Dissertations / Theses: 'Clinical judgment'

1

Ashworth, B. "A defence of clinical judgment." Thesis, Swansea University, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.635803.

Full text

Abstract:

Clinical consultation begins when a patient seeks help from a doctor. The doctor is called upon to advise and this advice is based on judgments in the areas of diagnosis, treatment, and prognosis. The logic of diagnosis is discussed and the importance of probability emphasised. Theories of knowledge, interpretation, and the use of models are reviewed. Judgment analysis is noted as a developing area and mistakes in clinical practice are discussed. Mention of treatment includes orthodox therapy, complementary methods, and factors contributing to quality of life. Prognosis is considered in relation to some common conditions and the impact of chaos theory. Clinical judgment is concerned with prudence and knowledge sufficient for action. The ability to make an appropriate judgment from imperfect materials is of crucial importance in medical consultation. It requires a capacity to take account of all relevant factors bearing on the case and apportioning due weight to each. Good clinical judgment is closely linked to wisdom. This thesis considers the meaning of normal in the setting of health, examines the relationship between traditional medical practice, models and computer methods, and assesses whether the capacity for clinical judgment can be improved by teaching and experience. It explores the new methods and the extent to which they can supplement or replace established practices. It is concluded that clinical judgment based on extensive knowledge and appreciation of the circumstances of the individual is a continuing need which cannot be replaced by an artificial system.

APA, Harvard, Vancouver, ISO, and other styles

2

Desrosiers, Sarah. "Facilitating critical thinking and clinical judgment in clinical nursing education." Thesis, University of British Columbia, 2017. http://hdl.handle.net/2429/63873.

Full text

Abstract:

Nurses who can critically think and make clinical judgments in the clinical setting are crucial to safe and effective nursing care. This type of critical thinking and clinical judgment is best developed during clinical education, which provides students with the opportunity to bridge the theory to practice gap. Clinical instructors guide students’ development of critical thinking and clinical judgment in the clinical setting. Despite clinical instructors having such a significant impact on critical thinking and clinical judgment there is limited research on how they facilitate students’ development of critical thinking and clinical judgment. This qualitative analysis explored how clinical instructors facilitate the development of critical thinking and clinical judgment of nursing students. This study used interpretive description to analyze interviews with eight clinical instructors to develop themes and subthemes within the data. These themes were discussed in relation to definitions of critical thinking and clinical judgment, indicators for evaluation, clinical teaching strategies, and contextual facilitators and barriers. Clinical instructors who took part in this study defined the concept of critical thinking as : The process that leads to clinical judgment, the decision. Evaluation was based on broad indicators of patient safety, effective communication, students’ confidence in their ability to critically think and make clinical decisions, and taking ownership of their patient care. Clinical instructors identified a variety of clinical teaching methods that they adapted and individualized to specific student needs. Clinical instructors also use multiple strategies to meet student needs, which they then adapt for each cohort. Contextual factors also impact students’ development of critical thinking and clinical judgment such as buddy nurses, the school of nursing curriculum, clinical ]instructors, and the nursing student themselves. This study identified suggestions for curriculum development, clinical instructor development, and potential areas for future research in relation to clinical education. Clinical instructors are key components of nursing education and the development of critical thinking and clinical judgment in nursing students; as such, it is important to understand their perspectives on how they develop these student abilities.
Applied Science, Faculty of
Nursing, School of
Graduate

APA, Harvard, Vancouver, ISO, and other styles

3

Tyne, Sheila. "Critical Thinking and Clinical Judgment in Novice Registered Nurses." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4822.

Full text

Abstract:

The health care field has become increasingly more complex, requiring new nurses to be prepared upon graduation to respond to a variety of complex situations. Unfortunately, many graduates from associate degree nursing (ADN) programs are not able to think critically upon entering the work force. This presents a major problem for the nurse and for the employer. The purpose of the study, therefore, was to gain a deeper understanding of the graduates' perceptions of their ability to critically think during their first year of clinical practice, and if they believed their program prepared them to be critical thinkers. The key research questions focused on how the novice nurses reconciled their performance on a critical thinking, online assessment, the Health Sciences Reasoning Test (HSRT), with their perception of their critical thinking skills, and if they felt prepared, during their first year of clinical practice, to critically think. The conceptual framework applied was Bloom's Taxonomy and Tanner's clinical judgment model. A purposeful sampling of 7 novice nurses from 3 ADN programs was chosen. After completing the HSRT, audio-taped phone interviews were conducted. The data indicated that the participants felt unprepared to respond to emergent patient situations, thus undermining their self-worth and clinical competency. The participants agreed there was a need for a critical thinking course in ADN curriculum. A project was created for a 9-week critical thinking course, incorporating theory, clinical practice, and simulation exercises. Social change is expected to occur when student nurses are able to critically think upon graduation, resulting in positive patient outcomes, both of which will benefit patients, their families, and their communities.

APA, Harvard, Vancouver, ISO, and other styles

4

Cobbs, David Lee. "Judgment of Contingency and the Cognitive Functioning of Clinical Depressives." Thesis, University of North Texas, 1990. https://digital.library.unt.edu/ark:/67531/metadc331923/.

Full text

Abstract:

Twenty-four psychiatric staff, 24 clinically depressed inpatients, and 24 nondepresssed schizophrenic patients at a state psychiatric facility completed five tasks under either reward or punishment conditions. Each task consisted of 30 trials of pressing or not pressing a button to make a light appear. Monetary reinforcement was contingent on light onset for the final ten trials of each task. Cash incentives for judgment of control accuracy were added for Tasks 3, 4, and 5. Cognitive functioning was evaluated on each task by measuring expectancy, judgment of control, evaluation of performance, and attribution. Mood and self- esteem were measured before and after the procedure. No significant differences were observed across mood groups for expectancy of control or judgment of control accuracy. Subject groups also did not differ in the attributions they made or in how successful they judged their performances to be. They set realistic, attainable criteria for success which were consistent with relevant conditional probabilities. Subjects in reward gave themselves more credit for task performance than subjects in punishment gave themselves blame for comparable performances. Punishment subjects demonstrated more stable, external attributions than those in reward. Across tasks, subjects overestimated when actual control was low and underestimated when actual control was high. Contrary to the "depressive realism" effect described by Alloy and Abramson (1979), clinical depressives did not display more accurate judgments of control than did nondepressives. All subjects appeared to base their control estimates on reinforcement frequency rather than actual control. Subjects showed a type of illusion of control for high frequency, low control tasks. Presumably, success in turning the light on led them to assume that their actions controlled light onset. Comparison to previous subclinical studies suggests a possible curvilinear relationship between judgment of control accuracy and level of psychopathology, with mild depressives displaying relatively greater accuracy than either nondepressives or clinical depressives.

APA, Harvard, Vancouver, ISO, and other styles

5

Hainguerlot, Marine. "Probability distortion in clinical judgment : field study and laboratory experiments." Thesis, Paris 1, 2017. http://www.theses.fr/2017PA01E034/document.

Full text

Abstract:

Cette thèse étudie la distorsion de probabilité dans le jugement clinique afin de comparer le jugement des médecins à des modèles statistiques. Nous supposons que les médecins forment leur jugement clinique en intégrant une composante analytique et une composante intuitive. Dans ce cadre, les médecins peuvent souffrir de plusieurs biais dans la façon dont ils évaluent et intègrent les deux composantes. Cette thèse rassemble les résultats obtenus sur le terrain et en laboratoire. À partir de données médicales, nous avons constaté que les médecins n'étaient pas aussi bons que les modèles statistiques à intégrer des évidences médicales. Ils surestimaient les petites probabilités que le patient soit malade et sous-estimaient les probabilités élevées. Nous avons constaté que leur jugement biaisé pourrait entraîner un sur-traitement. Comment améliorer leur jugement? Premièrement, nous avons envisagé de remplacer le jugement du médecin par la probabilité de notre modèle statistique. Pour améliorer la décision, il était nécessaire d'élaborer un score statistique qui combine le modèle analytique, la composante intuitive du médecin et sa déviation observée par rapport à la décision attendue. Deuxièmement, nous avons testé en laboratoire des facteurs qui peuvent influencer le traitement de l'information. Nous avons trouvé que la capacité des participants à apprendre la valeur de la composante analytique, sans feedback externe, dépend de la qualité de leur composante intuitive et de leur mémoire de travail. Nous avons aussi trouvé que la capacité des participants à intégrer les deux composantes dépend de leur mémoire de travail, mais pas de leur évaluation de la composante intuitive
This thesis studies probability distortion in clinical judgment to compare physicians’ judgment with statistical models. We considered that physicians form their clinical judgment by integrating an analytical component and an intuitive component. We documented that physicians may suffer from several biases in the way they evaluate and integrate the two components. This dissertation gathers findings from the field and the lab. With actual medical data practice, we found that physicians were not as good as the statistical models at integrating consistently medical evidence. They overestimated small probabilities that the patient had the disease and under estimated large probabilities. We found that their biased probability judgment might cause unnecessary health care treatment. How then can we improve physician judgment? First, we considered to replace physician judgment by the probability generated from our statistical model. To actually improve decision it was necessary to develop a statistical score that combines the analytical model, the intuitive component of the physician and his observed deviation from the expected decision. Second, we tested in the lab factors that may affect information processing. We found that participants’ ability to learn about the value of the analytical component, without external feedback, depends on the quality of their intuitive component and their working memory. We also found that participants’ ability to integrate both components together depends on their working memory but not their evaluation of the intuitive component

APA, Harvard, Vancouver, ISO, and other styles

6

Saunders, Dinah Jo. "Clinical decision-making and clinical judgment outcomes by nursing students in traditional or nontraditional curricula." W&M ScholarWorks, 1997. https://scholarworks.wm.edu/etd/1539618497.

Full text

Abstract:

The purpose of this study was to investigate the claim that nursing students in nontraditional curricula achieve program outcomes consistent with nursing students in traditional generic curricula. Clinical decision making and clinical judgment are essential components of critical thinking in nursing. Self-perception as a decision-maker was measured by the Clinical Decision Making in Nursing Scale (CDMNS) and clinical judgment was measured by the Clinical Judgment in Nursing Series #1: Emergencies in Adult Client Care Test (CJS:EACC).;Participants were recruited from three regional universities. One curricular group consisted of a generic (traditional) BSN group. One nontraditional curricular design was RN-BSN Completion programs designed for RN's to return for degree completion. The second nontraditional curricular group represented an Accelerated BSN program designed for adult learners with a previous baccalaureate degree to achieve a career change to nursing.;No significant outcome differences in self-perception as a clinical decision-maker as measured by mean scores on the CDMNS or in the decision making process as measured by subscale scores on the CDMNS were found between Traditional and nontraditional student groups. The hypotheses that there would be no differences in either self-perception as a decision maker or the decision making process were supported.;A significant difference was found between group scores related to clinical judgment as measured by the CJS:EACC. The nontraditional curricular groups, primarily adult learners, achieved higher scores than the generic group. The attributes of age, work experience, self-directedness, and readiness to learn may have influenced the adult learner's ability to achieve, through nontraditional program structures, at the same level or higher as traditional students. Age was an influencing variable on CJS:EACC scores. The instrument measures nursing assessment and intervention related to adult medical/surgical clients. The hypothesis that there would be no difference in clinical judgment could not be supported.;Interview responses representative of each curricular group were consistent with previous studies of the goals, barriers, learning needs, and characteristics of the adult learner.

APA, Harvard, Vancouver, ISO, and other styles

7

Salisbury, Tessa Nicole. "Predicting Youth Treatment Failure: An Investigation of Clinical Versus Actuarial Judgment." BYU ScholarsArchive, 2014. https://scholarsarchive.byu.edu/etd/5266.

Full text

Abstract:

Research investigating clinical versus actuarial prediction and judgment has consistently demonstrated the superiority of actuarial (statistical) methods. Little research to date has directly compared clinical and actuarial predictions in the context of patient-focused psychotherapy outcomes. The most relevant study on this issue was completed with an adult population and results indicated that the actuarial method was significantly more accurate at predicting client treatment failure compared to clinician’s predictions. This study examined clinical versus actuarial prediction of client deterioration in a sample of children and adolescents receiving treatment in a managed care and community mental health setting. Predictions of treatment failure made by the actuarial method were found to be significantly more accurate than predictions of treatment failure made by clinicians. More specifically, participating clinicians did not make a single prediction of treatment failure. These findings add further evidence to support the use of actuarial methods in enhancing clinical decision-making in community-based mental health services for children and adolescents.

APA, Harvard, Vancouver, ISO, and other styles

8

Gard, Tracy. "Reconsideration of gender bias in clinical judgment : characteristics of gender influenced counselors." Virtual Press, 1993. http://liblink.bsu.edu/uhtbin/catkey/864938.

Full text

Abstract:

The purpose of the present study was to examine the influence that feedback and goal setting have on overall job satisfaction when incorporated into the appraisal review process. The participants consisted of a sample of 100 (N=100) employees from an electronic repair service located in northern Indiana. Participants were given a survey consisting of basic demographic information plus the following three scales: The International Communication Audit (Goldhaber, Yates, Porter, & Lesniak, 1978), The Job Descriptive Index (Smith, Kendall, & Hulin, 1969), and a scale used by Greller (1978) to examine goal setting. The demographic questions consisted of sex, number of years with the company, supervisory/nonsupervisory position, and full/parttime work. Data were analyzed using multiple regression and Pearsonian correlations. The data suggest that feedback and goal setting do not increase overall job satisfaction. The results may have been influenced by the negative climate of the organization and sample population. Recommendations for future research are discussed.
Department of Counseling Psychology and Guidance Services

APA, Harvard, Vancouver, ISO, and other styles

9

Dickenson, Sheree Owens. "The impact of guided reflection on clinical judgment of associate degree nursing students." Thesis, The University of Alabama, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10006889.

Full text

Abstract:

The health care environment continues to be fraught with errors and poor patient outcomes. Nurses, having the most constant time with patients, are in a position to make a difference in those outcomes. Due to many technological, social, and health care changes and advancements, nurses have responsibilities requiring high levels of clinical judgment. Nursing education must respond to the changes and expanded roles of nurses by changing how students are taught, specifically in the clinical setting. Pedagogical tools and methods are needed to assist the student with making integrations between classroom theory and clinical practice. The purpose of this study was to explore the use of a guided reflection tool based on a model developed from the practice of novice and experienced registered nurses on clinical judgment development as measured by a rubric based on the same model, of associate degree nursing students, in an acute care setting. A mixed methods approach was used. Clinical judgment scores of a comparison group (n = 9) were compared with an intervention group (n = 9) and each groups’ scores were examined for progression of clinical judgment abilities using a quasi-experimental time series design for the quantitative portion of the study. Using RM-ANOVA, findings indicated there was no statistical significance between the two groups or within the time intervals for either of the groups. A focus group interview was also held to identify perceptions of each group concerning reflective journaling and development of clinical judgment. Both groups felt reflective journaling enhanced development of clinical judgment; however, the intervention group articulated situational learning to a greater degree than the comparison group.

APA, Harvard, Vancouver, ISO, and other styles

10

Fedko, Andrea Lauren. "Examining the relationship between clinical judgment and nursing action in baccalaureate nursing students." Thesis, Indiana University - Purdue University Indianapolis, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10241251.

Full text

Abstract:

Clinical judgment provides the basis for nurses’ actions and is essential for the provision of safe nursing care. Tanner’s Clinical Judgment Model and its associated instrument, the Lasater Clinical Judgment Rubric (LCJR) have been used in the discipline of nursing, yet it is unclear if scores on the rubric actually translate to the completion of an indicated nursing action. This is important because clinical judgment involves identifying and responding to patient situations through nursing action, and then evaluation of such actions. The purpose of this observational study was to explore the relationship between clinical judgment, as measured by the LCJR, and the completion of an indicated nursing action, as measured by a nursing action form.

The clinical judgment and completion of an indicated nursing action was measured in 92 participant students at a Midwestern university school of nursing who were enrolled in an adult medical/surgical nursing course that included simulation and debriefing during which scoring occurred. This study explored whether clinical judgment, as measured by the LCJR, was related to the completion of an indicated nursing action. In addition, this study evaluated whether Responding, as measured by the LCJR was related to the completion of an indicated nursing action. The data revealed that a very weak relationship was present between clinical judgment, as measured by the LCJR, and the completion of an indicated nursing action; however, these findings were not statistically significant. The data also revealed that a very weak relationship was present between the dimension Responding, and the completion of an indicated nursing action; however, these findings were also not statistically significant.

This study expands upon previous clinical judgment research in nursing and identifies a need for additional methods of evaluating clinical judgment in baccalaureate nursing students including action appraisal so that deficiencies are established and targeted for improvement.

APA, Harvard, Vancouver, ISO, and other styles

11

Howard, Beverly J. "Computer-based versus high-fidelity mannequin simulation in developing clinical judgment in nursing education." Thesis, Capella University, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=3558176.

Full text

Abstract:

The purpose of this study was to determine if students learn clinical judgment as effectively using computer-based simulations as when using high-fidelity mannequin simulations. There was a single research questions for this study: What is the difference in clinical judgment between participants completing high-fidelity human simulator mannequin simulation or computer-based simulation? A convenience sample of 50 associate degree nursing students in the last medical-surgical nursing course of their program were invited to participate in this study. Analysis of the demographic data confirmed the similarity of the two groups in terms of the potentially important confounding variables such as age, sex, education and prior healthcare experience. The score for each participant from the computer-based simulation (Simulation 2) and the percent of interventions completed in the high-fidelity human simulator simulation (Simulation 3) by each participant was added together to obtain an aggregate clinical judgment score for participants in Group C and Group M. Two-tailed t test for independent means was used to determine if a significant difference existed between the aggregate clinical judgment score for Group C and the aggregate clinical judgment score for Group M. Results from the test indicated that there was no difference between groups at the 95% confidence interval. The similarity of the clinical judgment scores of the computer-based simulation group to the scores of the high-fidelity mannequin simulation group indicates similar utility of the two instructional methods. The use of carefully planned and well-designed computer-based simulations can allow students to practice skills and develop confidence, self-efficacy and clinical judgment independently, freeing faculty for other instructional tasks.

APA, Harvard, Vancouver, ISO, and other styles

12

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.

Full text

Abstract:

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 approfondis
The 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

APA, Harvard, Vancouver, ISO, and other styles

13

Case, Andrew B. "The impact of training in holistic identity conceptualization on the clinical judgment of counselors-in-training." [Bloomington, Ind.] : Indiana University, 2005. http://wwwlib.umi.com/dissertations/fullcit/3183480.

Full text

Abstract:

Thesis (Ph.D.)--Indiana University, 2005.
Source: Dissertation Abstracts International, Volume: 66-08, Section: B, page: 4475. Chair: Charles R. Ridley. Title from dissertation home page (viewed Oct. 10, 2006).

APA, Harvard, Vancouver, ISO, and other styles

14

Wiles, Brenda L. "Using The National Early Warning Score As A Set Of Deliberate Cues To Detect Patient Deterioration And Enhance Clinical Judgment In Simulation." Case Western Reserve University Doctor of Nursing Practice / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=casednp1458074763.

Full text

APA, Harvard, Vancouver, ISO, and other styles

15

Hayden, Colleen Ann. "Clinical Judgment Regarding Suspicion of Child Sexual Abuse: A Pilot Study of Factors Associated with Differential Levels of Clinician Concern." Thesis, Boston College, 2015. http://hdl.handle.net/2345/bc-ir:104663.

Full text

Abstract:

Thesis advisor: Thomas M. Crea
Child sexual abuse is a major public health problem in the United States, but identifying risk, especially in young children with suspicion of abuse, poses many challenges. The aim of this study is to understand how clinicians judge the possible presence of sexual abuse in children where serious suspicion exists but without substantiated abuse. This study used data from randomly selected sexual abuse and trauma evaluations of preschool and school-aged children presenting to Boston Children’s Hospital (BCH) Outpatient Child Protection Program between 2000-2007 (N=100) to examine the association between child and family risk factors and level of clinician concern regarding likelihood of child sexual abuse. Multi-nomial logistic regression analysis was used to examine the relationship between child and family risk factors and level of clinician concern regarding suspicion of abuse, moderated by child’s gender and age. Results indicated that a child’s disclosure and trauma presentation were the key factors that clinicians considered within the higher level of clinician concern regarding likelihood of sexual abuse. Implications for future research and clinical practice include attention to methodology research to assist with the development and validation of assessments for evaluation of risk in complex cases of suspicion of sexual abuse that can be offered in clinical setting, without sole reliance on the child’s ability to disclose in order to access help. Additionally, it is essential that research focuses on the development of clinical models to help with clinical decision making protocols in ambiguous cases of sexual abuse with children who may not be in a position to disclose, but serious concerns have been raised, with focus on increasing their safety. The findings in this research strongly suggest that it is essential to continue to focus on assisting children who present with suspicion of sexual abuse in complex cases that do not fit neatly into our current forensic and child protective services systems. This is especially necessary with the most vulnerable children where disclosure is unlikely, but clinical evaluations can yield recommendations that maximize efforts at increasing safety, child mental health, and family cohesion, and build on strengths while simultaneously accounting for risks
Thesis (PhD) — Boston College, 2015
Submitted to: Boston College. Graduate School of Social Work
Discipline: Social Work

APA, Harvard, Vancouver, ISO, and other styles

16

Switzer, Melissa A. "The Impact of Bias and Cultural Competence on Therapists' Clinical Judgment of Arab American Clients." Xavier University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=xavier1433272977.

Full text

APA, Harvard, Vancouver, ISO, and other styles

17

Aronoff, Derek N. "Errors in clinical judgment : the effect of temporal order of client information on anchoring, adjustment, and adjustment mitigation and category of clinical inferences." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/nq29876.pdf.

Full text

APA, Harvard, Vancouver, ISO, and other styles

18

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.

Full text

Abstract:

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.

APA, Harvard, Vancouver, ISO, and other styles

19

Monahan, Maureen F. "An Evaluation of Suicide Risk Assessment and Management Trainings in Clinical Psychology Doctoral Programs." Scholar Commons, 2018. https://scholarcommons.usf.edu/etd/7342.

Full text

Abstract:

It has been suggested that mental health professionals are insufficiently trained to assess and manage suicide risk (U.S. Department of Veterans Affairs and Defense [USDVA/DOD], 2013; Goldsmith, Pellmar, Kleinman, & Burney, 2002; Jobes, Rudd, Overholser, & Joiner, 2008; Mirick, McCauley, Bridger, & Berkowitz, 2015; Silverman & Berman, 2014) and this problem may originate during graduate training (Feldman & Freedenthal, 2006; Mackelprang, Karle, Reighl, & Cash, 2014; Rudd, Cukrowicz, & Bryan, 2008; Schmitz et al., 2012). Unfortunately, however, this area has been inadequately studied (Battista, 2007; Cramer, Johnson, McLaughlin, Rausch, & Conroy, 2013; Department of Health and Human Services, 2012; Stuber & Quinnett, 2013), precluding a full understanding of this problem. The present study surveyed clinical psychology doctoral students’ behavioral competency in responding to suicidal clients, attitudes toward suicide prevention, perceived ability to engage in appropriate practices, subjective norms surrounding SRA behaviors, intentions to engage in these behaviors, and the relationship of amount of graduate training in suicide risk assessment (SRA) core competencies to the aforementioned constructs. It was hypothesized that amount of training in SRA competencies would be significantly related to participants’ attitudes, perceived behavioral control, and subjective norms related to SRA behaviors. Further, it was hypothesized that the aforementioned variables would be significantly related to participant intentions to engage in these behaviors. Finally, it was hypothesized that intentions to engage in SRA behaviors would be positively related to participants’ behavioral competency in SRA. Study participants were 167 students from 46 clinical psychology doctoral programs. Hypotheses were tested using path analysis. Results provided partial support for significant relationships between attitudes, PBC, subjective norms, and intentions (Hypothesis 1a). Implications of this research include advancing the training practices of clinical psychology doctoral programs so as to help increase the number of mental health practitioners competent in suicide risk assessment and management practices.

APA, Harvard, Vancouver, ISO, and other styles

20

Walsh, Susan A. "The Effects of Pattern Recognition Based Simulation Scenarios on Symptom Recognition of Myocardial Infarction, Critical Thinking, Clinical Decision-Making, and Clinical Judgment in Nursing Students." Digital Archive @ GSU, 2010. http://digitalarchive.gsu.edu/nursing_diss/18.

Full text

Abstract:

In the United States nearly 1 million annual new and recurrent myocardial infarctions (MI) occur with 10% of patients hospitalized with MI having unrecognized ischemic symptoms. Inexperienced nurses are expected to accurately interpret cardiac symptom cues, possibly without ever having experienced care of patients with MI, yet have been shown to be less able to classify symptom cues and reach accurate conclusions than experienced nurses. The purpose of this study was to test an educational intervention using theories of pattern recognition to develop CT in MI and improve nursing students’ clinical decision-making and clinical judgment using high fidelity patient simulation. This study used a quasi-experimental three group pre-/post-test design and qualitative data to triangulate information on critical thinking, clinical decision-making, and clinical judgment in MI. A sample of junior baccalaureate in nursing students (N = 54) from a large metropolitan university were divided in pairs and randomized to one of two control groups. Data were collected with instruments which measured pattern recognition in MI, critical thinking in MI, and self-perception of clinical decision-making. In addition, diagnostic efficiency and accuracy were measured. Triangulation on clinical decision making with semi-structured interviews using ‘thinking aloud’ technique was conducted. Data were analyzed as qualitative data and compared among groups. Students who were given prototypes for MI using simulation significantly improved critical thinking as measured by pattern recognition in MI (t(3.153(2), p = .038) compared with the non-simulation control group. Qualitative findings showed that students receiving the experimental simulation with a non-MI scenario and feedback-based debriefing had greatest gains in clinical reasoning which included development of clinical decision-making using analytic hypothetico-deductive and Bayesian reasoning processes and learned avoidance of heuristics. Students receiving the experimental simulation learned to identify salient symptom cues, analyzed data more complexly, and reflected on their simulation experience in a way which students reported improved learning. Students who were given MI only simulation scenarios developed deleterious heuristics and showed fewer gains in clinical reasoning, though both simulation groups demonstrated greater critical thinking ability than the non-simulation control group. Findings support the use of simulation to improve clinical reasoning including pattern recognition and clinical decision-making, and emphasize the significance of simulation scenario construction and debriefing to achieving learning outcomes. The findings could be used to guide further research to improve critical thinking, clinical decision-making, and clinical judgment in nursing students using simulation. Funding for this study was provided by the American Association of Critical Care Nurses and Philips Medical Systems and a testing grant from Elsevier, Assessment.

APA, Harvard, Vancouver, ISO, and other styles

21

Bowles, Ronald Robin. "From diagnosis to discernment : fostering the development of clinical judgment of paramedic learners in immersive high fidelity simulations." Thesis, University of British Columbia, 2013. http://hdl.handle.net/2429/44556.

Full text

Abstract:

Paramedic educators are challenged to produce greater numbers of graduates who are better prepared to function in an evolving health care system. The growth of high fidelity simulation (HFS) holds promise for reducing reliance on the practicum environment, long a crucial step between the classroom and field practice. Yet, despite significant investment in simulation infrastructure, HFS is still seen as an adjunct to, but not a replacement for, practicum placement. The practical problem addressed in this study, then, was the presumption that HF simulation can reduce reliance on practicum placement. The research question explored how HFS influences the development of clinical competence and clinical judgment. This multiple-case study employed a multi-vocal approach, gathering data from 75 classroom and HF simulations. An iterative, inductive process of analysis provided a phenomenological exploration of participants’ experiences and interactions and a critical analysis of their judgments and decision making. The findings in this study suggest that existing paramedic simulations and the practicum represent radically different learning environments, each with its own sets of roles, expectations, patterns of practice, and methods of evaluation that call on different epistemological and ontological conceptions of what constitutes competent practice, what knowledge matters most, and how learning occurs. The varied learning activities in this study fostered different ways of knowing as learners moved from the consistency of context-independent skill performance to the socially constructed adaptation of procedures and protocols in dynamic simulations, and, finally, to the socially negotiated understandings arising from co-emergent activity in a field setting. Effective simulations require situational blends of fidelity to create environments realistic enough to meet their pedagogic goals. Simulations intended to foster clinical competence and clinical judgment must provide occasions for discernment; they must create a milieu involving complex interpersonal interactions and genuine opportunities for clinical decision making. Thus, paramedic simulations must be as concerned with role, environmental, interpersonal, and social/cultural fidelity as with physiological and procedural fidelity. In this sense, populating HFS more richly with actors and authentic interdisciplinary responders may often be as important as the use of HF mannequins and standardized patients.

APA, Harvard, Vancouver, ISO, and other styles

22

Ewing, Jamesa R. "Training Clinical Judgment Skills for Interpreting Feeding Behavior in Preterm Infants: A Comparison of Video and In Vivo Simulation." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etd/2522.

Full text

Abstract:

Health and feeding outcomes for preterm infants depend upon healthcare providers’ ability to recognize non-verbal signs of distress during bottle-feeding. Methods of training future providers’ to interpret feeding behavior in preterm infants are unclear. This study used a pre-test/post-test design to compare the effects of in- vivo simulation and video-simulation training on students’ knowledge of feeding abnormalities, clinical judgment, and documentation accuracy. Fifty-two graduate level speech-language pathology students were assigned to the in-vivo (N= 27) or video-simulation (N= 25) group. Results revealed that both methods proved beneficial for increasing knowledge and clinical judgment skills. Participants trained using video-simulation training documented a greater number of distress signs. The use of patient simulators to train graduate level speech-language pathology students to use correct clinical judgment for managing abnormal feeding behavior is efficacious.

APA, Harvard, Vancouver, ISO, and other styles

23

Senita, Julie A. "Defining Critical Thinking Experiences of Senior Nursing Students." Kent State University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=kent1491305761316241.

Full text

APA, Harvard, Vancouver, ISO, and other styles

24

Yauri, Indriani. "Exploring an innovative educational approach to facilitating student nurses' clinical-reasoning skills in North Sulawesi Province, Indonesia." Thesis, Queensland University of Technology, 2015. https://eprints.qut.edu.au/87293/1/Indriani_Yauri_Thesis.pdf.

Full text

Abstract:

This study examined the effect of an educational intervention utilizing principles of cognitive apprenticeship on students’ ability to apply clinical reasoning skills within the context of a purpose-built clinical vignette. A quasi-experimental, non-equivalent control-group design was used to evaluate the effect of the educational intervention on students’ accuracy, inaccuracy and self-confidence in clinical reasoning. This study makes an important contribution to nursing education by providing evidence to understand how best to facilitate nursing students’ development of clinical reasoning.

APA, Harvard, Vancouver, ISO, and other styles

25

Loftus, Stephen Francis. "Language in clinical reasoning: using and learning the language of collective clinical decision making." Thesis, The University of Sydney, 2006. http://hdl.handle.net/2123/1165.

Full text

Abstract:

The aim of the research presented in this thesis was to come to a deeper understanding of clinical decision making from within the interpretive paradigm. The project draws on ideas from a number of schools of thought which have the common emphasis that the interpretive use of language is at the core of all human activity. This research project studied settings where health professionals and medical students engage in clinical decision making in groups. Settings included medical students participating in problem-based learning tutorials and a team of health professionals working in a multidisciplinary clinic. An underlying assumption of this project was that in such group settings, where health professionals are required to articulate their clinical reasoning for each other, the individuals involved are likely to have insights that could reveal the nature of clinical decision making. Another important assumption of this research is that human activities, such as clinical reasoning, take place in cultural contexts, are mediated by language and other symbol systems, and can be best understood when investigated in their historical development. Data were gathered by interviews of medical students and health professionals working in the two settings, and by non-participant observation. Data analysis and interpretation revealed that clinical decision making is primarily a social and linguistic skill, acquired by participating in communities of practice called health professions. These communities of practice have their own subculture including the language game called clinical decision making which includes an interpretive repertoire of specific language tools and skills. New participants to the profession must come to embody these skills under the guidance of more capable members of the profession, and do so by working through many cases. The interpretive repertoire that health professionals need to master includes skills with words, categories, metaphors, heuristics, narratives, rituals, rhetoric, and hermeneutics. All these skills need to be coordinated, both in constructing a diagnosis and management plan and in communicating clinical decisions to other people, in a manner that can be judged as intelligible, legitimate, persuasive, and carrying the moral authority for subsequent action.

APA, Harvard, Vancouver, ISO, and other styles

26

Loftus, Stephen Francis. "Language in clinical reasoning learning and using the language of collective clinical decision making /." Faculty of Health Sciences, School of Physiotherapy, University of Sydney, 2006. http://hdl.handle.net/2123/1165.

Full text

Abstract:

Doctor of Philosophy
The aim of the research presented in this thesis was to come to a deeper understanding of clinical decision making from within the interpretive paradigm. The project draws on ideas from a number of schools of thought which have the common emphasis that the interpretive use of language is at the core of all human activity. This research project studied settings where health professionals and medical students engage in clinical decision making in groups. Settings included medical students participating in problem-based learning tutorials and a team of health professionals working in a multidisciplinary clinic. An underlying assumption of this project was that in such group settings, where health professionals are required to articulate their clinical reasoning for each other, the individuals involved are likely to have insights that could reveal the nature of clinical decision making. Another important assumption of this research is that human activities, such as clinical reasoning, take place in cultural contexts, are mediated by language and other symbol systems, and can be best understood when investigated in their historical development. Data were gathered by interviews of medical students and health professionals working in the two settings, and by non-participant observation. Data analysis and interpretation revealed that clinical decision making is primarily a social and linguistic skill, acquired by participating in communities of practice called health professions. These communities of practice have their own subculture including the language game called clinical decision making which includes an interpretive repertoire of specific language tools and skills. New participants to the profession must come to embody these skills under the guidance of more capable members of the profession, and do so by working through many cases. The interpretive repertoire that health professionals need to master includes skills with words, categories, metaphors, heuristics, narratives, rituals, rhetoric, and hermeneutics. All these skills need to be coordinated, both in constructing a diagnosis and management plan and in communicating clinical decisions to other people, in a manner that can be judged as intelligible, legitimate, persuasive, and carrying the moral authority for subsequent action.

APA, Harvard, Vancouver, ISO, and other styles

27

Stamp, Kelly D. "Advanced registered nurse practitioners' judgments of coronary heart disease risk." [Tampa, Fla] : University of South Florida, 2006. http://purl.fcla.edu/usf/dc/et/SFE0001811.

Full text

APA, Harvard, Vancouver, ISO, and other styles

28

Fields, Kevin. "REHABILITATION COUNSELOR CLINICAL JUDGMENT MODEL APPLICATION WITH DATA FROM AN INDIVIDUALIZED PLACEMENT AND SUPPORT TRIAL FOR VETERANS LIVING WITH SPINAL CORD INJURIES." VCU Scholars Compass, 2019. https://scholarscompass.vcu.edu/etd/6087.

Full text

Abstract:

Employment rates for veterans with spinal cord injuries remain low despite legislation aimed at helping individuals with significant barriers to employment succeed in finding competitive work. As access to services and resultant outcomes become more scrutinized, the need for Rehabilitation Counselors to efficiently allocate resources grows more vital to the cause. Existing research supports a mediated path model of rehabilitation counselor clinical judgment asserting observations of disability severity, intelligence, and psychosocial adjustment lead to inferences of functional status and attribution thereof, which collectively influence predictions of successful rehabilitation. The current study investigated the variance attributable to this clinical judgement model in relation to access to services and successful employment outcomes in an implementation study of the Individualized Placement and Support Model of supported employment with a sample of veterans living with spinal cord injuries. The reduced model fit the data well, Chi-square (6, N=213) = 3.391, P=.758, CFI =1, RMSEA=.00, Hoelter .05 =788. Disability Severity was found to have an indirect effect on employment, .095 P<.05. Significant direct effects for disability severity on functional status, education on competitive employment, functional status on competitive employment, and minutes on competitive employment. The results indicate time as a resource was allocated equitably among participants in the first thirty days in regard to the exogenous variables in this study. The reduced model accounted for 8.6% of the observed variance in the data.

APA, Harvard, Vancouver, ISO, and other styles

29

Hagiwara, Magnus. "Development and Evaluation of a Computerised Decision Support System for use in pre-hospital care." Doctoral thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-23781.

Full text

Abstract:

The aim of the thesis was to develop and evaluate a Computerised Decision Support System (CDSS) for use in pre-hospital care. The thesis was guided by a theoretical framework for developing and evaluating a complex intervention. The four studies used different designs and methods. The first study was a systematic review of randomised controlled trials. The second and the last studies had experimental and quasi-experimental designs, where the CDSS was evaluated in a simulation setting and in a clinical setting. The third study included in the thesis had a qualitative case study design. The main findings from the studies in the thesis were that there is a weak evidence base for the use of CDSS in pre-hospital care. No studies have previously evaluated the effect of CDSS in pre-hospital care. Due to the context, pre-hospital care is dependent on protocol-based care to be able to deliver safe, high-quality care. The physical format of the current paper based guidelines and protocols are the main obstacle to their use. There is a request for guidelines and protocols in an electronic format among both clinicians and leaders of the ambulance organisations. The use of CDSS in the pre-hospital setting has a positive effect on compliance with pre-hospital guidelines. The largest effect is in the primary survey and in the anamnesis of the patient. The CDSS also increases the amount of information collected in the basic pre-hospital assessment process. The evaluated CDSS had a limited effect on on-the-scene time. The developed and evaluated CDSS has the ability to increase pre-hospital patient safety by reducing the risks of cognitive bias. Standardising the assessment process, enabling explicit decision support in the form of checklists, assessment rules, differential diagnosis lists and rule out worst-case scenario strategies, reduces the risk of premature closure in the assessment of the pre-hospital patient.

APA, Harvard, Vancouver, ISO, and other styles

30

Libano, Maria Candida. "Registered Nurse Job Satisfaction and Nursing Leadership." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3702.

Full text

Abstract:

Job dissatisfaction among nurses may contribute to disengagement and withdrawal from the profession. The degree of leadership support in the workplace influences job satisfaction, and when nurses are satisfied with their job, they provide better patient care. Guided by the social cognitive theory, which asserts a relationship between behavior change and one's surroundings, this quantitative, exploratory project sought to determine the type of nursing leadership practiced in the facility where the project took place, whether nurses were satisfied with their job, and if patients were satisfied with their care. Participants in the project included 55 registered nurses and 5 nurse managers. Three surveys of demographics, job satisfaction, and leadership styles were administered to 60 RN participants; patient satisfaction data were obtained from the hospital's last reported Hospital Consumer Assessment of Healthcare Providers and Systems survey. Descriptive statistics from the nurse surveys showed 75% were female, 56.7% had a bachelor's degree, and, most were under the age of 50 years. Results showed that 90.8% of nurses enjoyed working for the hospital, leaders primarily used transformational leadership styles, and 80.2 to 89.7% of patients were satisfied with their care. This project has implications for positive social change because healthy, transformative leadership leads to staff satisfaction and improved patient satisfaction.

APA, Harvard, Vancouver, ISO, and other styles

31

Smith, J. David. "Confidence in psychodiagnosis, a study of clinicians' judgment confidence in a psychological assessment task as a function of reliance on four inferential heuristics and clinical experience." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0019/NQ44591.pdf.

Full text

APA, Harvard, Vancouver, ISO, and other styles

32

Kotsch, Janeen S. "EXPLORING STUDENTS’ EXPERIENCES OF CONCEPT-BASED LEARNING IN AN ASYNCHRONOUS ONLINE PHARMACOLOGY COURSE: AN INTERPRETIVE STUDY." Kent State University / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=kent161787487052164.

Full text

APA, Harvard, Vancouver, ISO, and other styles

33

Brookes, Oscar, and Peter Johansson. ""Magkänsla" i mötet med en värld av vetenskap - Delar av sjuksköterskans kliniska blick." Thesis, Halmstad University, School of Social and Health Sciences (HOS), 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-2326.

Full text

Abstract:

Klinisk blick är en term som frekvent återkommer under sjuksköterskeutbildningen och i klinisk verksamhet. Den återfinns ofta i samband med klinisk bedömning och som

en övergripande beskrivning av en patient. Endast antydda betydelser har framkommit och då tätt knutna till andra termer och processer. Syftet med studien var att

undersöka komponenterna intuition och tyst kunskap som delar i sjuksköterskans kliniska blick. Studien genomfördes som en litteraturstudie där 17 vetenskapliga artiklar granskades. Resultatet visar att intuition och tyst kunskap är huvudkomponenter i sjuksköterskans kliniska blick. Intuition verkar som en länk mellan kognitiva, affektiva och perceptuella processer. Tyst kunskap sammanbinder intuition och teoretisk kunskap. Intuition och tyst kunskap utvecklas över tid och baseras på personlighet, erfarenhet och teoretisk kunskap. Förslag till vidare forskning är att försöka utveckla

och specificera termen och förstå de bakomliggande processerna bättre med syftet att utbilda och stödja sjuksköterskan i hennes professionella utveckling.

APA, Harvard, Vancouver, ISO, and other styles

34

Meyer, Denise R. "Mental Health Therapists' Perceptions of the Relationship between Client Gender and Personal Characteristics which Contribute to Successful Therapeutic Experiences." University of Cincinnati / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1353087682.

Full text

APA, Harvard, Vancouver, ISO, and other styles

35

Cerullo, Josinete Aparecida da Silva Bastos. "Cuidar de si, cuidar do outro - programa de aprimoramento do raciocínio clínico." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-20052009-112605/.

Full text

Abstract:

Esta pesquisa teve como finalidade permitir a expressão das características do diagnosticador, a fim de que ele próprio reconhecesse como suas características pessoais influenciam suas decisões clínicas. OBJETIVOS: Testar um programa de formação permanente, baseado em histórias de vida, para o aprimoramento do raciocínio clínico em enfermagem; descrever os temas presentes nos processos cognitivos e metacognitivos dos participantes, desencadeados pelas estratégias do programa; analisar a influência das estratégias do programa sobre o raciocínio clínico dos participantes; descrever as intervenções realizadas pelas pesquisadoras. MÉTODO: Planejamento e execução de pesquisa-formação em três hospitais e uma escola de enfermagem de São Paulo, Brasil. Os dados foram constituídos pelas produções escritas dos participantes e pelas observações das pesquisadoras, anotadas em diário. Esses dados foram interpretados a partir da análise de seus conteúdos, com base em proposições teóricas sobre raciocínio clínico e sobre histórias de vida e formação. RESULTADOS: O programa foi implementado com um grupo de 7 enfermeiras de um hospital geral universitário e com dois grupos (um com 7 e outro com 6) de estudantes de graduação em enfermagem. Nos três grupos houve 8 encontros semanais em que ocorreram análises de textos, avaliações de saúde, estudos de caso de pacientes, escritas e partilhas das histórias de vida e projetos. Os temas recuperados com o programa referiram-se aos domínios afetivo e cognitivo. As participantes realizaram e refletiram sobre a coleta e interpretação de informações, elaboraram julgamentos clínicos, analisaram dilemas ético-morais e significados sobre o cuidado de si e dos outros. CONCLUSÕES: As reflexões sobre o autocuidado e as próprias histórias de vida (cuidado de si) permitiram às participantes reavivarem as múltiplas influências que as formam, e que formam os outros, e dinamizaram conhecimentos, habilidades e atitudes necessárias em suas relações com os usuários do sistema de saúde, colegas de trabalho e profissão (cuidado de outros)
The present study intended to enable the expression of the characteristics of diagnosing professionals, so that they could acknowledge to what extent personal characteristics could influence their clinical decisions. OBJECTIVES: To test a program of permanent training, based on life histories, to improve clinical reasoning in nursing; to describe the topics present in cognitive and metacognitive processes of participants, triggered by program strategies; to analyze the influence of program strategies over clinical reasoning of participants; to describe the interventions used by the researchers. METHOD: Planning and execution of the research program and training in three hospitals and one nursing school in Sao Paulo, Brazil. Data consisted of the writing productions of participants and the observations of the researchers, registered in diaries. Data were interpreted by analyzing the content based on theoretical assumptions about clinical reasoning and life histories and training. RESULTS: The program was implemented in a group of 7 nurses in a general university hospital and in two groups (7 and 6 members, respectively) of undergraduate nursing students. The three groups had 8 weekly meetings where they analyzed texts, healthcare examinations, case studies, written pieces and shared life histories and projects. The topics retrieved by the program comprised the affective and cognitive domains. Participants performed and reflected about the collection and interpretation of information, made clinical judgments, analyzed ethical-moral dilemmas, and the meanings of taking care of others and of themselves. CONCLUSIONS: Reflections about self-care and their own life histories (taking care of themselves) enabled the participants to revive the multiple influences that had formed them and had formed the others. They could maximize knowledge, skills and attitudes required to their relationships with healthcare users, co-workers and the profession (taking care of the others)

APA, Harvard, Vancouver, ISO, and other styles

36

Nunes, Janaina Gomes Perbone. "Julgamento clínico e raciocínio diagnóstico de estudantes de enfermagem em simulação clínica de alta-fidelidade." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/83/83131/tde-06052016-192110/.

Full text

Abstract:

O ensino dos processos de julgamento clínico e de raciocínio diagnóstico para estudantes de enfermagem torna-se cada vez mais importante para a qualificação dos cursos de graduação em enfermagem e alcance do compromisso com a formação clínica por excelência do enfermeiro, em uma realidade de saúde cada vez mais complexa. Os objetivos deste estudo foram identificar o julgamento clínico e o raciocínio diagnóstico de estudantes de enfermagem, correlacionar estes dois processos e identificar diferenças entre estudantes da fase intermediária e os concluintes do curso, de uma Escola do interior paulista. Para avaliar o julgamento clínico, construímos um cenário de simulação clínica de alta-fidelidade, representando uma paciente com anemia falciforme em crise de dor e, ainda, traduzimos e adaptamos à cultura brasileira o instrumento Lasater Clinical Judgment Rubric (LASATER, 2007); para avaliar o raciocínio diagnóstico, utilizamos o instrumento já adaptado por Rodrigues (2012) denominado de Inventário de Raciocínio Diagnóstico (BORDAGE; GRANT; MARSDEN, 1990). Os resultados demonstraram que os estudantes de enfermagem apresentaram, predominantemente, nível Proficiente na maioria das dimensões de julgamento clínico (66,7% dos estudantes do grupo concluinte e 56,5% dos estudantes do grupo intermediário). Já para o raciocínio diagnóstico, a maioria dos estudantes foi considerada com ampla habilidade para realizar diagnósticos de enfermagem (91,3% dos estudantes do grupo intermediário e 83,4% dos estudantes do grupo concluinte). Destaca-se que dos concluintes 11,1% apresentaram habilidade máxima. Os estudantes do último ano de graduação em enfermagem apresentaram desempenho superior na fase de interpretação do julgamento clínico (p=0,021). Não se observou diferença entre os grupos para o raciocínio diagnóstico (p=0,334). Houve moderada correlação entre julgamento clínico e raciocínio diagnóstico; e ainda, a fase de reconhecimento do julgamento clínico apresentou-se moderadamente correlacionada ao processo de raciocínio diagnóstico. Considerando que o raciocínio diagnóstico está presente no processo de julgamento clínico, principalmente no momento da investigação do caso clínico (fase Reconhecimento do julgamento clínico) e que as habilidades de raciocinio diagnóstico se manifestam predominantemente nesta fase, a compreensão e o desenvolvimento destes processos pelos estudantes devem ser valorizados nos currículos de graduação em enfermagem
In the increasingly more complex reality of the health field, teaching clinical judgment and diagnostic thinking to nursing students has become more relevant to the qualification of undergraduate nursing programs and the commitment to excellence in nursing clinical training. The objectives of this study were to identify the clinical judgment and diagnostic thinking skills of nursing students, find correlations between these processes and identify differences between mid-course and graduating students at a nursing school in the state of São Paulo, Brazil. Clinical judgment was assessed through a high-fidelity clinical simulation, representing a patient with sickle-cell disease in acute pain, and with the Lasater Clinical Judgment Rubric (LASATER, 2007), translated and adapted by us to the Brazilian reality. To assess diagnostic thinking, we used the Diagnostic Thinking Inventory (BORDAGE; GRANT; MARSDEN, 1990), which was already adapted to Brazil by Rodrigues (2012). The results showed that most of the nursing students displayed, predominantly, Accomplished competency levels in most of the dimensions of clinical judgment (66.7% of the graduating students and 56.5% of mid-course students). Regarding diagnostic reasoning, most students displayed broad nursing diagnostic abilities (91.3% of the mid-course students and 83.4% of graduating students). It is noteworthy that, among graduating students, 11.1% presented maximum ability levels. Students taking the last year of the nursing course presented a higher performance in the phase of clinical judgment interpretation (p=0.021). No difference was observed between the groups as for diagnostic thinking (p=0.334). There was a moderate correlation between clinical judgment and diagnostic thinking; furthermore, there was a moderate correlation between the phase of clinical recognition and the diagnostic thinking process. Considering that diagnostic thinking skills are present in the process of clinical judgment, mainly in the investigation of clinical cases (the Recognition phase of clinical judgment), and that diagnostic thinking skills manifest predominantly in this phase, the understanding and development of these processes by students must be valued in the curricular programs of undergraduate nursing courses

APA, Harvard, Vancouver, ISO, and other styles

37

Johns, Lance. "The Development of a Comprehensive Model of Social Anxiety and Anticipatory Social Appraisals." CSUSB ScholarWorks, 2017. https://scholarworks.lib.csusb.edu/etd/515.

Full text

Abstract:

In anticipation of a future social interaction, socially anxious individuals (SAIs) may imagine themselves appearing stupid or foolish and predict and exaggerate the probability and costs of conveying these undesirable social images both on oneself (e.g., “I will feel stupid”) and on others impressions of oneself (e.g., “Others will think I’m stupid”). However, there is a paucity of research examining the latter bias; moreover, research regarding SAIs estimates of the probability and costs of conveying a positive impression (e.g., “I will feel smart”) has typically been neglected. Thus, the a novel questionnaire was created in order to develop a more comprehensive model of SAIs estimates of probability and costs. We expected that positive and negative, self- and other-related judgments will represent four distinct, latent constructs that will be related to trait social anxiety indirectly through fears of positive and negative evaluation per the evolutionary model of social anxiety. Structural equation modeling was used to test study hypotheses. The final sample included four hounded and seventy-four college students (307 males and 167 females). Results generally supported study hypotheses. After minor theoretically justified modifications, the hypothesized model provided good fit to the data, χ2(94) = 151.78, CFI = .99, TLI = .99, RMSEA = .04. All social appraisals (or judgments) with the exception of other-negative appraisals were indirectly related to social anxiety through fears of positive and negative evaluation. Contrary to expectations, other-positive appraisals were negatively related to fear of negative evaluation and other-negative appraisals were uncorrelated with fear of positive evaluation, providing partial incremental validity of the novel questionnaire used in this study. Results provide preliminary evidence that suggests future research should extend evaluation of SAIs anticipatory social appraisals beyond negative, self-related social impact. Implications, limitations, and future directions of the research are be discussed.

APA, Harvard, Vancouver, ISO, and other styles

38

Dougall, Jennifer Lara. "The Influence of Client Socioeconomic Status on Counselors' Attributional Biases and Objective Countertransference Reactions." University of Akron / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=akron1258136183.

Full text

APA, Harvard, Vancouver, ISO, and other styles

39

Overstreet, Belinda G. "Clinical judgments : application of social psychology in counseling." Virtual Press, 1993. http://liblink.bsu.edu/uhtbin/catkey/897472.

Full text

Abstract:

Clinicians are often required to make judgments regarding clients on the basis of relatively limited information. These judgments can have a substantial effect on the client's own self-perception and on the perceptions of others about the client. This study was designed to investigate the effect of demographic information on clinical judgments.A preliminary study was utilized to determine which demographic variables to vary in the demographic combination presented in the case study. A cluster analysis found that undergraduates reported differences in their perceptions of demographic combinations based on the age and socioeconomic status which was included. As only one part of the demographic combination was to be varied, age was selected.In the main study, graduate student clinicians were presented a case study. The gender, race and socioeconomic status of the client presented in the case study remained constant while the age of the client was varied. Half of the students received a case study where the demographic information represented a 74 year old and half received a case study where the demographic information represented a 35 year old. It was hypothesized that graduate student clinicians' ratings would vary based on the age of the client presented.In addition, it was hypothesized that placing demographic information at the beginning of the case study would result in different ratings than when demographic information was placed at the end of the case study. Half of those presented with the 74 year old client demographic information received that information early in the case study and half received that information near the end of the case study. The same manipulation was made for those presented with the demographic information representative of the 35 year old client.It was also hypothesized that those without demographic information would rate clients differently than those with demographic information. None of the hypotheses were supported; however, an effect for the time of rating was found. Later ratings were found to be more lenient than earlier ratings. Clinical implications and suggestions for future research are discussed.
Department of Counseling Psychology and Guidance Services

APA, Harvard, Vancouver, ISO, and other styles

40

Carter, Clare. "The effects of client obesity on clinical judgments made by trainee clinical psychologists." Thesis, Cardiff University, 2018. http://orca.cf.ac.uk/115895/.

Full text

Abstract:

This thesis explores potential weight stigma among trainee clinical psychologists and the potential impact of this upon their clinical decision making. Overall, the thesis is presented as three papers consisting of: 1) a systematic literature review; 2) an empirical research study and; 3) personal reflections and critical evaluation of the issues and processes involved in conducting this research. In Paper one a systematic literature review of weight stigma among mental health professionals (MHPs) was conducted. A small number of papers met inclusion criteria (8 in total) for systematic review, and results revealed significant methodological weaknesses across studies limiting the confidence in findings found. However, the review highlighted that MHPs are not exempt from having weight stigma. The review provided discussion of clinical implications and future research requirements. Paper Two sought to build on the findings from the systematic literature review, so as to further advance and develop our understanding of weight stigma among MHPS, specifically trainee clinical psychologists. The study aimed to assess weight stigma experimentally and to analyse how it may impact clinical judgments made by trainee clinical psychologists. One-hundred and fifty-one trainees completed an online experiment. Results showed trainees hold a moderate degree of weight stigma toward service users who have obesity and this may impact on clinical judgments in several ways. Implications for training were discussed. Paper 3 provides a critical and personal reflective account of conducting two distinct, albeit related, research studies. This paper is subdivided into two sections, with critical appraisal and personal reflections interwoven throughout. The first section of the paper relates to the process and complexities of conducting a systematic review of the literature, while the latter section pertains to the issues that arose during the experimental research process.

APA, Harvard, Vancouver, ISO, and other styles

41

Gillette, Yvonne. "Individual differences in clinical judgments of mother-child interaction /." The Ohio State University, 1990. http://rave.ohiolink.edu/etdc/view?acc_num=osu1487682558446537.

Full text

APA, Harvard, Vancouver, ISO, and other styles

42

Kinsella, Frederick C. "Is stereotyping of patients by registered nurses associated with inaccurate clinical judgments? /." Staten Island, N.Y. : [s.n.], 1987. http://library.wagner.edu/theses/nursing/1987/thesis_nur_1987_kinse_stere.pdf.

Full text

APA, Harvard, Vancouver, ISO, and other styles

43

McIntyre, Cindy L. "Osteopathic clinical reasoning : an ethnographic study of perceptual diagnostic judgments, metacognition, and reflective practice." Thesis, University of Bedfordshire, 2016. http://hdl.handle.net/10547/621838.

Full text

Abstract:

This thesis explores the use of reflective practice in osteopathic medicine and uses the method to narrate my work as an osteopathic practitioner. It explores the development of perceptual diagnostic judgments, and the role of metacognition, intuition and palpation in osteopathic clinical reasoning. A qualitative interpretive approach was used with a novel narrative method as an organising structure. This was broadly based around reflective practice models of Gibbs, (1988), Kolb, (1984) and Carper (1978) and the ideas of Schön (1983). Descriptive texts were constructed from notes taken of my thoughts whilst in the presence of patients. This allowed access, as closely as possible, to my decision making process. Finally, the descriptive texts were expanded into narratives through dialogue with the existing literature and peer review. The narratives were then analysed using thematic analysis to derive an understanding of concepts arising from the data. This thesis argues that osteopathic clinical reasoning involves multisensory perceptual diagnostic judgments that begin as soon as the patient enters the clinic, and arise as a result of the use of mental and visual imagery and embodied senses. The multisensory information that is detected by a practitioner activates pattern recognition, analytic reasoning and provides explicit feedback used in decision making. Diagnosis occurs as a result of piecing together and interpreting the multisensory information whilst maintaining awareness of other diagnostic possibilities. The findings also suggest that osteopathic clinical reasoning involves the supervision of cognition by the metacognitive processes of meta-knowledge (MK), meta-experiences (ME), and meta-skills (MS). The latter are used to plan, monitor, analyse, predict, evaluate and revise the consultation and patient management as suggested by Pesut and Herman (1992). ME is demonstrated by the presence of judgments of learning used to ensure sufficient information has been gathered, and feelings of rightness that are used to perceive the correctness of information arriving and decisions made. The use of reflective practice in this research has developed the understanding of osteopathic clinical reasoning, and demonstrated that it provides a powerful conduit for change in practice. As a result, it enables the provision of better patient-centred osteopathic healthcare incorporating the biopsychosocial model of healthcare. Although rooted in my own osteopathic practice style and strategies, it should have resonance for those within the discipline of osteopathy and has implications for osteopathic education, training and research.

APA, Harvard, Vancouver, ISO, and other styles

44

Goldstein, Lizabeth Alexandra. "Change in Bias Following Cognitive Therapy for Depression: An Investigation of Multiple Emotionally Engaging Judgments." The Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1331140682.

Full text

APA, Harvard, Vancouver, ISO, and other styles

45

Thomas, S. Margot. "Cue utilization by expert pediatric critical care nurses in making clinical judgments related to endotracheal suctioning." Thesis, University of Ottawa (Canada), 2002. http://hdl.handle.net/10393/6142.

Full text

Abstract:

The nature of nursing judgment in clinical practice situations remains incompletely explored. It is known that nurses perform endotracheal suctioning as part of the nursing care of critically ill children. However, the ways in which nurses judge the need for suctioning and the method used to suction are not well understood. This research study was conducted to describe the cues that expert pediatric critical care nurses use in making the judgment to suction and to describe how those cues are used in determining the timing of endotracheal suctioning. A qualitative naturalistic study was conducted in a quaternary pediatric critical care unit in Central Canada. A purposive sample of seven expert pediatric critical care nurses participated in the study. Data were collected using three methods---participant observations (field notes), think aloud (concurrent verbalizations) and semi-structured interviews (retrospective verbalizations)---as participants cared for ventilated, critically ill children. (Abstract shortened by UMI.)

APA, Harvard, Vancouver, ISO, and other styles

46

Weber, Jean-Christophe. "La clinique, laboratoire de la médecine : exploration philosophique." Thesis, Paris Sciences et Lettres (ComUE), 2019. http://www.theses.fr/2019PSLEE046.

Full text

Abstract:

La clinique médicale est le lieu d’une expérience. Son point originaire est l’expérience vécue par un malade dont le corps souffrant le conduit à s’en remettre à un autre pour lui adresser une demande. Le médecin perçoit et déchiffre des traces, corporelles et langagières, les intègre dans une construction qui mobilise imagination et entendement : une situation singulière fait l’objet d’une enquête, expérience qui entrelace tous les degrés de la connaissance, des plus sensibles aux plus théoriques. Formuler un diagnostic, proposer et conduire une thérapie : la rhétorique se mêle à la science. L’expérience experte s’acquiert par l’instruction reçue d’expérimentations particulières et répétées. Elles confrontent au réel et forcent à articuler corps et parole, savoirs et affects, besoins et désirs, traitement et soins : vulnérable comme tout agir pratique, la clinique médicale est en crise. Sont en question le statut épistémologique de la médecine, son pouvoir de gouvernement des corps et des esprits, la nature de ce qui est offert, la distribution des savoirs. La mouvance Evidence-based medicine, l’individualisation des soins, l’empowerment et les patients-experts, et tous les procédés visant à consolider la pratique risquent cependant de la fragiliser davantage. L’analyse critique de la clinique et des apories qui la traversent conduit à en ressaisir les lignes de force, à revenir à ses racines : la médecine est une tekhnē, qui suppose pour s’exercer un jugement réfléchissant, un raisonnement pratique, une esthésie élargie, la science impersonnelle et l’attention délicate au particulier. En l’abordant sous les angles de l’esthétique, de l’érotique et de l’éthique de ses vertus, la thèse dégage les coordonnées fondamentales d’une clinique qui apparaît comme le laboratoire véritable de la médecine
Clinical medicine is home to a very experiment. Its native point is the experience of a patient whosesuffering body led him to rely on someone else to send him a request. The doctor perceives anddecodes physical marks and linguistic indices, integrates them into a construction involvingimagination and understanding: a singular situation is being investigated through an experience thatinterweaves all the degrees of knowledge, from the most sensitive to the more theoretical ones.Making a diagnosis, proposing and leading a therapy requires not only science but also rhetoric.Expertise arises from repeated experimentations. They confront to the real and force to articulate bodyand language, knowledge and feelings, needs and desires, cure and care: vulnerable as everypractice, clinical medicine is said in crisis. The epistemological status of medicine, the medicalgovernment of bodies and souls, the nature of what is offered, the distribution of knowledge, are themain topics being called into question. Evidence-based medicine, individualization of care,empowerment and expert patients, and all processes engaged to strengthen the clinical practice mayhowever further compromise it. A critical reappraisal of clinical medicine and its aporia led us toaddress the key issues of practical medicine, and to return to its roots: medicine is a tekhnē, whichassumes to exercise reflective judgment, practical reasoning, expanded aesthesia, and entanglesimpersonal science and delicate attention to the individual. The thesis provides a comprehensiveaccount of three fundamental dimensions of clinical medicine: aesthetics, erotics and ethics. Clinicalpractice appears to be the real laboratory for medicine

APA, Harvard, Vancouver, ISO, and other styles

47

Woodruff, James Graham. "Sex-Role Stereotyping in Marital Counseling Sex- Role Style and Type of Problem Effects on Clinical Judgments." Thesis, North Texas State University, 1985. https://digital.library.unt.edu/ark:/67531/metadc332056/.

Full text

Abstract:

The analogue study was designed to extend previous research on clinical sex-role stereotyping of individual clients into the realm of marital counseling. The effects of clinician and couple sex-role style and type of marital problem on clinical judgements of couples was examined through ratings of four audiotaped couples constructed from two scripts depicting either couple financial or sexual problems. Each script produced both a stereotypical and counterstereotypical sex-role styled couple through reversal of spouse verbalizations. A sample of 40 (32 male, 8 female) practicing doctorate-level psychologists rated either two stereotypical or two counterstereotypical couples for level of maladjustment, need for treatment, and prognosis. Individual spouse ratings were also obtained to examine client gender effects.

APA, Harvard, Vancouver, ISO, and other styles

48

Johnson, Rowan Alexander. "An evaluation of the level of the moral judgment of behaviourally handicapped adolescent clinic school pupils of normal intelligence / Rowan Alexander Johnson." Thesis, Potchefstroom University for Christian Higher Education, 1990. http://hdl.handle.net/10394/10350.

Full text

Abstract:

This empirical study aimed at determining any significant difference in level of moral judgment between behaviourally handicapped adolescent clinic school pupils of normal intelligence (experimental group) and a matched sample of non-behaviourally handicapped pupils (control group). Moral judgment level was measured in terms of Global stage Scores and Weighted Average Scores using Kohlberg's Moral Judgment Interviews and standard Issue scoring. Secondary aims were to determine whether the data obtained indicated significant sex differences in level of moral judgment and to compare the mean level of moral judgment of the experimental and control groups with existing research. A statement and motivation of the problem and clarification of concepts were followed by an evaluation of applicable pre-Kohlbergian research, the philosophical foundations of Kohlberg’s theory and the theory itself. This was followed by an examination of the methods of research and the empirical study. The data generated indicated a significant difference in mean level of moral judgment between the research groups in favour of the control group when controlling for age, gender and socio-economic status. This difference was highlighted by comparisons with existing research. No significant gender differences in moral judgment were found. Important conclusions reached were: - Experimental group pupils were retarded in level of' moral judgment and, unlike the pupils in the control group, most had not yet reached stage 3 moral reasoning. - Sex differences in moral judgment were not found as is predicted in Kohlbergian theory (Colby & Kohlberg, 1987: 130). - Sub-group comparisons indicated chronological age to be an important factor in the measurement of moral judgment. The research findings imply that: - Attempts should be made to raise the level of moral judgment of pupils like those in the experimental group specifically, but also that of all pupils. - Planned moral education programmes can ignore sex differences, but not chronological age. - Varied research into moral judgment is necessary.
Dissertation (MEd)--PU for CHO, 1990

APA, Harvard, Vancouver, ISO, and other styles

49

Harris, Kevin A. "Clinical judgment faith bias : the impact of faith and multicultural competence on clinical judgment." 2011. http://liblink.bsu.edu/uhtbin/catkey/1637940.

Full text

Abstract:

Clinical judgment faith bias is a hypothesized tendency for clinicians to make more pathological judgments for clients with socially nonnormative faith than for otherwise identical clients with socially normative faith. To test for clinical judgment faith bias, Dillman’s (2007) Tailored Design method for mail and internet surveys was employed. A random sample of 141 psychologists in clinical practice completed a series of questionnaires measuring clinician religiousness and spirituality, view of faith helpfulness, multicultural awareness and knowledge, and diagnostic and prognostic judgments of a clinical vignette describing a client with Generalized Anxiety Disorder and two manipulated attributes: magnitude of faith (low, moderate, or high) and type of faith (religious or spiritual). Five multivariate multiple regression analyses were conducted, with a series of follow-up multivariate tests. The results of the analyses were not significant. The magnitude of faith in the vignette did not influence the diagnostic or prognostic judgments of clinicians, clinicians did not make significantly different judgments for religious cases than for spiritual cases, and faith magnitude did not interact with faith type. Furthermore, clinician attributes did not appear to affect clinical judgments in any way. Implications are discussed for theory, research and clinical practice.
Department of Counseling Psychology and Guidance Services

APA, Harvard, Vancouver, ISO, and other styles

50

GARTNER, JOHN DOUGLAS. "IDEOLOGICAL BIASES IN CLINICAL JUDGMENT (RELIGION, POLITICS, PREJUDICE)." 1985. https://scholarworks.umass.edu/dissertations/AAI8602638.

Full text

APA, Harvard, Vancouver, ISO, and other styles

Dissertations / Theses on the topic 'Clinical judgment'

Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles