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Bell, Ian Douglas, and ian bell@deakin edu au. "Improving clinical judgements." Deakin University. School of Psychology, 2003. http://tux.lib.deakin.edu.au./adt-VDU/public/adt-VDU20070119.100737.
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This portfolio explored issues that are relevant to the judgements routinely made by clinical psychologists. The first chapter provides a theoretical overview of relevant issues. In this chapter, firstly, the debate over the relative merits of clinical and statistical approaches to clinical judgement (Meehl, 1954) is reviewed. It is noted that, although much of the empirical evidence supports the greater accuracy of statistical approaches to making judgements (where appropriate methods exist), they are rarely routinely used, and clinical approaches to making judgements continue to dominate in the majority of clinical settings. Secondly, common sources of errors in clinical judgement are reviewed. These include the misuse of cognitive heuristics, the presence of clinicians biases, the limitations to human information-processing capacities and the over-reliance on clinical interviews. Finally, some of the basic strategies that can be useful to clinicians in improving the accuracy of clinical judgement are described. These include undertaking advanced level training programs, using quality instruments and procedures, being wary of over-reliance on theories, adhering to the scientist-practitioner approach and being selective in the distribution of professional efforts and time. In the subsequent chapters these strategies are explored further through four clinical case studies. These cases were collected during the university placement program and they have been selected to illustrate some of the approaches as clinician may use in attempting to optimise the accuracy of judgements necessary in the context of clinical psychological practice. The final chapter provides a brief overview and discussion of these cases in relation to the issues identified in Chapter One,
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Hollows, Anne. "Good enough judgements : a study of judgement making in social work with children and families." Thesis, University of Reading, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.367336.
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Miresco, Marc J. "Judgements of responsibility and mind brain dualism in clinical psychiatry." Thesis, McGill University, 2006. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=97970.
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This thesis explores the phenomenon of mind-brain dualism in contemporary Western psychiatry from an anthropological and social psychological perspective. In a first chapter, it reports on an empirical study involving 127 staff psychiatrists and psychologists at McGill University who responded to a questionnaire based on clinical vignettes. Results revealed a latent process of judging patients' responsibility for illness, where the more a behavioural problem was seen as 'psychological,' the more the patients tended to be viewed as responsible and blameworthy for their symptoms, while behaviours with 'neurobiological' causes showed the opposite tendency. A second chapter reviews the history of psychosomatic medicine and argues that specific biomedical and psychological sick roles exist for patients that determine the ways in which their actions are judged, as well as how the functions of the rational mind are commonly understood. Insights from evolutionary psychology are used in a third chapter to speculate on new models of mental illness that may provide new contexts for negotiating mind-brain dualism and judgements of responsibility.
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Harvey-Cook, Jane Elizabeth. "Graduate recruitment at professional entry level : clinical judgements and empirically derived methods of selection." Thesis, City University London, 1995. http://openaccess.city.ac.uk/7736/.
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This research provides evidence to support the argument that selection procedures dependent upon clinical judgements, being used in the chartered accountancy profession, may well provide results not significantly different from those obtained by chance. Research has suggested that personality type, choice of vocation and performance are predictable from personal histories (Holland, 1976; Owens and Schoenfeldt, 1979; Eberhardt and Muchinsky, 1982a; Super, 1980; Wernimont and Campbell, 1968) and using a predictive model approach to scoring biographical data (biodata) is explored here as a means of improving the selection function. Part I of this study develops predictive models for scoring the biodata of applicants to the profession. An original contribution is made by carefully comparing two empirical model-building methodologies: the generally accepted, non-parametric, Weighted Application Blank technique and the parametric, logistic regression technique. The validity of both are explicitly tested using information from a sample of 23 training offices from 22 medium size chartered accountancy firms. The sample trainees were all non-accounting graduates entrants entering between 1985 and 1987 (N=665). Evidence is provided of the superiority of the results of the parametric models, in terms of true predictive validity. Relevant theory and the important implications of the results for related biodata studies generally are discussed. The result of applying the models to applicants, rather than recruits, is examined in a pilot study. An original approach to scoring applications is presented. Specifically developed software is provided to minimise both processing time and error margins. The biodata logit scores of the applicants and their likely success as trainees as indicated by that score, are compared with the firm's decision whether to accept or reject. Severe problems inherent in the judgemental approach to selection are revealed and the superior performance of the model-based approach demonstrated. Part II addresses the crucial issue of long term validation of biodata models by scoring a sample of recruits from 3 representative firms' 1988-90 entrants (N=323). The evidence does not support criticism of long term validity, as the logit models demonstrate effective performance, measured interms of the probability of correct classification, successfully predicting the criteria on those entering the profession up to 5 years after subjects used in model development. It is suggested that poor methodology may be responsible for excessive loss of validity over time in other studies and their lack of use of hard data. In addition, original evidence is provided to support the hypothesis of the generalizability of such models (i) across organizations and (ii) across samples significantly different from the development sample. This evidence suggests that, not only may the models be used to score applicants accounting firms of different sizes (and are therefore not organization-specific) but they may be used to score accounting graduates, who differ considerably from the original development sample (indicating that they, are not sample specific). The appropriateness of using these models in a manner similar to psychometric tests is considered. An assessment of approximate net profit associated with successful, failing or partially successful trainees is made. Accounting graduate trainees are more financially viable than non-accounting graduates.
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Tate, Kerry. "An investigation into the effect of causal beliefs about depression on attitudes and clinical judgements." Thesis, Canterbury Christ Church University, 2013. http://create.canterbury.ac.uk/12368/.
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Biological explanations of depression have been found to increase professional perceptions of the effectiveness of medical treatments and reduce the perceptions of the effectiveness of psychological therapy. Studies in lay populations have shown that biological explanations reduce perceptions of self-efficacy and control over depression symptoms. There is a lack of research examining the impact of causal models on clinicians’ attitudes. The current study aimed to explore whether clinicians’ causal models of a client’s depression can be biased by aetiological labelling and, in turn, whether clinicians’ causal models impact clinical judgements and attitudes. An experimental design was utilised, with one independent variable (labelling of the client’s depression) with three levels (biological, psychosocial and neutral). Outcomes measured causal beliefs, treatment effectiveness, control, clinical attitudes and perceived stigma in relation to a client vignette. Observational data were analysed to explore the effects of clinicians’ primary causal models on the outcome variables. Over 200 trainee clinical psychologists, across England, Scotland and Wales, took part in an online survey, presented using surveymonkey®. Where appropriate data were analysed using ANOVA. There was a small effect of the manipulation; labelling the depression as biological increased biological causal attributions and increased perceptions of the effectiveness of medical treatments. The exploratory analysis demonstrated substantial effects of strongly endorsing biological causal beliefs on judgements of medical treatments and client engagement. The results suggest that clinicians’ causal models of a client’s depression may bias clinical judgements. These findings are preliminary and further research is needed.
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Van, den Berg Rick. "The integration of patient cues, nursing knowledge and clinical judgements by Intensive Care Unit nurses in simulated situations of urgency." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1996. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq20985.pdf.
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van, den Berg Rick. "The integration of patient cues, nursing knowledge and clinical judgements by Intensive Care Unit nurses in simulated situations of urgency." Thesis, University of Ottawa (Canada), 1996. http://hdl.handle.net/10393/10072.
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Nurses who work in critical care areas must learn how to make effective clinical judgements about patients under a variety of conditions. The process of making clinical judgements includes attending to cues from the patient and integrating prior nursing knowledge. The study examined this process within the context of simulated patient instability, in which there is minimal time for the nurse to reflect upon the judgements made. Registered Nurses from four Intensive Care Units (ICU) within the Regional Municipality of Ottawa-Carleton were randomly selected and invited to participate in the study and twenty-four nurses participated. The study employed a 'think aloud' method and verbal protocol analysis to examine the number and types of patient cues from six case studies, that were attended to by the nurses. The relationship between cue recognition, domain-specific knowledge and clinical judgements was examined. Nurses verbalized a low percentage of the available patient cues, knowledge, and clinical judgements. A significant and moderately positive correlation was found between cue recognition and knowledge verbalized, knowledge verbalized and clinical judgements made and cue recognition and clinical judgements made. The number of knowledge items verbalized were positively correlated with the level of ICU (tertiary or secondary), with higher levels of knowledge items verbalized found in the nurses working in the two tertiary level ICUs. The results of this study have implications for all nurses as well as those in advanced practice roles. Case reviews, as part of ongoing education, can encourage the nurses to examine and improve their clinical judgements. Teaching nurses to become reflective practitioners would provide them with tools to examine and improve their own process of making clinical judgements. Ensuring that nurses have current nursing knowledge can provide a stronger basis for their clinical judgements. Areas for further research are described.
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Coulter, Margaret Anne. "Nurses' early recognition of medical patients in transition states from acute to critical illness or cardiac arrest : the cue composition of clinical judgements." Thesis, University of Surrey, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.411482.
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Ahlzen, Rolf. "Understanding clinical judgement and its relation to literary experience." Thesis, Durham University, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.521791.
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Flores, Sepulveda Luis Jose. "Clinical judgement in the era of evidence based medicine." Thesis, King's College London (University of London), 2017. https://kclpure.kcl.ac.uk/portal/en/theses/clinical-judgement-in-the-era-of-evidence-based-medicine(d05f12b7-05fd-45a2-b1ff-78060d1d8520).html.
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“Evidence Based Medicine” (EBM) urges that medical recommendations be based on the best research evidence, rather than on clinical judgement. While I strongly endorse attention to relevant research evidence, I argue that the related downplaying of clinical judgement is a step backwards. This is because actual models of EBM encourage physicians to focus exclusively on research probabilities and so to neglect relevant information about patients. I call this feature of EBM the “Problem of Extra Information” (PEI), and contend that it leads to predictions and prescriptions based on the wrong probabilities. The PEI has been largely neglected by EBM, which has construed the challenge of clinical care as a matter of developing better research evidence, and of reminding physicians to attend to patients’ preferences and values. And although meritorious attempts have been made to connect research with individuals through sophisticated methodological improvements, these only address the PEI partially, and do not eliminate the need for clinical discretion. In this dissertation I contend that, in response to the PEI, clinical medicine requires a more Discretionary Approach (DA). This approach recognizes that the objective probabilities that matter for clinical recommendations are those in the reference class defined by everything the physician knows about the patient, and argues that the central role for judgment in clinical practice is to estimate these probabilities. So understood, the DA has two main advantages over the EBM approach: prudential adequacy and evidential flexibility. My defence of the DA consists of addressing criticisms of the role ascribed to judgment and clinical experience within this approach. The final two chapters of this doctoral dissertation complement my arguments with two meta-analytical empirical studies: one which compares “therapeutic guidelines based on evidence” with “usual care” with respect to patients’ outcomes, and another which examines the relative predictive performance of statistical models and physicians’ judgment in the context of diagnosis and prognosis. These studies refute previous evidence cited against judgment and vindicate the plausibility of the Discretionary Approach to clinical care.
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Harries, Priscilla Ann. "Occupational therapists' judgement of referral priorities : expertise and training." Thesis, Brunel University, 2004. http://bura.brunel.ac.uk/handle/2438/3110.
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The British government currently requires mental health services to be targeted at the most needy (Department of Health, 1999). For occupational therapy services, where service demand far exceeds service availability, skill in referral prioritisation is essential. The studies in this thesis describe how experienced occupational therapists’ referral prioritisation policies were used to successfully educate novices. 40 British occupational therapists’ referral prioritisation policies were modelled using judgement analysis. Individuals’ prioritisation decisions were regressed onto 90 referral scenarios to statistically model how referral information had been used. It was found that the reason for referral, history of violence and diagnosis were most important. The occupational therapists’ capacity for self-insight into their policies was also examined by comparing statistically modelled policies derived from their behaviour with their subjective view of their cue use. Self-insight was found to be moderate (mean r = 0.61). A Ward’s cluster analysis was used on the statistically modelled policies to identify if subgroups of therapists had differing referral prioritisation policies. Four clusters were found. They differed according to several factors including the percentage of role dedicated to specialist occupational therapy rather than generic work. The policies that led to more of an occupational therapy role were found to give particular importance to the reason for referral and the client’s diagnosis. The occupational therapy professional body supports this latter method of working as it has recommended that occupational therapists should use their specialist skills to ensure clients’ needs are met effectively. Therefore the policies that focussed on clients’ occupational functioning were used to train the novices. Thirty-seven students were asked to prioritise a set of referrals before and after being shown graphical and descriptive representations of the policies. Students gained statistically significant improvements in prioritisation. Students’ pre-training policies were found to be those of generic therapists; a method of working that has been found to be leading to reduced work satisfaction and burnout (Craik et al.1998b). The training is therefore needed to ensure undergraduate occupational therapy students develop effective referral prioritisation skills. This will help to ensure that clients’ needs are met most effectively and work stress is reduced.
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King, Roslyn Anne Lindy. "Levels of expertise in nurses working in surgical wards and intensive care units : a qualitative study." Thesis, King's College London (University of London), 1998. https://kclpure.kcl.ac.uk/portal/en/theses/levels-of-expertise-in-nurses-working-in-surgical-wards-and-intensive-care-units--a-qualitative-study(d1915802-e2fd-48f1-9686-ac3e6716ae2e).html.
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RODRIGUEZ, AUBREY JOY. "JUDGEMENT OF SUB-CLINICAL DEPRESSION IN PRIVATE AND PUBLIC SELF-DESCRIPTIONS." Thesis, The University of Arizona, 2008. http://hdl.handle.net/10150/192229.
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Murray, Jennifer. "Influencing clinical judgement : the role of attribution in violence risk assessment." Thesis, Glasgow Caledonian University, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.547438.
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Baker, Jacqueline Deborah. "Nurses' Perceptions of Clinical Decision Making in relation to Patients in Pain." University of Sydney. Family and Community Nursing, 2001. http://hdl.handle.net/2123/489.
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Clinical decision-making (CDM) research has focused on diagnostic reasoning, CDM models, factors influencing CDM and the development of expertise. The research approaches used, including phenomenology, have not addressed the question of how CDM is perceived and approached by nurses. This study describes perceptions of CDM in relation to patients in pain using a phenomenographic methodology. At semi-structured interviews, participants were asked to recall their responses to a situation involving a patient in pain. The responses fell into four categories: (1) the effect of the clinical environment; (2) the role of other health professionals; (3) the place of the patient; and (4) the role of experience. Examples of differences in perceptions that were likely to impact on the nurses� approach to CDM include: the ongoing effects of time and workload demands on CDM; nurses are initially dependent but were eventually able to make decisions autonomously; the patient who may be peripheral or central to CDM; and the nurses� move from the use of theoretical principles to experiential knowledge as reflection-on-practice is employed. Perceptions in all categories are strongly implicated in the nurses� sense of confidence and independence. Implications for nursing practice and nursing education suggested by the findings relate to the number of areas in which graduates work in the first year of practice, the size of new graduate workloads, graduate transition programs, the place of reflection-on-practice and undergraduate (UG) program clinical experience patterns. Among issues for further research arising from the study are: replication of the study; detailed examination of the development of CDM in the first year of nursing practice and during UG nursing education programs; the role of other health professionals in the development of CDM behaviour; the links between CDM and clinical knowledge development; and the type of clinical environments that foster confidence and independence. A conclusion of the study is that the way CDM is approached is influenced by the amount, quality, relevancy and recency of clinical experience. In this study, phenomenography was shown to be an appropriate approach to the description of nurses� perceptions of CDM in relation to patients in pain. In addition, nurses� changing perceptions over two years and the subsequent effect on CDM behaviour were described.
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Rowley, Dane Aaron. "Deployment of social cognition for communication and moral judgement in traumatic brain injury." Thesis, University of Hull, 2016. http://hydra.hull.ac.uk/resources/hull:14399.
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This portfolio comprises three parts. Part one is a systematic meta-analytic review of the relationship between cognition, including social cognition, and the pragmatic aspects of language comprehension and production following traumatic brain injury. Part two is an empirical paper which presents novel data pertaining to the characterisation of moral judgement disturbance following traumatic brain injury, and the relationship of these disturbances to social cognition. Part three comprises the appendices, which contain information supplementary to parts one and two, in addition to an epistemological and reflective statement.
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Cohen, Andrea. "A study of decision-making about risk of violence in mentally disordered offenders." Thesis, Open University, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.369030.
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Ahlzén, Rolf. "Why should physicians read? : Understanding clinical judgement and its relation to literary experience." Doctoral thesis, Karlstads universitet, Avdelningen för hälsa och miljö, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-6285.
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Is literary experience of any practical relevance to the clinician? This is the overall question addressed by this investigation, which starts by tracing the historical roots of scientific medicine. These are found to be intimately linked to a form of rationality associated with the scientific revolution of the 17th century and with “modernity”. Medical practice, however, is dependent also on another form of rationality associated with what Stephen Toulmin calls “the epistemology of the biographical”. The very core of clinical medicine is shown to be the clinical encounter, an interpretive meeting where the illness experience is at the centre of attention. The physician can reach the goals of medicine only by developing clinical judgement. Clinical judgement is subjected to close analysis and is assumed to be intimately connected to the form of knowledge Aristotle called phronesis. In order to explore how literature – drama, novels, poetry – may be related to clinical judgement, a view of literature is presented that emphasizes literature as an invitation to the reader, to be met responsibly and responsively. Literature carries a potential for a widened experience, for a more nuanced perception of reality – and this potential is suggested to be ethically relevant to the practice of medicine. The “narrative rationality” of a literary text constitutes a complement to the rationality pervading scientific medicine. The final step in my analysis is a closer exploration of the potential of the literary text to contribute to the growth of clinical judgement, in relation to the challenges of everyday clinical work. Some of the conditions that may facilitate such growth are outlined, but it is also shown that full empirical evidence for the beneficial effects of reading on the clinician reader is beyond reach.This is a PhD-thesis in Medical Humanities from Durham University.
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Smith, Julie MacAulay. "The transition from Final Year Medical Student to Foundation Doctor : the clinical reasoning journey." Thesis, University of Dundee, 2015. https://discovery.dundee.ac.uk/en/studentTheses/ec05577b-d97e-45a2-b0fe-010fc5dd0835.
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Although clinical reasoning is both broad and complex, the term “clinical reasoning” is contested and multiple definitions have been mooted within different contexts. In its simplest form, clinical reasoning is regarded as a “decision-making” process. Other definitions outline it in terms of a complex cognitive process, posited within multiple contextual factors. Traditionally, clinical reasoning models have been based upon cognitive theories. More recently, interpretive theories have been applied. Despite extensive research over the past four decades, no consensus on how clinical reasoning actually occurs has been achieved. Accurate clinical reasoning is vital to patient safety. Its importance as an essential clinical competence for healthcare professionals is well established. Indeed, it is the crux of a clinician’s work. Frequently, Foundation doctors are the first to review acutely unwell patients. During out-of-hours shifts senior help can be scant and Foundation doctors may have to rely on their own initial clinical reasoning to manage acutely unwell patients. This PhD explores clinical reasoning development in the transition phase between final year medical student and Foundation doctor (5MB-FY1 transition) in relation to acutely unwell patients. It follows a cohort of final year medical students from a single UK university on their clinical reasoning journeys as they transition into Foundation doctors, focusing on the role of the simulated healthcare setting and the workplace. The principle research question for this PhD was how does clinical reasoning develop across the transition phase between final year of medical school and Foundation year one? Within this overarching research question, the following sub-questions were posed: What do participants understand by the term clinical reasoning? What types of clinical reasoning experiences do participants narrate? How do participants clinically reason for acutely unwell patients? Which factors do participants perceive as being facilitating and hindering to their clinical reasoning? How do participants’ clinical reasoning processes develop across the 5MB-FY1 transition phase? This PhD uses multiple methodologies derived from interpretive approaches in innovative ways to tap into clinical reasoning processes and its development across four data collection points: T1: group and individual interviews; T2: Ward Simulation Exercise observations and stimulated recall interviews; T3: workplace observations and stimulated recall interviews; T4: final interviews. Data were collected from T1/T2 and T3/T4 during the final year of medical school and Foundation year one respectively. Primary thematic analyses were carried out cross-sectionally and longitudinally in terms of what participants said and how they said it. Secondary narrative analyses were undertaken of participants’ Personal Incident Narratives. By taking an interpretive approach, the complexities of clinical reasoning processes, both in terms of internal cognition and external socio-cultural influences were illuminated, drawing upon clinical reasoning, complexity and situated learning theories. The key findings of this PhD were that participants conceptualised clinical reasoning as a “decision-making” and “thinking” process, leading to a clinical judgement for patient care; participants narratives aided understanding of clinical reasoning process and factors which facilitated and hindered them; participants used experiential knowledge and protocols to clinically reason for diagnosis, investigation, management and prioritisation; participants retained flexibility and contextual variability in the processes of making their clinical judgements; multiple factors facilitated and hindered the equilibrium of clinical judgement processes; and clinical reasoning development is dependent upon a complex interplay of individual, interpersonal and systemic factors which are deeply embedded in social-cultural theory. This study has multiple strengths and original features such the high participant retention rate throughout the longitudinal study, the exploration of the 5MB-FY1 transition, contemporaneous observations of clinical interactions with patients, the exploration of the out-of-hour setting contemporaneously and the multiple methods of data collection used in innovative ways. This PhD develops the published literature further in these domains. However, its challenges were predominantly ethical, such as lack of patient capacity to consent in the workplace.
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Smith, J. David. "Confidence in psychodiagnosis : a study of clinicians' judgement confidence in a psychological assessment task as a function of reliance on four inferential heuristics and clinical experience." Thesis, McGill University, 1998. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=35620.
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Research in several domains has revealed that when individuals are asked to estimate the probability that their judgments are correct, they reveal an overconfidence effect. Judgments produced in decision environments such as psychodiagnosis, which are by their nature ambiguous and complex, appear to be most vulnerable to overconfidence. By implication, this phenomenon threatens the validity of clinical judgment and subjects clients to risks of flawed diagnoses and unsuitable treatments.In an effort to identify variables implicated in judgment confidence and overconfidence, this study examined the relationship between four different inferential biases (dispositionalism, confirmationism, truncated data search, and narrow problem formulation) and diagnostic confidence in the context of a psychological assessment task. A second aspect of this study examined the effect of clinical experience on psychodiagnostic confidence. Thirty-six clinicians (18 experienced professionals and 18 clinical trainees) were individually presented a written client casefile, which was segmented and serially presented, to read and clinically interpret aloud. Analyses of participants' verbal protocols revealed that one of the four inferential biases studied (i.e., dispositionalism) accounted for a significant proportion of the variance in psychodiagnostic confidence scores. The author concludes that other clinician variables likely moderate the relationship between particular heuristics and judgment confidence. Regarding the second hypothesis, the data revealed no difference between experienced clinicians and clinical trainees in the degrees of psychodiagnostic confidence manifested in their verbal protocols.
The author proposes that effective remedies to overconfidence begin in training programs that lead students through problem-solving experiences that can invalidate facile, premature, and dubious diagnostic judgments. The author delineates a number of strategies that may be used by educators to achieve this end.
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Eiman, Johansson Maria. "Sjuksköterskors kliniska beslutsfattande med fokus på perifera venkatetrar (PVK)." Licentiate thesis, Malmö högskola, Institutionen för vårdvetenskap (VV), 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-7380.
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För att kunna ge vård av säker och god kvalitet krävs att sjuksköterskor har kunskap inom många områden, eftersom de har ansvar för såväl bedömning, planering och genomförande, som utvärdering och dokumentation av omvårdnadsarbetet. Ett av flera ansvarsområden för sjuksköterskor i deras dagliga arbete är beslutsfattande om insättning och skötsel av perifera venkatetrar (PVK). En PVK är en tunn plastkateter som sätts in i ett blodkärl via en kanyl. PVK används vid intravenös behandling med till exempel antibiotika och andra läkemedel, blodkomponenter eller näringslösningar. En stor andel av alla patienter inom hälsooch sjukvård kommer någon gång i kontakt med en PVK och riskerar då också att utsättas för komplikationer. En vanlig komplikation i samband med PVK är tromboflebit. Tromboflebit förekommer i olika svårighetsgrader och innebär att inflammation har uppstått i blodkärlet i kombination med samtidig blodpropp. Symtom som kan uppstå är rodnad, svullnad, smärta, hårdhet i kärlet och varig infektion. Det finns kliniska riktlinjer om PVK framtagna både på nationell och på lokal nivå som fungerar som ett stöd i beslutsfattandet. Tidigare forskning har visat att kliniskt verksamma ibland inte följer riktlinjer. Anledningar till att inte riktlinjer följs kan till exempel vara att de kliniskt verksamma inte håller med om det som rekommenderas, inte känner till rekommendationerna, inte har tid eller möjlighet att påverka de beslut som fattas eller att det finns individuella faktorer att ta hänsyn till för den enskilda patienten. 52 Frågan kan ställas om sjuksköterskor använder sig av kliniska riktlinjer i sitt dagliga arbete eller om det är andra faktorer och aspekter som har betydelse och påverkar beslutsfattandet. Denna licentiatavhandling syftade till att beskriva sjuksköterskors kliniska beslutsfattande genom att fokusera på deras följsamhet till riktlinjer och beslutsresonemang om PVK. Två studier har genomförts inom ramen för denna licentiatavhandling. Studie I undersökte i vilken utsträckning sjuksköterskor följer nationella och lokala riktlinjer om PVK. PVKns placering och storlek, tiden som PVKn varit placerad i blodkärlet, dokumentation vid PVKns förband samt om det fanns tecken på tromboflebit vid PVKn var variabler som undersöktes i relation till de rekommendationer som fanns. Utifrån två protokoll samlades strukturerad data in och analyserades. Totalt 343 PVK ingick i analysen. I studie II undersöktes de tecken och påverkande faktorer som har betydelse när sjuksköterskor fattar beslut om skötsel av PVK. I studien observerades 43 sjuksköterskor i sitt dagliga arbete. Sjuksköterskorna intervjuades också dels om PVK-besluten som de fattade under observationerna, dels om deras beslutsfattande om PVK-skötsel i allmänhet. Studie I visade att sjuksköterskor delvis följer riktlinjer. Det fanns skillnader mellan de vårdavdelningar som hade nationella riktlinjer och de som hade lokala riktlinjer, i hur de olika avdelningarna valde placering, storlek och dokumenterade vid PVKns förband. PVKn hade suttit längre tid än rekommenderat i varierande utsträckning. Andelen tromboflebiter var låg (7.0%) och tromboflebiterna var milda. Det tyder på att sjuksköterskor är noga med att ta bort PVK vid tecken på komplikationer. Studie II visade att sjuksköterskor i sitt kliniska resonemang om PVK-skötsel tar hänsyn till den individuella patientsituationen, sjuksköterskans arbetssituation och erfarenhet av PVK-skötsel. Det framkom även att sjuksköterskor balanserar mellan att undvika eller minimera obehag och smärta för patienten och samtidigt förebygga komplikationer från PVKn. Resultaten från denna licentiatavhandling kan få betydelse för undervisning av sjuksköterskestudenter och även när kliniska riktlinjer ska införas på vårdavdelningar.Every working shift nurses make several decisions, including decisions about management of peripheral venous catheters (PVC). Peripheral catheterisation is a common procedure, which affects numerous patients in health care today. PVC are for example used for intravenous infusions with antibiotics, nutrients and blood components. Having PVC in situ may lead to complications such as thrombophlebitis. Clinical guidelines have been developed within the area to assist nurses in their decision-making, but clinical guidelines are not always adhered to. There are several reasons why clinicians do not always adhere to clinical guidelines, although such adherence may lead to fewer complications. Choices for decisions regarding PVC management have been investigated in previous studies, but not in a naturalistic setting. The overall aim of this licentiate thesis was to describe nurses’ clinical decision-making through focusing on their adherence to clinical guidelines and their clinical reasoning concerning decisions of PVC. Two studies have been conducted and data were collected during a six-month period, from December 2004 to June 2005. Study I investigated nurses’ adherence to national and local PVC guidelines by focusing on time in situ, site, size and documentation at the dressing. The thrombophlebitis frequency associated with PVC in situ was also investigated. Structured observations through two protocols were carried out and data about 343 PVC were analysed. Study II investigated nurses’ clinical reasoning regarding PVC management and cues and factors of importance in the decision10 making process were analysed. Nurses were observed in their daily work with focus on PVC management. They were interviewed both about the PVC decisions made in the observed situations and about factors influencing their reasoning regarding PVC management in general. The observations facilitated the interviews. Transcribed interview texts were analysed with content analysis. The results in study I showed that thrombophlebitis frequency was 7.0% and the nurses seemed to replace or remove PVC before any severe complications arose in accordance with clinical guidelines. Nurses partly adhered to national and local guidelines concerning site, size, documentation at the dressing and time in situ. Differences in guideline adherence were observed for wards with local or national guidelines, as well as for wards with different specialities. The results indicate that local guidelines may have an impact on guideline adherence but these results need further exploration. Analysis of interview texts in study II resulted in a category system with three main categories describing cues and factors of importance in the nurses’ clinical reasoning about PVC: the individual patient situation, the nurse’s work situation, and experience of PVC management. An overall theme was also revealed in the interview texts and the nurses balance in their clinical reasoning between avoiding or minimizing discomfort and pain for the patient and preventing complications from the PVC. The results from this licentiate thesis have implications for the education of nurses as well as during implementation of clinical guidelines.
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Sengül, Cemre Günes. "Kids out of control? Clinical Judgment and Psychiatric Reception of ADHD in Modern Turkey." Thesis, Lyon, 2020. http://www.theses.fr/2020LYSEN072.
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Les discussions sur la catégorie psychiatrique infantile la plus fréquemment diagnostiquée - le trouble du déficit de l’attention avec hyperactivité (TDAH) se situent à la croisée de l'approche qui la recherche au sein des fonctions neurobiologiques de l'organisme et de l'approche qui la recherche à travers des superstructures telles que les grandes entreprises pharmaceutiques. Le TDAH est considéré comme une catégorie discursive et un objet épistémique dans le cadre de mon étude. J’analyse cette expérience à travers les actes du psychiatre qui est l'agent ultime du jugement. Je me concentre sur l’expérience du jugement clinique elle-même en Turquie. Les ensembles de données ont été recueilli entre 2017 et 2019. Les déclarations des psychiatres ont été défini comme leurs propres déclarations anonymes (10 entretiens approfondis), leurs efforts scientifiques (guide de diagnostic et de traitement, articles dans la revue « Journal Turc de la Santé Mentale de L'enfant et de L’adolescent » (entre 2002 et 2019) ; et abstraits de communications dans le « Congrès turc de psychiatrie de l'enfant et de l'adolescent » (entre 2012 et 2019), vulgarisation pour la grand public (5 livres et 34 vidéos YouTube). L’objectif de l'étude est de cartographier le contexte social et moral dans lequel les jugements cliniques se forment en scrutant les détails discursifs et rhétoriques de ces actes. Les ensembles de données, à l'exception des entretiens, ont été examiné avec une analyse de contenu et le contenu et les entretiens liés au TDAH ont été étudié/analysé par le biais d’une analyse critique du discours. En conclusion, l'imaginaire social auquel les psychiatres appartiennent est une composante cruciale de leur jugement clinique et de leur processus de décision. La prédominance de l'approche biomédicale est observée à tous les niveaux de la production des connaissances. De ce point de vue, le processus de jugement clinique est objectif et mesurable. Contrairement à « un praticien biomédical » qui est représenté dans l’argumentation fondamentale sur le TDAH, j’ai rencontré « un praticien humaniste » dans les fonds du langage et du sens ainsi que dans des entretiens approfondisThe discussions about the most frequently diagnosed childhood psychiatric category –Attention Deficit Hyperactivity Disorder (ADHD) – positions on the crossroad of the approach that seeks it within neurobiological functions of organism, and the approach that seeks it through superstructures such as Big Pharma. ADHD is postulated as a discursive category, and an epistemic object within the scope of my study. I look at this experience through the acts of the psychiatrist, who is the ultimate agent of the judgement. I concentrate on the clinical judgement experience’s itself in Turkey. The data sets were collected between 2017-2019. The psychiatrists’ acts were defined as their own anonymous statements (10 in-dept interviews), their scientific endeavors (1 diagnosis and treatment guideline, Journal articles in the Turkish Journal of Child and Adolescent Mental Health: 2002-2019; and congress presentations as Turkish Child and Adolescent Psychiatry Congress’ abstract books: 2012-2019), communication with general public (5 books, and 34 YouTube videos). The aim of the study is mapping social and moral context in which clinical judgements shape by scrutinizing the discursive and rhetorical details of these acts. The data sets except for interviews were scanned with content analysis, and ADHD-related content and interviews were analyzed with critical discourse analysis. As a conclusion, the social imaginary where psychiatrists belong to is a crucial component of their clinical judgement and decision-making process. The dominance of biomedical approach is observed at all the stage of knowledge production. From this point of view, clinical judgement process is objective and measurable. In comparison with ‘a biomedical practitioner’ is represented in fundamental argumentation about ADHD, I have met ‘a humanistic practitioner’ in the depths of language and meaning as well as in- depth interviews
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Mattsson, Carin, and Malin Sande. "Plötsligt händer det! Vad gör jag? : Nyexaminerade sjuksköterskans utvecklande av kliniskt omdöme." Thesis, Ersta Sköndal högskola, Institutionen för vårdvetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-5246.
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Bakgrund: Kliniskt omdöme kan beskrivas som förmågan att på ett insiktsfullt sätt identifiera och agera på en förändring eller ett behov relaterat till patientens hälsotillstånd. Kliniskt omdöme kommer till sin spets i komplexa situationer som exempelvis när en patient plötsligt försämras. Det har skett en akademisering av sjuksköterskeutbildningen som gett sjuksköterskor en stadigare teoretisk grund men det kliniska omdömet behöver utvecklas efter examen. Syfte: Syftet var att beskriva faktorer som påverkar utvecklingen av nyexaminerade sjuksköterskans (NS) kliniska omdöme. Metod: Metoden som användes var litteraturöversikt, baserad på tio vetenskapliga artiklar varav åtta kvalitativ metod och två mixad metod. Artiklarna hämtades ur databaserna CINAHL Complete och PubMed. Resultat: Faktorer som påverkar utvecklingen av NS kliniska omdöme sammanfattas under tre huvudteman: Förvärvandet av kliniska förmågor, Ansvarsfull kommunikation och Integrerat stöd. NS behöver utveckla förmågan att identifiera relevanta förändringar, tolka dem i relation till en helhetsbild av patienten, prioritera åtgärder samt kommunicera med kollegor. Utvecklande av kliniskt omdöme underlättas i ett positivt arbetsklimat med stöd av erfarna sjuksköterskor (ES). Vårderfarenheter ger teoretiska kunskaper en ny mening, vilket också bidrar till utvecklandet av kliniskt omdöme. Diskussion: Resultatet diskuterades med utgångspunkt i Benners teori för hur sjuksköterskans kliniska omdöme utvecklas från novisens till expertens. NS är inte mogen att hantera komplexa kliniska situationer och organisationen måste utformas för att ge NS det stöd som behövs för att utveckla det kliniska omdömet. Tillgången till ES, reflektion och ett rimligt arbetstempo är viktiga stöttande faktorer, men sällan en självklarhet i vården.Background: Clinical judgement can be described as the ability to wisely identify and act upon changes in - or needs of a patient’s - health status. Clinical judgement is most applicable to complex situations such as caring for deteriorating patients. As nursing was included in higher education nurses have acquired a more solid theoretical knowledge base, however their clinical judgement needs to be further developed post graduation. Aim: The aim of was to describe factors influencing the development of newly graduated nurse’s (NN) clinical judgment. Method: The method consists of a literature review based upon ten scientific articles, of which eight were qualitative and two followed a mixed method. The articles were retrieved from CINAHL Complete and PubMed databases. Results: Contributing factors to the development of NN clinical judgment were grouped into three main themes: Development of clinical abilities, Responsible communication and Integrated support. NN needs to develop the ability to recognise relevant changes, relate them to a holistic assessment of the patient and to communicate findings. The development of clinical judgment is supported by a positive work climate and by access to experienced nurses. Caring for patients adds a new dimension to theoretical knowledge and contributes to the development of clinical judgment. Discussion: The results were discussed using Benner´s theory of how the clinical judgement of nurses develops from novice to expert. NN is not able to safely handle complex clinical situations without the support of experienced staff. It is also essential for the development of clinical judgment that NN is given a reasonable workload and opportunities for reflection. However, there may often be a lack of these supporting factors in nursing organisations today.
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Martin, Peter J. "An exploration of the influences on clinical judgement within mental health nursing practice in the United Kingdom, including a critique of the grounded theory approach." Thesis, Cardiff University, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.287497.
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O'Connor, Laserina. "Clinical judgement of critical care nurses in the context of the ventilated patient in pain in the immediate phase post cardiac surgery : a case study." Thesis, University of Surrey, 2006. http://epubs.surrey.ac.uk/842684/.
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The critical care environment is a complex arena in which clinical judgements of the ventilated patients pain state are made over the course of their surgical trajectory. The presence of the critical care nurse at the bedside is the key to informed judgement in this unpredictable and fragile situation. This study sought to capture the judgement process of thirty critical care nurses in the context of the ventilated patient in pain in the immediate phase after cardiac surgery i.e. six-hours. Evidence of the judgement process was sought using the Lens Model as a framework, utilising the cognitive side of the model. Moreover, in order to capture this phenomenon of interest, the researcher observed the pain behaviours of thirty ventilated patients in the immediate phase post cardiac surgery. Within-methods triangulation was employed as an approach for justifying and underpinning knowledge by acquiring additional knowledge, which was seen as pertinent to this naturalistic case study. The data collection approach included think-aloud by thirty critical care nurses and simultaneous researcher observation over a six-hour period in the natural habitat of the ventilated patient post cardiac surgery. The findings give tentative support for the hypothesis that critical care nurses use a pattern of cues to make a judgement of ventilated patients' pain state in the immediate phase post cardiac surgery. Conversely, there was tentative support for the hypothesis that ventilated patients convey a pattern of cues to the critical care nurse in the immediate phase post cardiac surgery. Moreover, tentative conclusions are afforded which are as follows: a judgement structure is employed by critical care nurses which is comprised of two stages. The initial stage involves a pattern of physiological, behavioural general, covert behaviour, physical, overt motor pain behaviour, mechanical, technical, paraclinical, knowledge and pain descriptor cues. These aforesaid cues are utilised and integrated into a small number of intermediate judgements which operate as second order cues. Consequently the second order cues are combined in order to make a final judgement of the ventilated patient's pain state in the immediate phase post cardiac surgery: '(s)he is in acute pain' or '(s)he is not in acute pain'. In addition, critically ill ventilated patients convey a pattern of pain cues to the critical care nurses which comprises of physiological, behavioural general, overt motor pain behaviour cues, patient ventilator dysynchrony cues and verbal subjective pain behaviour cues. The pattern of cues conveyed by the ventilated patient may be influenced by many factors in an unpredictable and delicate surgical trajectory and chief among these factors is haemodynamic instability. The critical care nurse must make sense of all of this to gain access to the pattern of cues.
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Mason, Brenda. "Advanced-Beginner Registered Nurses' Perceptions on Growth From Entry Level." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6921.
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Many entry-level nurses are not prepared to handle medical emergencies. Although responsible for managing the care of individuals with complex medical conditions, many of these nurses compromise the safety of patients due to a lack of experience and an inability to apply clinical judgment. The purpose of this study was to explore the perceptions of registered nurses about their transition from entry-level to advanced beginner. Bandura's social cognitive theory, along with Colaizzi's descriptive method of data analysis, provided a basis for this phenomenological study. Research questions focused on challenges that entry-level nurses have experienced with problem-solving and complex patient care that requires advanced critical thinking and the application of clinical judgment. Criterion sampling facilitated recruitment of advanced-beginner RNs, with data collected through semistructured, one-on-one interviews. Data analysis occurred in a series of steps, including extracting and developing meanings from interview transcripts, clustering meanings into description lists, and eliminating outliers. Data analysis revealed 12 major themes aligned with behavior, clinical environment, and personal/cognitive factors. Among the findings were that nurses often felt unsupported, unable to manage conflict, unprepared, unseasoned, inefficient, and unable to lead others effectively. This study was necessary because its findings may provide insights leaders in health services can use to develop strategies to better prepare entry-level nurses to care for individuals with complex medical conditions. Among the implications for positive social change are developing a better tool for the training and advancement of entry-level nurses, consequently improving patient safety and reducing health care costs.
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Spencer, Peter. "Cognitive bias and heuristics and their effects on clinical judgement amongst psychological therapists: a review, and, Problem solving in an empathic task: an experimental study of expertise and intuition." Thesis, University of Sheffield, 2013. http://etheses.whiterose.ac.uk/4655/.
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Mayer, Sarah A. "Clinical judgement vs. evidence-based practice: two models to predict postoperative hematocrit following uncomplicated hysterectomy." Thesis, 2017. https://hdl.handle.net/2144/23817.
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BACKGROUND: Hysterectomies are one of the most frequently performed surgical procedures in the United States. There are a wide variety of diagnoses that require a patient to obtain this procedure, but the majority of hysterectomies are performed for benign indications. Currently, gynecologists do not follow a standardized protocol surrounding postoperative laboratory ordering, and healthcare professionals can order a wide range of tests as often as they choose. Extraneous laboratory orders are disruptive to the patients’ well-being and risk their health following surgery. These orders are costly for hospital systems, take up precious time of hospital employees, and influence the course of patient treatment only in extremely rare circumstances.
There are few studies that develop exclusion criteria for patients who may not require a laboratory test following surgery. Though systems to predict postoperative hematocrit have been created, they are complicated and difficult to use. The few studies that were performed are yet to be accepted by the medical community, in part because of their limited scope. This study will be the first to incorporate the results of robotic surgery in the analysis.
OBJECTIVE: The purpose of this study is to determine concrete parameters to indicate that a patient is in need of postoperative laboratory work and at risk for anemia or transfusion. We aim to develop two comprehensive models that guide surgical practitioners to identify the cases which do not require laboratory data.
METHODS: A total of 1027 gynecologic surgeries were performed at Saint Francis Hospital and Medical Center between April 1, 2014 and May 31, 2016. This retrospective study extracted data from EPIC EMR according to 42 variables preconceived to be the leading indicators of postoperative hematocrit and overall healing. Five healthcare professionals were surveyed to identify the variables that influence their postsurgical patient assessments and their decisions to order blood testing. This information was developed into score sheets with differing levels of stringency. Correlation highlighted 14 of the initial 42 variables as contributors to postoperative hematocrit and an equation model was built. Stepwise linear regression was used for univariate and multivariate analyses, from which we created our equation to predict all patients’ postoperative hematocrit.
RESULTS: Out of the 1027 initial cases, a total of 602 cases were identified as hysterectomies for benign indications. Survey data gave the highest value to urine output and heart rate as key indicators of postoperative anemia. From the survey data, two clinical scoring sheets with differing stringency were created to guide practitioner laboratory ordering. These sheets gave parameters of heart rate and urine output the largest correlative weight in determining postoperative hematocrit. However, based on regression analysis, parameters of age (AGE), body mass index (BMI), preoperative platelet count (PPC), estimated blood loss during surgery (IO EBL), preoperative hematocrit (PHCT) and postoperative fluid bolus orders (POSTOP FB) proved to be the key variables impacting postoperative hematocrit (POSTOP HCT). These items were translated into the equation: POSTOP HCT = 22.51 – 0.40*POSTOP FB – 0.01*IO EBL + 0.25 PHCT + 0.09*BMI + 0.06*AGE – 0.01*PPC (R-squared = 0.310).
CONCLUSIONS: This study aims to decrease superfluous laboratory testing, as well as to contribute to a larger conversation considering the potential merits of clinical judgement in a data-driven healthcare system. We have created a number of comparable strategies in order to reduce the number of unnecessary blood draws: two clinical scoring sheets and an equation. The score sheets indicate when to order additional testing. These sheets are representative of a range of surgical practitioners’ conventional clinical judgement. The equation serves as an evidence-based guide for determining postoperative hematocrit following benign gynecologic surgery. These predictive mechanisms will be validated and a superior method determined as our research continues with prospective application. We eventually expect to use the most accurate mechanism to reduce postoperative blood testing following all surgeries.
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Dubula, Mapule Pamella. "Stimulation debriefing and the development of clinical judgement of student nurses at a University in Gauteng." Thesis, 2018. https://hdl.handle.net/10539/25402.
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A research report submitted to the Faculty of Health Sciences, University of the
Witwatersrand, Johannesburg, in partial fulfillment of the requirement for the degree of Master of Science in Nursing. Johannesburg, 2018.Background: There are limited learning opportunities available for students in the clinical settings due to the reduction in the length of patient hospital stays, the shortage of clinical educators and increasing number of students competing for clinical learning opportunities. Simulation-based learning is an innovative way of replicating the real-life clinical scenarios in the nursing school setting. Clinical simulation includes prebriefing, simulation action, and debriefing phases. Debriefing is a critical component of simulation-based learning because most knowledge is gained during that phase. Objective: This study sought to assess the effect of debriefing on the development of clinical judgement in second and fourth-year nursing students in a university in Gauteng. Methods: A one group pre-test/ post-test quasi-experimental design was utilized in this study. Ethical clearance was obtained from the university’s Human Research Ethics Committee. 60 out of the 64, second and fourth year students consented to participate in the study. Only 56 out of the 60 consenting students completed the self-administered pre and post-test Lasater Clinical Judgement Rubrics. Results: The data were analysed quantitatively using descriptive and inferential statistics. The mean difference between the post- and pre-tests is 3.267857 at 95% confident interval. There was a significant improvement in the level of clinical judgement after debriefing (p-value=0.000006421). The results have also shown that debriefing improved clinical judgement among the 4th more than the 2nd years (2nd-year p-value 0.00305, 4th-year p-value 0.0004326) Conclusion: Debriefing is a critical element of simulation for the development of clinical judgement as it gives the students the opportunity to reflect on their thoughts and actions during the simulation action, and plan for improvement.
LG2018
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Van, Graan Anna Catharina. "Clinical judgement in nursing : a teaching-learning strategy for South African undergraduate nursing students / Anna Catharina van Graan." Thesis, 2014. http://hdl.handle.net/10394/15686.
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Recent reforms in the South African health care and educational system were founded in the ideal that the country would produce independent, critical thinkers. Nurses need to cope with diversity in a more creative way, defining their role in a complex, uncertain, rapidly changing health care environment. Learning facilitators are held accountable for finding adequate learning experiences to prepare nursing students for such practice demands so that newly qualified nurses do meet expectations for entry level clinical judgement ability. Quality clinical judgement is therefore imperative as an identified characteristic of newly qualified professional nurses.
There is a scarceness of information on the concept of clinical judgement especially within the South African nursing environment. Relevant information in this regard can assist in clarifying the meaning, which will facilitate a common understanding of the concept within the clinical nursing environment. This in turn can lead to the formulation of a teaching-learning strategy to facilitate clinical judgement in undergraduate nursing students, which would be of benefit in the nursing care environment.
The objective of this study was addressed in three phases. The first phase of this research analysed the concept of clinical judgement through various data sources and a review of literature to clarify the meaning and facilitate a common understanding through identification of the characteristics and to develop a connotative (theoretical) definition of the concept. The second phase of the research investigated professional nurses‟ understanding of the meaning of clinical judgement, as well as the factors that influence the development of clinical judgement within the nursing environment. During the third phase a conceptual framework for an enabling teaching-learning environment was constructed from a modern day constructivist approach to facilitate clinical judgement. The section included a description and diagrammatic presentation of the framework. The conceptual framework formed the scientific basis from which a teaching-learning strategy for the creation of an enabling teaching-learning environment to facilitate clinical judgement in undergraduate nursing students within the South African nursing environment was synthesised.
A qualitative design was used for the study. During the first phase (manuscript 1) an explorative, descriptive qualitative design was used to discover the complexity and meaning of the phenomenon. Multiple data sources and search engines were consulted for the time frame 1982-2013. An extensive concept analysis resulted in a theoretical definition of the concept „clinical judgement‟, a complex cognitive skill to evaluate patient treatment alternatives within the clinical nursing environment. The second phase (manuscript 2) is qualitative in nature and explored professional nurses‟ understanding of clinical judgement, as well as the factors influencing the development of clinical judgement in undergraduate nursing students.
The findings emphasised clinical judgement as skill within the nursing environment. This assisted in the development of teaching-learning strategy for the creation of an enabling teaching-learning environment to facilitate clinical judgement in undergraduate nursing students within the South African Nursing environment as the third phase (manuscript 3). Such an environment should impact positively to promotion of autonomous and accountable nursing care.PhD (Nursing), North-West University, Potchefstroom Campus, 2015
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Rosenthal, David. "Perceptions of African-American versus white clients by rehabilitation counselors in training a study of stereotypes and clinical judgement /." 1993. http://catalog.hathitrust.org/api/volumes/oclc/31058946.html.
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Thesis (Ph. D.)--University of Wisconsin--Madison, 1993.Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 93-102).
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Burton, C. R., Maria Horne, K. Woodward-Nutt, A. Bowen, and P. J. Tyrrell. "What is rehabilitation potential? Development of a theoretical model through the accounts of healthcare professionals working in stroke rehabilitation services." 2015. http://hdl.handle.net/10454/7356.
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noIntroduction: Multi-disciplinary team members predict each patient’s rehabilitation potential to maximise best use of resources. A lack of underpinning theory about rehabilitation potential makes it difficult to apply this concept in clinical practice. This study theorises about rehabilitation potential drawing on everyday decision-making by Health Care Professionals (HCPs) working in stroke rehabilitation services. Methods: A clinical scenario, checked for face validity, was used in two focus groups to explore meaning and practice around rehabilitation potential. Participants were 12 HCPs working across the stroke pathway. Groups were co-facilitated, audio-recorded and fully transcribed. Analysis paid attention to data grounded in first-hand experience, convergence within and across groups and constructed a conceptual overview of HCPs’ judgements about rehabilitation potential. Results: Rehabilitation potential is predicted by observations of “carry-over” and functional gain and managed differently across recovery trajectories. HCPs’ responses to rehabilitation potential judgements include prioritising workload, working around the system and balancing optimism and realism. Impacts for patients are streaming of rehabilitation intensity, rationing access to rehabilitation and a shifting emphasis between management and active rehabilitation. For staff, the emotional burden of judging rehabilitation potential is significant. Current service organisation restricts opportunities for feedback on the accuracy of previous judgements. Conclusion: Patients should have the opportunity to demonstrate rehabilitation potential by participation in therapy. As therapy resources are limited and responses to therapy may be context-dependent, early decisions about a lack of potential should not limit longer-term opportunities for rehabilitation. Services should develop strategies to enhance the quality of judgements through feedback to HCPs of longer-term patient outcomes.Implications for Rehabilitation Rehabilitation potential is judged at the level of individual patients (rather than population-based predictive models of rehabilitation outcome), draws on different sources of often experiential knowledge, and may be less than reliable. Decisions about rehabilitation potential may have far reaching consequences for individual patients, including the withdrawal of active rehabilitation in hospital or in the community and eventual care placement. A better understanding of what people mean by rehabilitation potential by all team members, and by patients and carers, may improve the quality of joint decision making and communication.
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Faisal, Muhammad, Binish Khatoon, Andy J. Scally, D. Richardson, S. Irwin, R. Davidson, D. Heseltine, et al. "A prospective study of consecutive emergency medical admissions to compare a novel automated computer-aided mortality risk score and clinical judgement of patient mortality risk." 2019. http://hdl.handle.net/10454/18015.
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YesObjectives: To compare the performance of a validated automatic computer-aided risk of mortality (CARM) score versus medical judgement in predicting the risk of in-hospital mortality for patients following emergency medical admission. Design: A prospective study. Setting: Consecutive emergency medical admissions in York hospital. Participants: Elderly medical admissions in one ward were assigned a risk of death at the first post-take ward round by consultant staff over a 2-week period. The consultant medical staff used the same variables to assign a risk of death to the patient as the CARM (age, sex, National Early Warning Score and blood test results) but also had access to the clinical history, examination findings and any immediately available investigations such as ECGs. The performance of the CARM versus consultant medical judgement was compared using the c-statistic and the positive predictive value (PPV). Results: The in-hospital mortality was 31.8% (130/409). For patients with complete blood test results, the c-statistic for CARM was 0.75 (95% CI: 0.69 to 0.81) versus 0.72 (95% CI: 0.66 to 0.78) for medical judgements (p=0.28). For patients with at least one missing blood test result, the c-statistics were similar (medical judgements 0.70 (95% CI: 0.60 to 0.81) vs CARM 0.70 (95% CI: 0.59 to 0.80)). At a 10% mortality risk, the PPV for CARM was higher than medical judgements in patients with complete blood test results, 62.0% (95% CI: 51.2 to 71.9) versus 49.2% (95% CI: 39.8 to 58.5) but not when blood test results were missing, 50.0% (95% CI: 24.7 to 75.3) versus 53.3% (95% CI: 34.3 to 71.7). Conclusions: CARM is comparable with medical judgements in discriminating in-hospital mortality following emergency admission to an elderly care ward. CARM may have a promising role in supporting medical judgements in determining the patient's risk of death in hospital. Further evaluation of CARM in routine practice is required.
Supported by the Health Foundation, National Institute for Health Research (NIHR) Yorkshire and Humberside Patient Safety Translational Research Centre (NIHR YHPSTRC).
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Drolet, Christine. "Exploration des motifs justifiant le recours aux mesures de contention et d'isolement en centre de réadaptation pour jeunes au Québec: la perception des intervenants." Thèse, 2019. http://hdl.handle.net/1866/22727.
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Dumas, Marie-Michèle. "Considérer les écarts de conduite dans le processus de réadaptation : comment les intervenants adaptent-ils le cadre général de l’intervention à la résistance des jeunes délinquants à haut risque de récidive?" Thèse, 2017. http://hdl.handle.net/1866/20092.
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