or other adults in decision making. The results indicated that adolescents raised by authoritative parents tended to refer to their parents for moral and informational decisions, while adolescents raised by authoritarian, permissive, or neglecting-rejecting parents more often referenced their peers for moral and informational decisions. Adolescents referred to their peers for social decisions regardless of how they were raised. Parental responsiveness was a significant factor in determining the source of adolescent decision-making assistance, but parental demandingness was not. It was concluded that less orientation toward peers during late adolescence seems to be another advantage of authoritative parenting.

Adolescent↗

PubMed2000

An analysis and evaluation of student nurses' participation in ethical decision making.

This study analyses the types and frequencies of ethical dilemmas and the rationale of ethical decision making in student nurses; it also evaluates their decision making. One hundred senior student nurses who were enrolled in a two-credit course in nursing ethics were asked to provide an informal description of a dilemma that they had experienced during their clinical practice. The results were as follows. The ethical dilemmas identified fell into four categories and were of 27 types. Those most frequently experienced were 'family giving up on a patient because he or she could not be cured', and 'not telling the truth to the patient'. The Korean Nurses' Code of Ethics was applied, in particular the preamble, and the third, fourth, seventh and tenth clauses. The most common rule of ethics and principle applied in these nurses' ethical decision making were veracity and nonmaleficence. With regard to the moral reasoning process, the primary concern was the welfare of the patients. These students were equipped with the ability to exercise critical and reflective thought when they experienced ethical dilemmas.

Attitude of Health Personnel↗

PubMedDate not supplied

Medical and nonmedical determinants of decision making about potentially life-prolonging interventions.

Patient characteristics may influence medical decision making in various ways. The contribution of several patient characteristics to medical decision making was studied. Thirty oncologists, 29 nursing home physicians, and 22 cardiologists were interviewed (overall response = 60%). Respondents were asked whether they would apply a specified intervention for a number of hypothetical seriously ill patients, who varied with respect to factors that were not relevant to the outcome of treatment. The condition that made patients clearly eligible for treatment was kept constant. In a multivariate regression model, patients with a better physical condition, a more obvious social role, and a lower age were more likely to be treated than were other patients. Medical decision making is not exclusively based on empirical evidence but also related to morally complex issues such as patient age and social status.

Adult↗