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Boren, Shedrick John. "Ignoring Ambiguity: Legitimating Clinical Decisions." Scholarly Repository, 2008. http://scholarlyrepository.miami.edu/oa_dissertations/170.
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As technology advances, health care decisions have become increasingly complex. American hospitals, based on accreditation standards, are required to have a system and process to address ethics, patient rights, and responsibilities. These practices vary widely, and there is very little consistency and few standards across the country. Key court cases have provided minor structure, and the federal government has been silent in the formulation of these structures but not necessarily in this arena. Most often, these accreditation standards related to clinical ethics are managed by Healthcare Ethics Committees (HEC). Bioethics has become a growing field, the level of integration between this discipline and healthcare practice varies widely. Using qualitative methods based on Grounded Theory, this analysis presents six key thematic findings, as well as interpretations to identify current challenges and opportunities to make recommendations for improvement by enhancing clarity and reducing ambiguity.
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Vaithianathan, Rhema. "Economic Incentives and Clinical Decisions." Thesis, University of Auckland, 2000. http://hdl.handle.net/2292/2235.
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In the face of escalating health care expenditure, OECD countries are turning to a variety of cost-containment strategies. This thesis analyses three such mechanisms. In Part I, I consider the use of coinsurance to limit the demand for health care. Because coinsurance reduces the elasticity of demand with respect to the price of health care, consumers facing low coinsurance rates may be charged a higher price by doctors. Such discriminatory pricing enables the doctor to extract surplus created in the insurance market, and therefore reduces the effectiveness of coinsurance. I show that in equilibrium, some consumers remain uninsured. I also show how this problem is solved if the doctor and insurer enter into managed care style arrangements. Such arrangements improve insurer and doctor profitability, and restore complete insurance market coverage. In Part II, I consider the design of fundholding schemes which encourage doctors to restrict expensive treatment to severely ill patients. I show that such schemes may be undermined by a patient-doctor side contract. In the face of such patient-doctor collusion, the fundholding scheme may be made collusion-proof by increasing its "power". I show that the optimal collusion-proof scheme may pay the doctor more than his reservation wage. An alternative solution to patient-doctor collusion is to use a partial fundholding scheme that requires some additional co-payment from the patient. Part III analyses New Zealand's internal market reforms. Introduced in 1993, the reforms involved the separation of funding and provision of health care, and were intended to simulate a competitive market environment, thereby improving the incentives of government owned health care providers to be efficient. On the supply side, I look at the internal restructuring of hospitals into private-sector clones. I argue that this commercialisation failed to take account of informational issues within the hospital. On the demand-side, I examine the suitability of internal markets for eliciting optimal innovation from the hospital sector. Again, I find that a standard argument, namely that increased competition leads to innovation, is questionable in the context of the internal market.Whole document restricted, but available by request, use the feedback form to request access.
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Whittle, Rosemary Anne. "Decisions, decisions: factors that influence student selection of final year clinical placements." Thesis, University of Canterbury. Education, 2007. http://hdl.handle.net/10092/1057.
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Clinical practice is an essential and integral component of nursing education. The decision-making process involved in student selection of clinical placements is influenced by a range of factors which are internal or external to students. As there was little research that explored these factors and the influence they have on student decisions, I wanted to investigate this further. A mixed-method approach was used, using a questionnaire and focus group interview, to give breadth and depth to the research. This study found that students are particularly influenced by previous positive experiences, or an interest in a particular area of practice. Their personality will also influence their placement decisions. Nurse preceptors and clinical lecturers also provide a key support role to students in the clinical environment.
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Adams, Barbara L. Rhodes Dent. "Making clinical decisions baccalaureate nursing student thought processes /." Normal, Ill. Illinois State University, 2003. http://wwwlib.umi.com/cr/ilstu/fullcit?p3106754.
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Thesis (Ed. D.)--Illinois State University, 2003.Title from title page screen, viewed October 19, 2005. Dissertation Committee: Dent M. Rhodes (chair), Cathy A. Toll, Eileen T. Borgia, Saundra L. Theis. Includes bibliographical references (leaves 108-116) and abstract. Also available in print.
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Llewelyn, David Evan Huw. "Assessing the validity of diagnostic tests and clinical decisions." Thesis, King's College London (University of London), 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.325963.
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Palmer, Barbara Benson 1958. "Clinical decision making about end-of-life decisions of persons over 65: Perceptions of clinicians." Thesis, The University of Arizona, 1992. http://hdl.handle.net/10150/278251.
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A descriptive study was conducted to explore whether or not there were any differences in perceptions of physicians, acute care nurses, long-term care nurses, and nurse practitioners associated with end-of-life decision making for people over 65 years of age. A convenience sample of 95 health care providers, all of whom were involved in direct patient care was used. Quantitative research techniques were employed for data collection and analysis. Statistically significant differences were found between four individual items on the CDMS and the health care providers. It was found that long-term care nurses believed items associated with pain and suffering, and culture to be more important than either physicians or acute care nurses, where as they found physicians input less important. A statistical significance was also found between the years spent in practice by health care providers and scores on the CDMS.
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Duriseti, Ram S. "Making high quality clinical decisions : influence diagrams in cost-effectiveness analysis /." May be available electronically:, 2007. http://proquest.umi.com/login?COPT=REJTPTU1MTUmSU5UPTAmVkVSPTI=&clientId=12498.
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Gong, Jen J. (Jen Jian). "Improving clinical decisions using correspondences within and across electronic health records." Thesis, Massachusetts Institute of Technology, 2018. http://hdl.handle.net/1721.1/118087.
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Thesis: Ph. D., Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science, 2018.Cataloged from PDF version of thesis.
Includes bibliographical references (pages 106-112).
Electronic Health Record (EHR) adoption and retrospective analyses of health care data are part of a broader conversation about health care quality and cost in the United States. Machine learning in health care can be used to develop clinical decision-making aids and assess quality of care. This can help improve quality of care while lowering cost. In this thesis, we present three methods of using different kinds of data in health care records to aid clinicians in making care decisions. We focus on the critical care environment, where patient state can rapidly change, and many care decisions need to be made in short periods of time. First, we introduce a method to use correspondences between structured fields from two different EHR systems to a shared space of clinical concepts encoded in an existing domain ontology. We use these correspondences to enable the transfer of machine learning models across different or evolving EHR systems. Second, we introduce a method to learn correspondences between structured health record data and topic distributions of clinical notes written by care team members. Finally, we present a method to characterize care processes by learning correspondences between observations of patient state and actions taken by care team members.
by Jen Jian Gong.
Ph. D.
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AMARAL, Thiago Magalhães. "Optimal control in biological systems as a support for clinical decisions." Universidade Federal de Pernambuco, 2009. https://repositorio.ufpe.br/handle/123456789/6002.
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O controle ótimo no mundo biológico tem uma vasta aplicação em incontáveis sistemas os quais influenciam enormemente nossas vidas. Objetiva-se a aplicação desta ferramenta em dois sistemas. O primeiro diz respeito ao controle ótimo de dosagem de drogas no tratamento de pacientes infectados pelo vírus HIV . O modelo de Campello de Souza (1999) é usado para estimar a dosagem de drogas onde a função objetivo é minimizada. Esta função representa um balanço entre os benefícios do tratamento e os efeitos colaterais. A técnica de controle ótimo usada é o Princípio do Máximo de Pontryagin, a qual é simulada através do PROPT-TOMLAB - Matlab Optimal Control System Software em uma versão de demonstração. As simulações objetivam a análise de três diferentes pacientes em dois diferentes cenários. Estes cenários têm como objetivo forçar as variáveis de estado a atingirem valores "normais" a fim de estabilizar a carga viral próximo a uma taxa que seja insignificante e elevar o nível de CD4 do paciente. São simulados tratamentos cedos e tardios. As simulações computacionais compararam diferentes cenários para investigar os parâmetros de incerteza da dinâmica entre o vírus HIV e os linfócitos CD4 e CD8. Os resultados mostram que o controle ótimo permite uma melhor administração entre os efeitos positivos da terapia e os efeitos colaterais, ao invés de se usar dosagens constantes de drogas como na atual prática médica. O segundo sistema descreve a aplicação do controle ótimo, também através do Princípio Máximo de Pontryagin, para controlar o nível de glicose em indivíduos diabéticos usando o modelo matemático desenvolvido por Bergman (1971, 1981). Correlacionam-se dados reais da literatura com o modelo teórico para analisar a robustez do modelo. É também estudada a minimização do funcional objetivo para diminuir os efeitos colaterais e consequentemente melhorar o estado de saúde do paciente. Os resultados mostram os benefícios de se utilizar o controle ótimo para regular a taxa de glicose em pacientes diabéticos
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Bell, Emily Rachel. "An exploration of future orientation in adolescents' decisions to continue or terminate a pregnancy." Thesis, University of Hull, 2008. http://hydra.hull.ac.uk/resources/hull:1592.
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This study explores aspects of the future in adolescents' choices to continue or terminate pregnancy. Future orientation (FO) (e.g. Seginer, 2005) and reasons for pregnancy resolution were investigated using a researcher constructed and administered questionnaire. Three groups were included: termination of pregnancy (ToP) (n = 19), ante natal (AN) (n = 9), and never pregnant (NP) (n = 23). Participants were 13-18 years-old. Statistical and content analyses reveal groups differ in aspects of FO and reasons for pregnancy resolution choice. Future factors are shown to be important in teenagers' pregnancy resolution decisions. The impact of negative discourses about teenage pregnancy and parenting is discussed. Suggestions are made for conducting research that can advance understanding of this complex issue.
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Sotero, Charity Faith Gallemit. "Statistical Support Algorithms for Clinical Decisions and Prevention of Genetic-related Heart Disease." Thesis, California State University, Long Beach, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10751893.
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Drug-induced long QT syndrome (diLQTS) can lead to seemingly healthy patients experiencing cardiac arrest, specifically Torsades de Pointes (TdP), which may lead to death. Clinical decision support systems (CDSS) assist better prescribing of drugs, in part by issuing alerts that warn of the drug’s potential harm. LQTS may be either genetic or acquired. Thirteen distinct genetic mutations have already been identified for hereditary LQTS. Since hereditary and acquired LQTS both share similar clinical symptoms, it is reasonable to assume that they both have some sort of genetic component. The goal of this study is to identify genetic risk markers for diLQTS and TdP. These markers will be used to develop a statistical DSS for clinical applications and prevention of genetic-related heart disease. We will use data from a genome-wide associate study conducted by the Pharmacogenomics of Arrhythmia Therapy subgroup of the Pharmacogenetics Research Network, focused on subjects with a history of diLQTS or TdP after taking medication. The data was made available for general research use by National Center for Biotechnology Information (NCBI). The data consists of 831 total patients, with 172 diLQTS and TdP case patients. Out of 620,901 initial markers, variable screening is done by a preliminary t-test (α=0.01), and the resulting feasible set of 5,754 markers associated with diLQTS to prevent TdP were used to create an appropriate predictive model. Methods used to create a predictive model were ensemble logistic regression, elastic net, random forests, artificial neural networks, and linear discriminant analysis. Of these methods using all 5,754 markers, accuracy ranged from 76.84% to 90.29%, with artificial neural networks as the most accurate model. Finally, variable importance algorithms were applied to extract a feasible set of markers from the ensemble logistic regression, elastic net, and random forests methods, and used to produce a subset of genetic markers suitable to build a proposed DSS. Of the methods using a subset of 61 markers, accuracy ranged from 76.59% to 87.00%, with ensemble logistic regression as the most accurate model. Of the methods using a subset of 22 markers, accuracy ranged from 74.24% to 82.87%, with the single hidden layer neural network (using the subset of markers extracted from the ensemble bagged logistic model) as the most accurate model.
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Benjamin, Leah B. "Emerging Adults’ Experiences of Agency in Higher Education Decisions." Antioch University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1555258445462788.
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Sooriyarachchi, Marina Roshini. "The use of interim inspections for making decisions and testing assumptions in clinical trials." Thesis, University of Southampton, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.239435.
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Marshall, Andrea. "Information use in clinical practice: A case study of critical care nurses' enteral feeding decisions." University of Sydney, 2008. http://hdl.handle.net/2123/3658.
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Doctor of Philosophy (PhD)Although registered nurses have a plethora of information sources available to assist them in making clinical decisions, how this information informs such decisions is not well understood. Through the work undertaken in this thesis a deeper understanding of information use in clinical practice is developed. Information use in clinical uncertainty is explored, specifically in the context of making decisions about enteral feeding practices within critical care environments. Instrumental case studies were used to access the information use processes of registered nurses working in an intensive care unit. Two case sites (a Level III intensive care unit in metropolitan teaching hospital and a Level II intensive care unit in a district hospital) were selected for the purpose of theoretical replication. Data were collected to inform specific issues. Concurrent verbal protocols (think aloud), observation and retrospective probing were used to explore documented clinical decisions and the information used to inform those decisions. Q sorting was used to determine the accessibility and usefulness of information available to participants and focus groups were used to explore senior nurse clinician’s perceptions of the authority of the identified information sources. A synthesis of findings from the two case sites highlighted three key issues. First, natural testimony (the use of personal communication to obtain information) was privileged over other, more formal sources of information however the veracity of the information obtained through natural testimony was not explicitly assessed. Registered nurses relied on the credibility of the person providing the information, leaving the information itself unchallenged. The clear reliance on information accessed through natural testimony, but the evident lack of critical evaluation of information obtained in this way, indicates a need for the development of strategies for the critical assessment of the accuracy of this clinical information. Second, the findings highlighted nurses’ use of clinical inquiry. Nurses used clinical inquiry to resolve clinical uncertainty as well as for logistic reasons. Participant’s use of inquiry was influenced by their approach to work, the impact of both organisational and personal perspectives on the perceived value of their work; and by models of clinical leadership where an investment in relational capital was considered a strategy to positively influence a culture of inquiry. Although organisational documents which are designed to ensure quality and consistency of patient care as required by current clinical governance strategies were considered useful, these document were not widely used as a primary source of information. The use of organisational documents, as well as the need to practice in concert with such documents, was identified as a factor negatively impacting on the development and support of nurses’ use of clinical inquiry. Third, findings addressed the usefulness of information for clinical decisions and the resolution of clinical uncertainty. The usefulness of information was influenced by its relevance to a clinical question or information deficit, and by the media used to convey the information. In general, print based media was considered more useful than other forms such as electronic documents. While original research was not considered useful, nurses valued research-based practice and responded positively to incorporating research into practice, particularly if research was pre-appraised by colleagues who were able to disseminate research findings to the clinical area and facilitate its use in clinical practice. This case study indicates that information use is less about individuals and the clinical context in which they are making decisions, and more about the social, cultural and organisational influences that shape decision making, and the information selected to support those decisions. The preference for natural testimony as information in decision making may, on first consideration, be viewed as undesirable in a work context that relies on accurate and consistent documentation. Determining the credibility of the information provider and the accuracy of the information itself is also challenging in an environment where this type of information and the approach to accessing it is selected for its ease of accessibility and the speed at which it can be applied. Yet, the pervasiveness with which nurses rely on others for information suggests verbal testimony is important in the context of clinical practice and highlights the need to develop a clearer understanding of why nurses privilege this information. Therefore verbal testimony must be considered carefully as a strategy for providing information, particularly research-based information and this study therefore highlights the need to develop strategies that enable those providing information to convey their expertise as a clinician as well as a user and provider of information. The organisational culture and work structures currently in place in Australia are unlikely to undergo significant change in the coming years, therefore their impact on information use warrants careful consideration. The nursing profession and the higher education sector aim to foster through inquiry, the independent, evidence-based practice of registered nurses. Health care organisations also highly value independent, evidence-based practice but also promote patient safety through use of current clinical governance strategies. While these two goals can be complimentary they also create tension when clinical governance strategies stifle inquiry and independent decision making of registered nurses. Ultimately, the current health care system in Australia and the wider community expect an evidence base for practice together with clinical governance strategies that promote safe practice. Nurses, as part, of this system must be accountable for both in the context of their clinical practice. We therefore need with some urgency to determine how to best balance these complementary and simultaneously competing ideals.
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Stables, R. H. "Clinical choices in the management of coronary heart disease : data and decisions in cardiac catheterisation." Thesis, University of Oxford, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.343447.
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Marshall, Andrea Pauline. "Information use in clinical practice a case study of critical care nurses' enteral feeding decisions /." Connect to full text, 2008. http://hdl.handle.net/2123/3658.
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Thesis (Ph. D.)--University of Sydney, 2008.Title from title screen (viewed 11 February 2009). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Faculty of Nursing And Midwifery. Includes bibliographical references. Also available in print form.
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Jackson, Sue Ellen. "An investigation of factors used by patients for medical treatment selection decisions : an examination of therapy options for erectile dysfunction /." Digital version accessible at:, 1998. http://wwwlib.umi.com/cr/utexas/main.
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Drummond, Iain Donald. "Exploring the role of tactical decision games as a novel method of developing medical students' non-technical skills." Thesis, University of Edinburgh, 2017. http://hdl.handle.net/1842/28825.
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Introduction Clinical decision-making, situation awareness, task management, and teamwork are key non-technical skills (NTS) required by junior doctors. However, research has demonstrated that new doctors have difficulty demonstrating effective NTS behaviours. Tactical decision games (TDGs) are low-fidelity classroom-based activities designed to develop proficiency in NTS. They have been used in other safety-critical industries to develop NTS but their use in undergraduate medical education has been very limited. This aim of this thesis was to explore the potential role of TDGs as a novel method of developing final year medical students’ NTS. Methods Throughout this thesis a qualitative approach was taken, underpinned by constructivist epistemology. In the first instance the feasibility and acceptability of using generic (non-medical) TDGs with groups of final year medical students was explored. Thereafter, the use of non-medical TDGs and acute care simulation scenarios to develop NTS was investigated. Acute medical TDGs were developed with support and guidance from an expert panel. The potential role of medical TDGs to develop final year medical students’ NTS was then explored. Medical TDGs were then implemented into the core undergraduate curriculum in the clinical assistantship programme. Results In the feasibility study six key themes emerged from the data: ‘‘the value of non-medical games’’; ‘‘giving and receiving feedback’’; ‘‘observing and reflecting’’; ‘‘recognizing and understanding NTS’’; ‘‘dealing with uncertainty and ambiguity’’, and ‘‘introducing TDGs into the curriculum’’. Exploring the use of non-medical TDGs and acute care simulation to develop NTS, five key themes emerged from the data: “situation awareness and fixation”; “expectations influencing behaviour”; “being uncomfortable with uncertainty”; “transmitting and receiving information” and “working with peers and seniors”. Using acute medical TDGs to develop NTS, five key themes emerged from the data: “understanding capabilities and responsibilities of team members”; “prioritising in a busy clinical environment”; “developing a workable solution”; “relating medical TDGs to clinical experience” and “introducing medical TDGs into the undergraduate curriculum”. A team of facilitators were trained and medical TDGs delivered to the full final year cohort in the clinical assistantship programme. Discussion and conclusions This thesis has found that generic and acute medical TDGs represent an exciting potential method of teaching medical students NTS. TDGs appear to be versatile activities that can be adapted to meet the needs of participants in different contexts. As such, the full potential of TDGs in the undergraduate curriculum and beyond remains to be explored.
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Hatfield, Derek R. "The Influence of Outcome Measures in Assessing Client Change and Treatment Decisions." Ohio University / OhioLINK, 2006. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1156442730.
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Taylor, Carol Dorothy. "Why do some clinicians access research evidence to inform their clinical decisions and others do not?" Thesis, Middlesex University, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.529375.
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Hoomans, Ties. "Economic evaluation of change in clinical practice methods for informing decisions about guidelines and implementation strategies /." Maastricht : Maastricht : Universitaire Pers ; University Library, Universiteit Maastricht [host], 2008. http://arno.unimaas.nl/show.cgi?fid=14837.
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Li, Yuqiang [Verfasser]. "The value of predictive models in guiding clinical decisions for colorectal and pancreatic cancer / Yuqiang Li." Hamburg : Staats- und Universitätsbibliothek Hamburg Carl von Ossietzky, 2021. http://d-nb.info/1236695240/34.
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Thomas, Nicole. "Validation of Criteria Used to Predict Warfarin Dosing Decisions." BYU ScholarsArchive, 2004. https://scholarsarchive.byu.edu/etd/40.
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People at risk for blood clots are often treated with anticoagulants, warfarin is such an anticoagulant. The dose's effect is measured by comparing the time for blood to clot to a control time called an INR value. Previous anticoagulant studies have addressed agreement between fingerstick (POC) devices and the standard laboratory, however these studies rely on mathematical formulas as criteria for clinical evaluations, i.e. clinical evaluation vs. precision and bias. Fourteen such criteria were found in the literature. There exists little consistency among these criteria for assessing clinical agreement, furthermore whether these methods of assessing agreement are reasonable estimates of clinical decision-making is unknown and has yet to be validated. One previous study compared actual clinical agreement by having two physicians indicate a dosing decision based on patient history and INR values. This analysis attempts to justify previously used mathematical criteria for clinical agreement. Generalized additive models with smoothing spline estimates were calculated for each of the 14 criteria and compared to the smoothing spline estimate for the method using actual physician decisions (considered the "gold standard"). The area between the criteria method spline and the gold standard method spline served as the comparison, using bootstrapping for statistical inference. Although some of the criteria methods performed better than others, none of them matched the gold standard. This stresses the need for clinical assessment of devices.
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Lutteropp, Michael. "The emergence and early fate decisions of stem and progenitor cells in the haematopoietic system." Thesis, University of Oxford, 2012. http://ora.ox.ac.uk/objects/uuid:eef3e876-bde2-4114-8ac2-bf0c87492a55.
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The alternative road map describes the separation of lympho-myeloid and myeloid-megakaryocyte-erythroid (myeloid-Mk-E) lineages as the earliest haematopoietic commitment event. However, a number of aspects of this lineage restriction process remain poorly understood. Herein this work identified a lympho-myeloid restricted progenitor in the embryo, which resembles the adult LMPP, and demonstrated that lymphoid lineage restriction is initiated prior to definitive haematopoiesis, much earlier than previously appreciated. In vivo fate mapping showed that lympho-myeloid progenitors significantly contribute to steady state myelopoiesis in the embryo. The early thymic progenitor (ETP) as most primitive cell in the thymus was characterised and demonstrated to sustain B, T and myeloid but not Mk potentials at the single cell level. The ETP therefore largely resembles the cellular properties of lympho-myeloid progenitors in bone marrow and foetal liver, which points to these cells as candidate thymus seeding progenitors (TSP). Furthermore the existence of a putative Mk progenitor was explored within the LSKCD150+CD48+Gata1pos compartment of a Gata1 reporter mouse providing the basis for a future prospective characterisation. Finally, this work evaluated the earliest lineage restriction of von Willebrand factor (Vwf)-EGFP+ and EGFP- haematopoietic stem cells (HSCs) through in vitro paired daughter fate mapping. Single Vwf+ HSCs showed heterogeneous Mk priming and more frequently sustained Mk potential after cell division. Moreover, analysis of lineage priming between daughter cells revealed the asymmetric expression of key lineage determinants and stem cell regulators, which might be employed as reporters for future fate mapping studies.
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Keith, Brian Alan. "An analysis of Virginia school psychologists' decisions relative to assessment profiles and recommended handicapping condition." W&M ScholarWorks, 1992. https://scholarworks.wm.edu/etd/1539618421.
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The purpose of this study was to investigate the classification congruency of Virginia school psychologists as it related to assessment profile analysis and, additionally, to examine assessment instrument rankings and demographic variables when classifying targeted handicapping conditions. The targeted conditions were learning disability, educable mentally handicapped, and attention deficit hyperactivity disorder/attentional problems.;The seventy-two certified Virginia school psychologists who participated in the study were each mailed identical packets containing a letter of explanation, demographic questionnaire, the test profiles for each of the handicapping conditions, and a profile for a non-handicapped child.;The data were analyzed using a discriminant analysis and a logistic regression. Results show that Virginia school psychologists were congruent in identifying LD, EMH, and non-handicapped students but less so in identifying ADHD students. The WISC-R emerged as the most significant test instrument used by the subjects in making a correct diagnosis. The most significant demographic variable in influencing the recommendations was "years of experience.".
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Syrowatka, Ania. "Understanding the Role of the Ottawa Ankle Rules in Physicians' Radiography Decisions: A Social Judgment Analysis Approach." Thèse, Université d'Ottawa / University of Ottawa, 2012. http://hdl.handle.net/10393/22854.
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Clinical decision rules improve health care fidelity, benefit patients, physicians and healthcare systems, without reducing patient safety or satisfaction, while promoting cost-effective practice standards. It is critical to appropriately and consistently apply clinical decision rules to realize these benefits. The objective of this thesis was to understand how physicians use the Ottawa Ankle Rules to guide radiography decision-making. The study employed a clinical judgment survey targeting members of the Canadian Association of Emergency Physicians. Statistical analyses were informed by the Brunswik Lens Model and Social Judgment Analysis. Physicians’ overall agreement with the ankle rule was high, but can be improved. Physicians placed greatest value on rule-based cues, while considering non-rule-based cues as moderately important. There is room to improve physician agreement with the ankle rule and use of rule-based cues through knowledge translation interventions. Further development of this Lens Modeling technique could lend itself to a valuable cognitive behavioral intervention.
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Stavrou, Stavros. "GP referrals to on-site clinical psychologists and counsellors : analysing the decisions behind referring and not referring patients." Thesis, University College London (University of London), 2005. http://discovery.ucl.ac.uk/1446567/.
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The literature review examines the research on general practitioner (GP) referral rates and referral decisions. It explores the variation in GP referral rates to medical specialists, addressing the shift from quantitative to qualitative methodologies in studies that have examined GP referral decisions. The final section focuses on GP referrals to mental health professionals and looks at the effects of on-site mental health professionals on GP referrals. The empirical paper is a qualitative study examining GP decisions to refer, or not refer, patients suffering from minor mental illness to on-site clinical psychologists and counsellors. 14 GPs were asked to compare and contrast matched patient pairs, consisting of a patient who had been referred paired with another similar patient the general practitioner was treating. Three main themes of Patient Choice, Patient Benefit and GP Capacity to Help were identified, each including factors for and against referral. The critical appraisal reflects on what prompted this research, examines the research process, its strengths and weaknesses, and considers what might have been done differently. The clinical implications of the study are then discussed, alongside possible avenues for future research. Finally, it ends with a personal reflection on how this project has influenced my views concerning qualitative research and my clinical practice.
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Combs, Elizabeth Lucas. "FACTORS THAT INFLUENCE MATERNAL FEEDING DECISIONS FOR TODDLERS: EXTENDING THE THEORY OF PLANNED BEHAVIOR." UKnowledge, 2019. https://uknowledge.uky.edu/khp_etds/58.
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Establishing healthy eating behaviors is vital in the early years to help combat the development of obesity and other chronic diseases. Mothers play an invaluable role in shaping their children's eating habits through controlling what and when children eat as well as the overall food environment, which is why a better understanding of what influences mothers’ decisions about these behaviors is important.
The purpose of the dissertation was to gain a better understanding of what impacts maternal feeding decisions regarding toddler nutrition behaviors. This was a two-phased mixed methods study. The aim of the initial study was to explore, using a Theory of Planned Behavior (TPB) framework, the influences on mothers’ toddler feeding decisions. These included attitude, subjective norms, and perceived behavioral control. These constructs were derived from discussions about what sources of nutrition information mothers use and trust. The aim of the subsequent study was to use the TPB to assess factors affecting a mother’s behavioral intention to provide their toddler with a healthy diet and to see if the addition of the parental role construction variable strengthened the TPB’s ability to significantly predict the mother’s behavioral intention.
The first study used a qualitative approach to gather data from three focus groups that consisted of mothers of toddlers (N = 15). Qualitative thematic analysis was used to define prominent themes. Four major themes emerged from the data analysis: (1) attitudes (subthemes: positive towards maternal role of feeding and negative towards the maternal role of feeding); (2) subjective norms positively accepted (subthemes: social media, pediatricians, and registered dietitians); (3) subjective norms negatively accepted (subthemes: pediatricians and registered dietitians); (4) perceived behavioral control (subthemes: acceptance, scarcity of time and outside influences).
An online survey was created using data gathered from the focus groups and a previously validated survey that fit the theoretical basis of the study. The survey utilized the TPB to assess the connections between the constructs and the mothers’ behavioral intentions surrounding toddler feeding. The final sample consisted of 148 mothers. The mean age was 32.83 (SD = 6.16) years. The majority of participants were married (87.2%), had earned a college degree or higher (79.7%), held part-time or fulltime employment, (60.8%), and were White (90.3%). The TPB model predicted 53% of the variance in mother’s behavioral intention surrounding the behavior of providing meals that include a wide variety of the five food groups in appropriate amounts. The addition of the parental role construction variable added 6% more predictive power to the model. The most salient predictors included attitude, perceived behavioral control, and parental role construction.
Mothers positively and negatively receive information from a variety of sources, they have many strong emotions associated with feeding that are deeply rooted in their roles as mothers, and their feeding decisions were strongly influenced by the TPB constructs. Health promotion efforts should aim to increase the mother’s sense of behavioral control and parental responsibility rather than focusing on the benefits of healthy eating. Programs should provide tangible ways to help mothers overcome perceived barriers and, in turn, increase mothers’ beliefs in their ability to provide toddlers with a balanced diet.
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Smith, Sarah Kathleen. "Peer Taught sex Education's Influence on Adolescent Sexual Decisions and Hookups." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6376.
Full textAbstract:
The Teen Prevention Education Program (PEP) utilizes different methods, mainly peer teaching via skits and small groups, to help influence adolescents to make informed sexual decisions. The purpose of this study is to find how Teen PEP can have an effect on an adolescent's decision on whether to or not hookup. This study utilized interviews with participants of the program asking them about their views on hooking up and how they view how Teen PEP aided in their decision-making whether to or not hook up. While transcribing the interviews and looking for keywords related to the research questions, the analysis found that out of the 9 interviews performed only one participant had hooked up and that that Teen PEP had influenced their sexual decisions in the future. Another result of the study showed that faith and morality played a part in a participant's decision to not hookup. Some recommendations would be make the scope of the study larger and interview more Teen PEP participants. This study benefits the Teen PEP organization and any high schools that are looking to institute a peer taught sexual education program since the study shows that Teen PEP is an effective program. By showing the efficacy of Teen PEP, that could lead to social change by causing more high schools to implement Teen PEP in order to institute an effective program for sexual education.
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Hoogen, Siri Rebecca. "Contexts of choice: Personal constructs of motherhood in women's abortion decisions." Miami University / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=miami1292364393.
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Naci, Huseyin. "Generating comparative data on clinical benefits and harms of statins to inform prescribing decisions : evidence from network meta-analyses." Thesis, London School of Economics and Political Science (University of London), 2014. http://etheses.lse.ac.uk/973/.
Full textAbstract:
Background and Importance: comparative evidence generated using systematic reviews and meta-analyses can form the basis of high quality prescribing decisions in clinical practice. Such evidence is imperative when choosing a first-line treatment among multiple alternatives, particularly in the United States where there is no single national authority responsible for providing practice guidelines for prescribers. Objective: Using cholesterol-lowering statins as a case study, this thesis set out to evaluate the comparative clinical benefits and harms of statins for the prevention of coronary heart disease. Novelty and Empirical Contribution: The empirical work presented in this thesis was based on a systematic review and network meta-analysis, for the first time combining the placebo-controlled and active-comparator trials of statins. Using 184 randomized trials including 260,630 individuals with or without cardiovascular disease, this thesis makes four major contributions to the literature on the comparative effectiveness and safety of statins, showing the following:(1) cholesterol-lowering effects of statins are less pronounced than suggested by the previous reviews; (2) statins potentially differ in terms of their comparative effects on clinically meaningful benefit outcomes, which are not fully explained by their cholesterol-lowering effects;(3) harms associated with statins are rare; still, some statins are safer than others; and (4) unlike previous findings in the literature, there is no evidence of industry sponsorship bias affecting the trials of statins. Implications for Clinical Practice: Although there are statistically detectable and clinically relevant differences among individual statins, the empirical work presented in this thesis does not conclusively identify a clear winner among statins that should be favored in clinical practice. Future&Research Directions: The potential mechanisms underlying the observed differences between individual statins should be investigated in future studies. Policy Relevance: The findings presented in this thesis suggest that statin prescribing patterns over the past decade – and in particular atorvastatin’s exceptional sales performance despite its equivalence to simvastatin – are not supported by the current best evidence. A proposed policy option is to raise the bar for market entry of new drugs by requiring comparative evidence at the time of approval decisions. Network meta-analysis methods can be used at the United States Food and Drug Administration setting, thereby making comparative evidence available before prescribing patterns are established.
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McDonald, Simon Francis. "Better clinical decisions for less effort : building prediction software models to improve anti-coagulation care and prevent thrombosis and strokes." Thesis, Lancaster University, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.539665.
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Tee, Stephen R. "A co-operative inquiry : participation of mental health service users in the clinical practice decisions of mental health student nurses." Thesis, University of Southampton, 2005. https://eprints.soton.ac.uk/57948/.
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This is a study about participation of mental health service users in the clinical practice decisions of mental health student nurses undertaking their nurse training. The research was undertaken with students, recruited from a higher education institution, in collaboration with mental health service users, recruited from mental health service user organisations, and was conducted over a period of eighteen months. Mental health service users have long been calling for greater involvement in the clinical decisions which affect their lives. Involvement in this context means decisions made collaboratively with service users where there is determined effort, on the part of the nurse, to share decisional power. Concern has also been expressed that current theory used to inform practice is derived predominantly from professional academics rather then those who use services. In order to address these issues, a co-operative inquiry design was adopted which engaged all participants as co-researchers, as well as co-subjects, and involved repeated cycles of action and reflection, using recorded group meetings as the means to collect the data. The aims of the study were to identify strategies for increasing user participation in decisions, to develop a model of good practice and to explore the value of co-operative inquiry as a vehicle for bringing about increased participation. The outcomes of the inquiry have been to identify, from a service user perspective, professional values, behaviours and actions and cultural aspects within organisations which inhibit or enable the sharing of power and participation in decisions. In addition the inquiry has developed the ‘time for change’ model which it is proposed could be used to evaluate aspects of participation within the clinical practice and education environment. The inquiry concludes by demonstrating the potential benefits and challenges of conducting meaningful participatory research. It also reflects on the value of the co-operative inquiry process as a vehicle for developing the students’ practice and moral development, which, it is argued, has wider utility in higher education and the practice learning environment. Finally the inquiry emphasises the need for an organisational culture in which the practice of participation can evolve and be nurtured, in order to overcome the systematic exclusion, or what has been termed ‘institutional userism’, which was a common experience for the inquiry participants.
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Wilson, Edward. "How much detail is needed in cost estimation in an economic evaluation alongside a clinical trial to optimise evidence for decisions?" Thesis, University of East Anglia, 2014. https://ueaeprints.uea.ac.uk/49474/.
Full textAbstract:
Acquiring evidence to support decision making is expensive. Collecting resource use data alongside a randomised controlled clinical trial is particularly so due to the multidimensional nature of costs: different costs are incurred by different agencies with varying methods and systems to account for these. Trialists are faced with decisions over how to collect such data, in particular different ‘levels’ of detail are possible. For example, hospitalisations can be costed (1) on a top-down, per admission basis multiplied by a representative unit cost, (2) a bottom-up basis measuring every component of care such as nursing and medic time, investigations and other procedures and drugs used which are each multiplied by relevant unit costs, or (3) some intermediate level of aggregation. The top-down data will be less expensive to obtain but may be less accurate (biased and/or over- or under-estimation of uncertainty) compared with the bottom-up. I refer to these alternative methods as ‘data collection processes’. Currently such decisions are based on the judgement of the trialist(s). However, formal quantification of the added value of one data collection process versus another compared with the added cost would inform the efficient allocation of research resources. In this thesis I extend the use of value of information analysis to compare the incremental cost and benefit of one data process with another, further extending this to estimate the optimal mix of observations between two processes. Using an example dataset I find that the method is workable, requiring prior information on the relationship between the two processes which can be obtained from either a pilot or feasibility study or expert opinion. When incorporated with other concurrent developments in value of information analysis, the method has the potential to provide a decision analytic approach to the complete design of clinical trials.
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Andronis, Lazaros. "Analytic approaches for informing research funding decisions : an exploration of their role and value using case studies of cancer clinical trials." Thesis, University of Birmingham, 2013. http://etheses.bham.ac.uk//id/eprint/4153/.
Full textAbstract:
Patient-level evidence obtained from clinical trials is essential in assessing the cost-effectiveness of health care technologies. Given the increasing demand for primary evidence and limited public resources for health care research, research funding organisations are routinely called to make decisions on which clinical trials to fund. Such decisions need to be informed by evidence on the likely costs and benefits of competing research programmes. Two main analytic approaches have been proposed to provide such evidence, ‘payback of research’ and ‘value of information’. This work applied the ‘payback’ and ‘value of information’ methodologies to case studies representing proposals for clinical trials in cancer. This application gave estimates of the value of undertaking the trials and offered an insight into the strengths, limitations and usefulness of the methods. ‘Payback of research’ and ‘value of information’ can help with different funding decisions in the context of different funding streams, they are practical to undertake and can be readily incorporated into the existing research funding processes. It is suggested that the methods should be used as part of existing deliberative processes, to provide additional assurance that limited public resources are allocated to clinical trials which are likely to result in benefits to the population.
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Edwards, Katie M. "College Women's Stay/Leave Decisions in Sexually Violent Relationships: A Prospective Analysis." Ohio : Ohio University, 2007. http://www.ohiolink.edu/etd/view.cgi?ohiou1192941493.
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Ali, Irena Malgorzata, and n/a. "The impact of information provided by medical libraries on clinical decision making : A study of two hospitals." University of Canberra. Information, Language & Culture Studies, 1996. http://erl.canberra.edu.au./public/adt-AUC20060530.115422.
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A quantitative survey was conducted in two Canberra hospitals that aimed
at ascertaining the impact of information provided by medical libraries on
clinical decision making. Specifically, this research study investigated
clinical, cognitive and quality value of information provided by the medical
librarians to the management of patients and doctors' ability to handle
clinical cases differently as a result of such information. Furthermore, the
relative value of information received from the library was assessed by
comparing it to the value of information received from other sources in
dealing with clinical problems.
The research involved medical specialists and registrars affiliated with these
hospitals. Doctors were asked to select any clinical situation which they
frequently or currently encounter and for which further information would
be useful to them. Once their information requests were identified, they
were then asked to present such requests to the hospital library. In order to
avoid any special treatment, participants were urged not to identify
themselves to the library staff as partaking in the study. It was important
that participants did not search for the information themselves. The doctors
were asked to evaluate the material provided by the library in relation to
clinical care and, thereafter, complete a short questionnaire. This research
took place between October 1994 and March 1995. The questionnaires were
sent to 288 doctors. This represented the total population of specialists and
registrars affiliated with both hospitals at the time of the study. Analysis of
the results is based on a 34% useable response rate.
Medical specialists were by far the higher number of respondents (70%) as
compared with registrars (30%). Eighty-one per cent of the doctors said that
the information provided by the library refreshed their memory and 82% said
that it would contribute to better quality of medical care. Eighty-six per cent
indicated that some of this information was new to them and 99% said that
the information provided was up to date. Ninety-four per cent said that the
information provided by the library was of clinical value to them.
As the result of the information provided by the library 75% of respondents
would either definitely or probably handle some aspects of the clinical
situation differently than they would have done it otherwise. The level of
importance of the change for the optimal care of patients was assessed with
54% regarding it as important, 42% as moderately important.
Specifically, as the result of the information provided, the doctors were
able to change the following:
diagnosis 10%,
choice of lab tests 20%,
choice of other diagnostic investigations 24%,
choice of drugs 27%,
choice of other management 58%,
reduce length of hospitalisation 10%,
post-operative care of patients 25%,
advice given to patients 47%. On the basis of the received information the doctors were able to avoid
the following:
hospitalisation of patients 11%,
risk of hospital acquired infection 8%,
surgical intervention 19%,
tests or other investigation 23%,
additional out-patient visits 12%.
Discussions with colleagues were reported to be most valued sources of
information for the purpose of clinical decisions (59%), followed by diagnostic
imaging (49%), librarian (45%), lab tests (42%) and patients' medical records
(30%). The librarian's role as contributing to the process of clinical decisions was
rated highly with 88% ranking it as either important or moderately important.
The results of significance p test statistic performed at 0.05 significance level
suggested that, for this study, there was a significant relationship between the
frequency of library use and doctors' ability to change the choice of laboratory
tests, diagnostic investigations, and the choice of prescribed drugs.
The results of this research study demonstrate that medical librarians can
positively contribute to clinical management of patients by providing timely and
accurate information. Further research is recommended in order to determine
the impact of the whole range of library services on health care outcomes.
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Otal, Tanveer K. "The Effects of Suggestibility, Compliance, and Situational Stress on Miranda Abilities, Waiver Decisions, and False Confessions." Thesis, University of North Texas, 2019. https://digital.library.unt.edu/ark:/67531/metadc1538689/.
Full textAbstract:
Miranda abilities, individual characteristics, and contextual factors are critical elements to evaluate in determining the validity of Miranda rights waivers and confessions. Research indicates that many individuals waive their Miranda rights without adequate comprehension or reasoning. In addition, personality characteristics of suggestibility and compliance are key factors influencing waiver decisions. Furthermore, scholars found that situational anxiety likewise impairs Miranda abilities and waiver decisions. Previous research has investigated the effects of Miranda abilities, individual characteristics, and contextual factors on Miranda waivers and confessions by utilizing confession paradigms. A methodological limitation of these paradigms is the lack of volition and autonomy in committing the accused acts of wrongdoings. The current study of undergraduate students advances previous research through examining the detrimental impact of false accusations of wrongdoings committed independently and intentionally using a novel paradigm. This thesis sought to further the understanding of the effects of Miranda abilities (i.e., comprehension and reasoning), personality characteristics (i.e., suggestibility and compliance), and situational factors (i.e., false accusation) in relation to Miranda waivers and confession decisions. The final sample included 87 undergraduate students, of whom approximately 97% waived their rights and 40% falsely confessed to the wrongdoing. The results indicate that Miranda reasoning, suggestibility, and compliance significantly predict the likelihood of false confession. These findings can be used to inform policy changes as well as the evaluations of the validity of Miranda waivers and confessions.
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Duncan, Paula K. "Sexual offending and sentencing : an investigation of the factors affecting sentencing decisions regarding perpetrators of sexual offences against children. In particular an investigation of the impact and usefulness clinical psychology reports have in judicial decisions about sentencing sexual offenders." Thesis, Open University, 1996. http://oro.open.ac.uk/57626/.
Full textAbstract:
The sentencing of sexual offenders has become a national concern with public outcries about the injustice of the diversity of sentencing. Clinical Psychologists working in Forensic settings are increasingly involved in the treatment of child sexual offenders through consultation and therapeutic interventions in out-patient, residential and prison settings. Psychologists in these settings need to determine the characteristics of the sexual offender population they are likely to come in contact with in each of the different settings. This research aims to investigate a range of factors that impact and influence decisions about the sentencing of sexual offenders. A mixed methodological approach comprising case-file audit, qualitative interviews and statistical tests of association and prediction of variance was used to investigate the research area from different perspectives. A comprehensive profile of characteristics of child sexual offender's and their offences was obtained from audit data on 117 perpetrators of sexual offences against children. Statistical analysis of a number of these characteristics found that Psychological report recommendations were the most predictive of sentencing outcome when all other tested variables had been taken into account. The impact and influence of psychological reports in the sentencing process was further highlighted through interviews with Judges.
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Geiger, Constance J. "Using Adaptive Conjoint Analysis and Market Simulations to Detemine the Effect and Usefulness of Nutrition Label Information in Consumer Purchase Decisions." DigitalCommons@USU, 1988. https://digitalcommons.usu.edu/etd/5358.
Full textAbstract:
Nutrition labeling research suggests consumers want nutrition information on the label; however, many do not comprehend it. The purpose of Phase I was to determine the effect of: 1. two levels of nutrition label formats; 2. three levels of nutrition information load on consumers' preference for product choice using adaptive conjoint analysis. A computer interactive interview was conducted on 252 consumers in Crossroads Mall, Salt Lake City, Utah. label alternatives were printed on soup cans to realistically portray the information. The conjoint analysis compared the attributes, nutrition information format, and nutrition information load in addition to brand and price and determined how the study participants ranked choices within each of these attributes and against the other attributes. There were significant differences (p < .000) among all three mean utility values± Standard Error of the Mean (SEM) of information load, most (.300 ± .03) , more (.154 ± .02), and some (-.231 ± .03). There was no difference between graphical (.093 ± .027) and traditional (.055 ± .020) formats (p = .298). For the other attributes, there were significant differences (p < .000) among all brands, Campbell's (.590 ± .03), Private label (-.007 ± .02) Generic (-.361 ± .03) and all prices, (p < .000), low (.431 ± .03), medium (.022 ± .02), and high (-.230 ± .03). Market simulations were performed and market share was shifted from the major brand when nutrition information was added to a Private label or Generic brand.
The purpose of Phase II was to determine the effect of: 1. three levels of nutrition information content load; 2. two levels of nutrition information order; 3. three levels of nutrition information format; and 4. four levels of nutrition information expression on consumers' perceptions of label usefulness in purchase decisions. The methodology was the same as Phase I. There were significant differences (p < .000) among all three mean utility values ± SEM of information load, most (.327 ± .02), more (.091 ± .02) , and some (-.213 ± .03), and between the two mean utility values ± SEM of information order, rearranged (.157 ± .03) and traditional (-.02 ± .02). Consumers significantly preferred (p < .000) the graphical format (.148 ± .02) over the graphical nutrient density (.038 ± .02) and traditional (.018 ± .03) formats. Consumers significantly preferred (p < .000) nutrition information stated in absolute numbers and percentages (.296 ± .03), versus absolute numbers only (.028 ± .03), traditional (-.026 ± .03), and percentages only (-.025 ± .03) expressions. The most useful nutrition label in a purchase decision was one that contained the most information, in a rearranged order, with a graphical format, and an absolute number and percentages expression.
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van, Raders Petronella. "Pain is what the patient says it is, but ... : an ethnographic study of the factors which influence nurses when they make pain management decisions in a clinical setting." Thesis, University of Warwick, 2012. http://wrap.warwick.ac.uk/54051/.
Full textAbstract:
Barriers to effective postoperative pain management mean many patients suffer needless pain. Few studies have observed nurses as they manage postoperative pain in a clinical setting; those who used observation have demonstrated the importance of context to pain management practice. This ethnographic study aimed to examine what factors influenced nurses when they made pain management decisions, and how the culture of the clinical environment impacted on pain management practice. One hundred and fifty seven hours of participant and non-participant observation, semistructured interviews with thirty-six members of staff, contemporaneous field notes, and document analysis were used to investigate the culture of pain management in one postoperative ward. Analysis identified three themes with sub themes. First, the revealing of a pain management culture, which incorporated the ward environment and processes, and a new finding of the silence of routine pain management communication. Second, nurses' decision-making responses to pain management opportunities including a new finding of a single pain management action. The final theme is nurses' expectations of patient behaviours and knowledge, including how patients should look, what they should say and know, and nurses' responses to patients who do not conform to expectations. The findings suggest culturally mediated pain management behaviours, linked to a ward culture where pain was not a priority, leading to inattention to pain management. Using Social identity theory these behaviours are presented as in-group pain management social norms; part of the culture of 'how pain management is done around here'. These pain management in-group behaviours are presented as the critical factors influencing nurses' pain management decision-making in a clinical setting. They are not targeted through traditional education and their explication may indicate pain management education should be directed more towards cultural change.
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Torres, Misty Dawn. "Finding Childcare for the Disabled Child: The Process and Decisions Through the Primary Caregiver’s Lens." Antioch University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1433776716.
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Cumming, Jonathan. "Clinical decision support." Thesis, Durham University, 2006. http://etheses.dur.ac.uk/1814/.
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Sibayan, Juanita. "Family Relational Experiences During Major Transitions with a Chronic Illness." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5266.
Full textAbstract:
Although health care transitions have received some attention in the literature, few researchers have emphasized family relational experiences and communication during major changes while living with a chronic illness. The purpose of this phenomenological study was to understand the lived experience of parents and their adult children while transitioning from pediatric to adult care of a chronic illness. The bio-psychosocial theory, family systems theory, and attachment theory established the context for this study. A criterion-based sampling technique and snowball sampling were used to recruit 7 parents and 6 of their adult children aged 18 to 30 years who were diagnosed with cystic fibrosis or congenital heart disease, and who had either completed or were in the process of completing the transition from pediatric to adult healthcare. Semi-structured interviews were conducted, and content analysis was used to code and analyze themes that emerged from the experiences of participants. The themes that were identified included that parents were instrumental in maintenance of treatments during high risk periods of adolescence, healthy parent and child relations included collaboration that accommodated autonomy, and that early coaching helped reduce parental anxiety about non-adherence while increasing the self-efficacy of the child. This study contributes to positive social change by informing the design of current procedures to transition young adults with chronic illness by recommending flexibility in negotiations, early education, shadowing between facilities, and incorporating evidence-based practice based on feedback from each family member.
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Jensen, Jan L. "Paramedic Clinical Decision Making." BMC Emergency Medicine, 2009. http://hdl.handle.net/10222/12738.
Full textAbstract:
Paramedics are responsible for the care of patients requiring emergency assistance in the out of hospital setting. These health care providers need to make many decisions during the course of an emergency call. This thesis on paramedic clinical decision-making includes two studies, intended to determine which decisions paramedics make that are most important for patient safety and clinical outcome, and what thinking strategies paramedics rely on to make decisions. Forty-two decisions were found to be most important for outcome and safety. The highest decision density of an emergency call is during the on-scene treatment phase. Paramedics use a mix of thinking strategies, including rule out worst scenario, algorithmic, and exhaustive thinking. The results of these studies have implications for future research, paramedic practice and training.
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Koehn, Amy R. "To report or not report : a qualitative study of nurses' decisions in error reporting." Thesis, Indiana University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3665927.
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This qualitative study was successful in utilization of grounded theory methodology to ascertain nurses' decision-making processes following their awareness of having made a medical error, as well as how and/or if they corrected and reported the error. Significant literature documents the existence of medical errors; however, this unique study interviewed thirty nurses from adult intensive care units seeking to discover through a detailed interview process their individual stories and experiences, which were then analyzed for common themes. Common themes led to the development of a theoretical model of thought processes regarding error reporting when nurses made an error. Within this theoretical model are multiple processes that outline a shared, time-orientated sequence of events nurses encounter before, during, and after an error. One common theme was the error occurred during a busy day when they had been doing something unfamiliar. Each nurse expressed personal anguish at the realization she had made an error, she sought to understand why the error happened and what corrective action was needed. Whether the error was reported on or told about depended on each unit's expectation and what needed to be done to protect the patient. If there was no perceived patient harm, errors were not reported. Even for reported errors, no one followed-up with the nurses in this study. Nurses were left on their own to reflect on what had happened and to consider what could be done to prevent error recurrence. The overall impact of the process of and the recovery from the error led to learning from the error that persisted throughout her nursing career. Findings from this study illuminate the unique viewpoint of licensed nurses' experiences with errors and have the potential to influence how the prevention of, notification about and resolution of errors are dealt with in the clinical setting. Further research is needed to answer multiple questions that will contribute to nursing knowledge about error reporting activities and the means to continue to improve error-reporting rates.
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Vilardo, Maria Aglaé Tedesco. "Decisões judiciais no campo da biotecnociência: a bioética como fonte de legitimação." Universidade do Estado do Rio de Janeiro, 2014. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=7549.
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A tese analisa decisões judiciais prolatadas em casos da bioética clínica, especificamente: requerimento de autorização para interrupção de gestação de feto anencéfalo, liberdade de recusa à imposição de procedimento de transfusão de sangue em razão de crença religiosa em paciente Testemunha de Jeová e a mudança de nome e sexo de transexual com ou sem realização de cirurgia de transgenitalismo. A escolha dos três tipos de casos levados a julgamento ao Poder Judiciário se deu em virtude de serem questões características ao direito existencial, de repercussão no Ser do indivíduo, em seus direitos personalíssimos. Para isso foram analisadas 84 decisões judiciais, mediante a aplicação da teoria Principiológica de Beauchamp & Childress e análise de cada decisão quanto à aplicação dos quatro Princípios que desenvolve: do respeito à autonomia, da não maleficência, da beneficência e da justiça. O resultado da análise demonstrou que ao utilizar os quatro Princípios, com especificação e ponderação dos mesmos, o julgador profere decisões de cunho liberal. Quando não utiliza os Princípios ou extrapola os limites de sua aplicação, o julgador profere decisões de cunho conservador. As decisões judiciais de caráter liberal são despidas de preconceitos e moralismos e permitem o respeito aos direitos individuais sem descuidar dos direitos dos demais membros da sociedade. As decisões conservadoras se baseiam na literalidade da lei e violam direitos individuais, sem acrescentar segurança à sociedade. A apropriação desta teoria da ética biomédica pelo biodireito, se apresenta como método seguro e eficaz na prolação de decisão judicial em casos da bioética clínica e conduz o julgador a decisões mais justas por serem apoiadas em boas razões.The thesis analyzes judicial decisions rendered in clinical bioethics cases, specifically requests for permission to termination of pregnancy of anencephalic fetus, freedom to refuse the imposition of blood transfusion procedure for Jehovahs Witnesses because of religious belief, and the change of name and sex with or without the performance of sex reassignment surgery. The choice of these three types of cases brought to the Judiciary for trial was due to their being issues characteristic of existential law, that have an impact on the individual Being, on his very personal rights. For that, 84 judicial decisions were analyzed, through the appropriation of the Beauchamp and Childress Principles theory and the analysis of each decision as to the application of the four Principles that it develops: respect for autonomy, non-maleficence, beneficence and justice. The result of the analysis showed that using the four principles, specifying and pondering them, the judge enters decisions of liberal intent. When he does not use the Principles or when he crosses the limits of their application, the judge enters decisions for conservative intent. Judicial decisions of liberal character are stripped of prejudice and moralism and allow respect for individual rights without neglecting the rights of other members of society. Conservative decisions are based on the literalness of the law and violate individual rights, without adding security to society. The appropriation of the biomedical ethics theory by biolaw represents a safe and effective method for the entry of judicial decisions in clinical bioethics cases and leads the judge to fairer decisions, for being supported by good reasons.
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Svantesson, Mia. "Postpone death? : Nurse-physician perspectives on life-sustaining treatment and ethics rounds." Doctoral thesis, Örebro universitet, Hälsoakademin, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-2093.
Full textAbstract:
The starting point of the present thesis is nurses’ reported experiences of disagreements with physicians for pushing life sustaining treatment too far. The overall aim was to describe and compare nurses’ and physicians’ perspectives on the boundaries for life-sustaining treatment and to evaluate whether ethics rounds could promote mutual understanding and stimulate ethical reflection. A mixed methods design with qualitative and quantitative data was used, including interviews and questionnaires. The health professionals’ experiences/perceptions were based on known patients foremost from general wards, but also intensive care units, at four Swedish hospitals. The first two studies treated the perspective on boundaries for life-sustaining treatment and the last two evaluated philosopher- ethicist led ethics rounds. Analysis of data was performed using a phenomenological approach and content analysis as well as comparative and descriptive non-parametric statistics. In the first study, the essence of the physicians’ decision-making process to limit life-sustaining treatment for ICU patients, was a process of principally medical considerations in discussions with other physicians. In the second study, there were more similarities than differences between nurses’ and physicians’ opinions regarding the 714 patients studied. The physicians considered limited treatment as often as the nurses did. The ethics rounds studies generated mixed experiences/perceptions. It seemed that more progress was made toward the goal of promoting mutual understanding than toward the goal of stimulating ethical reflection. Above all, the rounds seemed to meet the need for a forum for crossing over professional boundaries. The most salient finding was the insight to enhance team collaboration, that the interprofessional dialogue was sure to continue. Predominating new insights after rounds were interpreted as corresponding to a hermeneutic approach. One of nurses’ negative experiences of the ethics rounds was associated with the lack of solutions. Based on the present findings, one suggestion for improvement of the model of ethics rounds is made with regard to achieving a balance between ethical analyses, conflict resolution and problem solving. In conclusion, the present thesis provides strong evidence that differences in opinions regarding boundaries for life-sustaining treatment are not associated with professional status. The findings support the notion of a collaborative team approach to end-of-life decision-making for patients with diminished decisionmaking capacity. There is an indication that stimulation of ethical reflection in relation to known patients may foremost yield psychosocial insights. This could imply that social conflicts may overshadow ethical analysis or that ethical conflicts and social conflicts are impossible to distinguish.
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Wong, Thomas Kwok Shing. "Clinical decision making in nursing." Thesis, Glasgow Caledonian University, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.283692.
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Gurbutt, Russell. "Demonstrating nurses' clinical decision-making." Thesis, University of Central Lancashire, 2005. http://clok.uclan.ac.uk/21842/.
Full textAbstract:
The study answers the question: 'How can nurses' properly considered decisions relating to patient care be demonstrated?' Nurses in the United Kingdom have a professional requirement to demonstrate': the properly considered clinical decisions relating to patient care' (UKCC, 1994; NMC, 2002). However, their decisionmaking has been reported as complex and poorly understood, and apart from nursing records, little evidence exists to demonstrate their decisions. The development of the nurses' role as a decision-maker is traced from an origin in Nightingale's text (1860) through to the present day. This role is shaped by organisational, nursing and medical profession influences. Having established that nurses have a role as decision-makers, a conceptual framework is used to examine different explanations about the decision process, outcome, context and how decisions are made. Before undertaking fieldwork, a survey of nurses' decision-making in general medical and surgical wards was conducted. The findings were compared with the conceptual framework to generate questions and avenues for enquiry. An ethnographic study was undertaken in 1999 - 2000 in four general medical wards in two English provincial NHS Trusts with registered nurses (general). A model of decision-making was developed as a mid range theoretical explanation of how they made decisions. This involved a narrative based approach in which nurses generated an account (narrative) of knowing a patient and used this to identify needs. The patient was known in a narrative through three categories of information: nursing, management and medical. These categories were constructed through nurses' information seeking and processing using a tripartite conceptual lens. These facets correspond to different aspects of the nurse's role as a carer, care manager and medical assistant. The patient is known in three ways in a narrative, as a person to care for, an object to be managed, and as a medical case. An oral tradition surrounded its use, and nursing records were not central to decision-making. The narrative was used to make decisions and influence medical decisions. Once it was established how nurses made decisions, a method was developed to show how they could demonstrate their properly considered clinical decisions relating to patient care. This involved using the narrative based decision-making model as an analytical framework applied to nurse decision narratives. Narrative based decisionmaking offers a development of existing descriptive theoretical accounts and new explanations of some features of the decision process. This particularly includes the use of personal note sheets, the role of judgements and the cycle of communicating the narrative to nurses and its subsequent development as a process of developing an explanation of how the patient is known. Having addressed how nurses can demonstrate their properly considered clinical decisions relating to patient care, conclusions are drawn and implications explored in relation to practice, professional regulation, education and method. Recommendations include a challenge to the assumption about decision-making underpinning existing NMC guidance on recordkeeping, and the need to recognise diversity of decision-making practice across different nursing sub-groups. The narrative revealed nurses' ways of constructing knowing patients and rendering this visible. Nurses' not only have a duty, but also a need, to demonstrate decisions so that they can render visible what it is they are and do.