Relevant bibliographies by topics / Emergency nursing Decision making

Academic literature on the topic 'Emergency nursing Decision making'

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Published: 10 December 2022
Last updated: 21 February 2023

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Journal articles on the topic "Emergency nursing Decision making"

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Lugg, Jason. "Clinical Judgement and Decision Making in Nursing." Emergency Nurse 25, no. 09 (February 9, 2018): 16. http://dx.doi.org/10.7748/en.25.09.16.s18.

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Abu Arra, Ahmed Yahya, Ahmad Ayed, Dalia Toqan, Mohammed Albashtawy, Basma Salameh, Adnan Lutfi Sarhan, and Ahmad Batran. "The Factors Influencing Nurses’ Clinical Decision-Making in Emergency Department." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 60 (January 2023): 004695802311520. http://dx.doi.org/10.1177/00469580231152080.

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In an emergency, making the correct decision is vital. It is a necessary element of professional nursing care, and the ability of nurses to make successful clinical decisions is the most critical element influencing care quality. The purpose of this study was to assess the factors influencing nurses’ clinical decision-making in the emergency department of Palestinan hospitals. A cross-sectional study was targeted at all nurses working in emergency departments at the Palestinian hospitals. The study was completed with 227 nurses, and collecting data was performed with the Clinical Decision Making in Nursing Scale. Results of the study revealed that the average score for the total clinical decision-making score was 3.3 (SD = 0.23). The subscales of clinical decision making were “search for alternatives or options,” “canvassing of objectives and values,” “evaluation and reevaluation of consequences,” and “search for information and unbiased assimilation of new information.” Furthermore, multiple linear regression analysis revealed that degree and work hours accounted for 11.7% of the variance in clinical decision-making. The study confirmed the average score for clinical decision-making was slightly higher than the average score. Also, it approved that nursing degree and work hours were predictors of clinical decision-making among nurses in emergency departments.
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Rubio-Navarro, Alfonso, Diego José García-Capilla, Maria José Torralba-Madrid, and Jane Rutty. "Decision-making in an emergency department: A nursing accountability model." Nursing Ethics 27, no. 2 (July 18, 2019): 567–86. http://dx.doi.org/10.1177/0969733019851542.

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Introduction: Nurses who work in an emergency department regularly care for acute patients in a fast-paced environment, being at risk of suffering high levels of burnout. This situation makes them especially vulnerable to be accountable for decisions they did not have time to consider or have been pressured into. Research objective: The objective of this study was to find which factors influence ethical, legal and professional accountability in nursing practice in an emergency department. Research design: Data were analysed, codified and triangulated using qualitative ethnographic content analysis. Participants and research context: This research is set in a large emergency department in the Midlands area of England. Data were collected from 186 nurses using participant observation, 34 semi-structured interviews with nurses and ethical analysis of 54 applicable clinical policies. Ethical considerations: Ethical approval was granted by two research ethics committees and the National Health Service Health Research Authority. Results: The main result was the clinical nursing accountability cycle model, which showed accountability as a subjective concept that flows between the nurse and the healthcare institution. Moreover, the relations among the clinical nursing accountability factors are also analysed to understand which factors affect decision-making. Discussion: The retrospective understanding of the factors that regulate nursing accountability is essential to promote that both the nurse and the healthcare institution take responsibility not only for the direct consequences of their actions but also for the indirect consequences derived from previous decisions. Conclusion: The decision-making process and the accountability linked to it are affected by several factors that represent the holistic nature of both entities, which are organised and interconnected in a complex grid. This pragmatic interpretation of nursing accountability allows the nurse to comprehend how their decisions are affected, while the healthcare institution could act proactively to avoid any problems before they happen.
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Alba, Barbara. "Factors that impact on emergency nurses’ ethical decision-making ability." Nursing Ethics 25, no. 7 (November 10, 2016): 855–66. http://dx.doi.org/10.1177/0969733016674769.

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Background: Reliance on moral principles and professional codes has given nurses direction for ethical decision-making. However, rational models do not capture the emotion and reality of human choice. Intuitive response must be considered. Research purpose: Supporting intuition as an important ethical decision-making tool for nurses, the aim of this study was to determine relationships between intuition, years of worked nursing experience, and perceived ethical decision-making ability. A secondary aim explored the relationships between rational thought to years of worked nursing experience and perceived ethical decision-making ability. Research design and context: A non-experimental, correlational research design was used. The Rational Experiential Inventory measured intuition and rational thought. The Clinical Decision Making in Nursing Scale measured perceived ethical decision-making ability. Pearson’s r was the statistical method used to analyze three primary and two secondary research questions. Participants: A sample of 182 emergency nurses was recruited electronically through the Emergency Nurses Association. Participants were self-selected. Ethical considerations: Approval to conduct this study was obtained by the Adelphi University Institutional Review Board. Findings: A relationship between intuition and perceived ethical decision-making ability ( r = .252, p = .001) was a significant finding in this study. Discussion: This study is one of the first of this nature to make a connection between intuition and nurses’ ethical decision-making ability. Conclusion: This investigation contributes to a broader understanding of the different thought processes used by emergency nurses to make ethical decisions.
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Grieve, DL. "Decision making in emergency nursing M Mancini Decision making in emergency nursing B C Decker 224pp £19.95 1-55664-003-X." Nursing Standard 2, no. 30 (April 30, 1988): 52. http://dx.doi.org/10.7748/ns.2.30.52.s85.

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Mirhaghi, A., G. R. Mohammadi, and M. Asghari. "(A260) Triage Decision-Making in Intoxication." Prehospital and Disaster Medicine 26, S1 (May 2011): s71—s72. http://dx.doi.org/10.1017/s1049023x11002445.

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Background and AimsDecision-making is the major component in triaging EDs patients. EDs Triage systems have applied different approaches to triaging intoxicated patients. Pros & Cons for these approaches need to be identified. Aim is to analysis management of intoxicated patients during various triage process.MethodsCritical review includes five triage systems, Emergency Severity Index, Australasian Triage Scale, Canadian triage and Acuity Scale, Manchester Triage System and 5-tier Triage protocol. These systems have been analyzed via meta-synthesis in terms of evidence-based criteria, inclusiveness, specific application and practicability.ResultsGeneral physiologic signs & symptoms were the gold standard for determining acuity in patients that have been applied by all triage systems. Conscious level, air way, respiratory status and circulation assessment were identified as major criteria in decision-making. 5-tier Triage protocol showed the most comprehensiveness characteristics to prioritizing intoxicated patients.DiscussionResources necessary for evidence-based performance to support nursing decisions in triaging intoxicated patients needs fundamentally to be developed. It`s necessary to develop National Triage Scale to approach intoxicated patients effectively.
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Beaulieu, Richard, Susan M. Kools, Holly Powell Kennedy, and Janice Humphreys. "Young Adult Couples’ Decision Making Regarding Emergency Contraceptive Pills." Journal of Nursing Scholarship 43, no. 1 (January 14, 2011): 41–48. http://dx.doi.org/10.1111/j.1547-5069.2010.01381.x.

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Wang, Li-Hsiang, Suzanne Goopy, Chun-Chih Lin, Alan Barnard, Chin-Yen Han, and Hsueh-Erh Liu. "The emergency patient's participation in medical decision-making." Journal of Clinical Nursing 25, no. 17-18 (May 1, 2016): 2550–58. http://dx.doi.org/10.1111/jocn.13296.

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Peate, Ian. "Nursing Knowledge and Practice: Foundations for decision making Maggie Mallik Nursing Knowledge and Practice: Foundations for decision making Carol Hall David Howard (Eds)Elsevier£29.99504pp97807020294000702029408." Emergency Nurse 17, no. 6 (October 6, 2009): 9. http://dx.doi.org/10.7748/en.17.6.9.s15.

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Willinsky, J. L., and I. Hyun. "P140: Emergency department decision-making for incapacitated and unrepresented patients: a comprehensive review of the literature." CJEM 18, S1 (May 2016): S124—S125. http://dx.doi.org/10.1017/cem.2016.314.

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Introduction: Incapacitated patients who lack substitute decision-makers (SDM) are commonly encountered in the emergency department (ED). The number of these patients will rise dramatically as the Baby Boomers age. We can expect an influx of elderly patients who lack decisional capacity due to dementia and other illnesses, and who present without family. It is estimated that 3 to 4 percent of U.S. nursing home residents have no SDM or advance directives. Medical decision-making for this cohort poses an ethical challenge, particularly in the ED setting. Methods: A comprehensive review of the literature was conducted surrounding decision-making for incapacitated and unrepresented patients in the hospital setting. Articles were identified using MEDLINE (1946-October 2015) and Embase (1974-October 2015). The reference lists of relevant articles were hand searched. Articles describing decision-making processes that have been proposed, tested or applied in practice were chosen for full review. The aim of this review was to outline recognized medical decision-making processes for incapacitated and unrepresented patients, and to identify areas for future research. Results: The search yielded 20 articles addressing decision-making for incapacitated and unrepresented patients in the hospital setting. All of these articles focus on the intensive care unit and other hospital wards; no literature on the ED setting was found. Five types of formal consulting bodies exist to assist physicians in applying the best interest standard for this patient cohort: internal hospital ethics committees, external ethics committees, public guardians, court-appointed guardians, or judges. The majority of decisions for these patients, however, are made informally by a single physician or by a healthcare team, although it is well recognized that this approach lacks appropriate safeguards. There is no consensus surrounding the optimal approach to decision-making in these cases, and as such there is significant inconsistency in how medical decisions are made for these patients. Conclusion: There are several articles describing decision-making processes for incapacitated and unrepresented patients, none of which focus on the ED. These processes are not practical for use in the ED. Further inquiry is needed into the most ethical and respectful method of decision-making for this patient cohort in the ED.
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Dissertations / Theses on the topic "Emergency nursing Decision making"

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Pugh, Dale M. "A phenomenological study of clinical decision making by flight nurse specialists in emergency situations." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1999. https://ro.ecu.edu.au/theses/1249.

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Clinical decision making is an integral, multifaceted phenomenon fundamental to nursing practice. The domain of flight nursing practice is unique in terms of knowledge, structure, clinical presentations and environment. The uniqueness and diversity of patient scenarios and the advanced practice level of the flight nurse role blend to provide a potential rollercoaster flight mission. At the time this research was conducted nursing standards to guide clinical decision making were being developed. Medically orientated clinical guidelines were in place, but they were designed to highlight a specific, well defined clinical scenario or skill. It has been argued that guidelines for nursing practice do not always parallel the complex clinical situations in which advanced practitioners may find themselves (Malone, 1992b). Flight Nurse Specialists (FNSs) with greater than two years flight nursing experience employed by the Royal Flying Doctor Service (RFDS) - Western Operations were interviewed regarding their experiences of clinical decision making in emergency situations. Using a phenomenological methodology, indepth interviews were audiotaped and transcribed. The interviews were analysed using the method described by Colaizzi (1978). Data was described and interpreted, common themes were extrapolated and analysed. A Gestalt of Knowing was identified by the interconnection and interrelationships of the extrapolated themes. The three themes are: Ways of Knowing the Patient, Context of Knowing and Reflective Practice. Ways of Knowing the Patient is constructed with the sub-themes intuitive knowing, experiential knowing and objective knowing. The second theme, Context of Knowing, is made up of the sub-themes aviation environment, non or minimised involvement in triage, knowing co11eagues, solo practitioner, experiential level and practice guidelines. Self-critique and change in practice formed the theme Reflective Practice. Findings provide a significant contribution to the knowledge of clinical decision making in nursing and to the practice of flight nursing in the Western Australian context. Several recommendations arose from the findings in relation to further research, policy making, standards development and practice developments. Further research is needed into the themes and sub-themes. FNSs need to be allowed to undertake the role of triage for those flights that they will undertake as the solo health professional. The development of standards for flight nursing would benefit from the consideration of the findings of this study and other qualitative studies of clinical decision making. Reflective practice should be considered as a mechanism for not only evaluating practice but as a mechanism for identifying stressful events.
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Meeks-Sjostrom, Diana. "Clinical decision-making of nurses regarding elder abuse." unrestricted, 2008. http://etd.gsu.edu/theses/available/etd-04302008-123109/.

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Thesis (Ph. D.)--Georgia State University, 2008.
Title from file title page. Cecelia Gatson Grindel, committee chair; Anne Koci, Annette Bairan, committee members. Electronic text (144 p. : ill.) : digital, PDF file. Description based on contents viewed July 10, 2008. Includes bibliographical references (p. 82-86).
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Fry, Margaret. "Triage Nursing Practice in Australian Emergency Departments 2002-2004: An Ethnography." University of Sydney, 2004. http://hdl.handle.net/2123/701.

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This ethnographic study provides insight and understanding, which is needed to educate and support the Triage Nursing role in Australian Emergency Departments (EDs). The triage role has emerged to address issues in providing efficient emergency care. However, Triage Nurses and educators have found the role challenging and not well understood. Method: Sampling was done first by developing a profile of 900 nurses who undertake the triage role in 50 NSW EDs through survey techniques. Purposive sampling was then done with data collected from participant observation in four metropolitan EDs (Level 4 and 6), observations and interviews with 10 Triage Nurses and the maintenance of a record of secondary data sources. Analysis used standard content and thematic analysis techniques. Findings: An ED culture is reflected in a standard geography of care and embedded beliefs and rituals that sustain a cadence of care. Triage Nurses to accomplish their role and maintain this rhythm of care used three processes: gatekeeping, timekeeping and decision-making. When patient overcrowding occurred the three processes enabled Triage Nurses to implement a range of practices to restore the cadence of care to which they were culturally oriented. Conclusion: The findings provide a framework that offers new ways of considering triage nursing practice, educational programs, policy development and future research.
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Alba, Barbara. "An Investigation of Intuition, Years of Worked Nursing Experience, and Emergency Nurses' Perceived Ethical Decision Making." Thesis, Adelphi University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10669616.

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The purpose of this study was to explore the relationship between nurses' use of intuition, years of worked nursing experience, and nurses' perceived ethical decision making ability. Additionally, recognizing the relationship between the intuitive/experiential and the analytic/rational systems, this research extended beyond the intuitive/experiential system capturing analytic/rational thought. A sample of 182 nurses from the Emergency Nurses Association (ENA) was recruited for this investigation. A nonexperimental, correlational research design was used to examine the relationship between the variables. Intuition was measured using the Experiential scale of the Rational-Experiential Inventory (REI) and analytic/rational was measured using Rationality scale of the REI. Perceived ethical decision making ability was measured with the Clinical Decision Making in Nursing Scale (CDMNS) applied to an ethical dilemma within the participants own practice. Cognitive-Experiential Self-Theory (CEST) provided the theoretical framework for this study. According to CEST, information is processed by two independent, interactive conceptual systems; a preconscious intuitive/experiential system and a conscious analytic/rational system. These are thought to function parallel from yet interactively with each other. One-way ANOVAs, independent sample t-tests, Pearson's r correlation, and multiple regressions analysis provided the statistical methods used to answer nine research questions. A significant relationship was found between intuition and perceived ethical decision making (r = .252, p = .001). This contributes to a broader understanding of the different thought processes used by emergency nurses to make ethical decisions.

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Kihlgren, Annica. "Older patients in transition : from home care towards emergency care /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-271-3/.

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Wolf, Lisa Adams. "Testing and refinement of an integrated, ethically-driven environmental model of clinical decision-making in emergency settings." Thesis, Boston College, 2011. http://hdl.handle.net/2345/2224.

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Thesis advisor: Dorothy A. Jones
Thesis advisor: Pamela J. Grace
The purpose of the study was to explore the relationship between multiple variables within a model of critical thinking and moral reasoning that support and refine the elements that significantly correlate with accuracy and clinical decision-making. Background: Research to date has identified multiple factors that are integral to clinical decision-making. The interplay among suggested elements within the decision making process particular to the nurse, the patient, and the environment remain unknown. Determining the clinical usefulness and predictive capacity of an integrated ethically driven environmental model of decision making (IEDEM-CD) in emergency settings in facilitating accuracy in problem identification is critical to initial interventions and safe, cost effective, quality patient care outcomes. Extending the literature of accuracy and clinical decision making can inform utilization, determination of staffing ratios, and the development of evidence driven care models. Methodology: The study used a quantitative descriptive correlational design to examine the relationships between multiple variables within the IEDEM-CD model. A purposive sample of emergency nurses was recruited to participate in the study resulting in a sample size of 200, calculated to yield a power of 0.80, significance of .05, and a moderate effect size. The dependent variable, accuracy in clinical decision-making, was measured by scores on clinical vignettes. The independent variables of moral reasoning, perceived environment of care, age, gender, certification in emergency nursing, educational level, and years of experience in emergency nursing, were measures by the Defining Issues Test, version 2, the Revised Professional Practice Environment scale, and a demographic survey. These instruments were identified to test and refine the elements within the IEDEM-CD model. Data collection occurred via internet survey over a one month period. Rest's Defining Issues Test, version 2 (DIT-2), the Revised Professional Practice Environment tool (RPPE), clinical vignettes as well as a demographic survey were made available as an internet survey package using Qualtrics TM. Data from each participant was scored and entered into a PASW database. The analysis plan included bivariate correlation analysis using Pearson's product-moment correlation coefficients followed by chi square and multiple linear regression analysis. Findings: The elements as identified in the IEDEM-CD model supported moral reasoning and environment of care as factors significantly affecting accuracy in decision-making. Findings reported that in complex clinical situations, higher levels of moral reasoning significantly affected accuracy in problem identification. Attributes of the environment of care including teamwork, communication about patients, and control over practice also significantly affected nurses' critical cue recognition and selection of appropriate interventions. Study results supported the conceptualization of the IEDEM-CD model and its usefulness as a framework for predicting clinical decision making accuracy for emergency nurses in practice, with further implications in education, research and policy
Thesis (PhD) — Boston College, 2011
Submitted to: Boston College. Connell School of Nursing
Discipline: Nursing
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Göransson, Katarina. "Registered nurse-led emergency department triage : organisation, allocation of acuity ratings and triage decision making." Doctoral thesis, Örebro University, Department of Health Sciences, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-732.

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Successful triage is the basis for sound emergency department (ED) care, whereas unsuccessful triage could result in adverse outcomes. ED triage is a rather unexplored area in the Swedish health care system. This thesis contributes to our understanding of this complex nursing task. The main focus of this study has been on the organisation, performance, and decision making in Swedish ED triage. Specific aims were to describe the Swedish ED triage context, describe and compare registered nurses’ (RNs) allocation of acuity ratings, use of thinking strategies and the way they structure the ED triage process.

In this descriptive, comparative, and correlative research project quantitative and qualitative data were collected using telephone interviews, patient scenarios and think aloud method. Both convenience and purposeful sampling were used when identifying the participating 69 nurse managers and 423 RNs from various types of hospital-based EDs throughout the country.

The results showed national variation, both in the way triage was organised and in the way it was conducted. From an organisational perspective, the variation emerged in several areas: the use of various triageurs, designated triage nurses, and triage scales. Variation was also noted in the accuracy and concordance of allocated acuity ratings. Statistical methods provided limited explanations for these variations, suggesting that RNs’ clinical experience might have some affect on the RNs’ triage accuracy. The project identified several thinking strategies used by the RNs, indicating that the RNs, amongst other things, searched for additional information, generated hypotheses about the fictitious patients and provided explanations for the interventions chosen. The RNs formed relationships between their interventions and the fictitious patients’ symptoms. The RNs structured the triage process in several ways, beginning the process by searching for information, generating hypotheses, or allocating acuity ratings. Comparison of RNs’ use of thinking strategies and the structure of the triage process based on triage accuracy revealed only slight differences.

The findings in this dissertation indicate that the way a patient is triaged, and by whom, depends upon the particular organisation of the ED. Moreover, the large variation in RNs triage accuracy and the inter-rater agreement and concordance of the allocated acuity ratings suggest that the acuity rating allocated to a patient may vary considerably, depending on who does the allocation. That neither clinical experience nor the RNs’ decision-making processes alone can explain the variations in the RNs triage accuracy indicates that accuracy might be influenced by individual and contextual factors. Future studies investigating triage accuracy are recommended to be carried out in natural settings.

In conclusion, Swedish ED triage is permeated by diversity, both in its organisation and in its performance. The reasons for these variations are not well understood.

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Duro, Carmen Lúcia Mottin. "Classificação de risco em serviços de urgência na perspectivas dos enfermeiros." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2014. http://hdl.handle.net/10183/98547.

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A Classificação de Risco foi implantada nos serviços de urgência com a finalidade de priorizar o atendimento, considerando a gravidade da situação clínica e a necessidade de cuidados imediatos dos usuários. No entanto, há dificuldades em relação ao desenvolvimento desta atividade pelo enfermeiro. Assim, o objetivo do estudo é avaliar a Classificação de Risco nos serviços de urgência na perspectiva dos enfermeiros. Para atingir essa finalidade foi realizado estudo exploratório, quantitativo, de mensuração de opinião, por meio da técnica Delphi. Foram realizadas três rodadas de aplicação de questionários interativos, que circularam entre os participantes até obtenção de consenso. Para a composição do painel dos especialistas foi utilizada a técnica de bola de neve. Os dados foram coletados por meio de questionário inserido na plataforma eletrônica SurveyMonkey®, de acesso on-line, e foram submetidos a tratamento estatístico. Foi estipulado como consenso o percentual acima ou igual a 70% das respostas. Os resultados obtidos indicaram que a Classificação de Risco é um dispositivo orientador de fluxo de usuários e de priorização da gravidade clínica, contribuindo para a diminuição do tempo de espera dos pacientes em condições clínicas graves e permitindo a redução de agravos e sequelas de pacientes urgentes. Além disso, os participantes concordaram que a classificação de risco organiza o trabalho dos enfermeiros e do serviço de urgência. A avaliação do estado clínico por meio do desenvolvimento da escuta qualificada às queixas dos usuários foi identificada como uma das ações dos enfermeiros na classificação de risco, sendo que a autonomia no exercício dessa atividade foi considerada como uma das potencialidades. Quanto à formação necessária para a realização da classificação de risco, foi indicado o conhecimento clínico como base para a tomada de decisão na priorização do atendimento ao paciente. A experiência profissional em classificação de risco foi também identificada para o julgamento da prioridade de atendimento do paciente e a capacidade intuitiva foi apontada como facilitadora. Para isso, os enfermeiros necessitam de habilidades de comunicação e de enfrentamento dos conflitos com os usuários. Dentre as fragilidades, houve consenso de discordância de que o ambiente da classificação de risco seja capaz de promover o acolhimento do paciente e de favorecer a privacidade. Foi considerado que o dimensionamento do número de enfermeiros por turno de trabalho não é suficiente para a realização da classificação de risco nos serviços de urgência, de forma que a demanda excessiva de usuários e o número inadequado de profissionais podem expor os enfermeiros da classificação de risco à elevada carga de trabalho. Também houve consenso de discordância quanto à disponibilização de capacitações periódicas aos enfermeiros sobre a utilização dos protocolos/escalas de classificação de risco. Quanto à fragilidade de ações dos enfermeiros na classificação de risco, foi indicada a falta de reavaliação da condição clínica do paciente durante o período de tempo de espera pelo atendimento, o que pode gerar agravamento da condição clínica do paciente e prejuízos ao exercício profissional do enfermeiro. Conclui-se que os enfermeiros representam suporte profissional, cognitivo e emocional na Classificação de Risco. Os resultados sinalizam que a qualificação permite que os enfermeiros continuem atuando na avaliação e classificação do risco nos serviços de urgência e permanecerão realizando essa atividade no futuro.
The Risk Classification was deployed in emergency services in order to prioritize care, considering the severity of clinical status and need immediate attention from users. However, there are difficulties regarding the development of this activity by nurses. The objective of the study is to evaluate the triage performed at emergency services, from the nurses‘ perspective. To achieve this purpose was conducted exploratory study, quantitative measurement of opinion by the Delphi technique. The subjects answered interactive questionnaires, which circulated among the participants for three rounds, until reaching consensus. The board of experts was composed using the snowball method. Data were collected using a questionnaire available on SurveyMonkey®,an online electronic platform, and submitted to statistical analysis. It was established that consensus would be reached when 70% or more answers were equal. The findings show that triage is a tool that guides patient flow and rates clinical severity, thus contributing to reducing the waiting time for patients in severe clinical conditions, and permitting to reduce complications and sequels in emergency patients. Furthermore, the participants agreed that triage organizes the work of nurses and the emergency service. It was identified that the evaluation of the clinical condition by carefully listening to the patient‘s complaints was one of the actions that nurses used to classify the risk, and that the autonomy of this activity was considered one of its strengths. As to the necessary training to conducttriage, it was indicated that clinical knowledge should be the foundation for making decisions when establishing priorities in patient care. Professional experience was also considered important in triage to judge the priority of patient care, and intuition was pointed out as a facilitator. Nurses, therefore, must have communication skills as well as coping skills to deal with the patients‘ conflicts. Among the weaknesses, there was consensus of the disagreement that the triage environment promotes patient embracement and offers privacy. It was considered that nurse staffing per working shift is insufficient to perform triage at emergency services, in a way that the excessive demand of patients and the insufficient number of professionals can expose triage nurses to high work overload. There was also consensus regarding the disagreement of the availability of periodic training for nurses on how to use triage protocols/scales. Regarding the weaknessof the triage nurses‘ practice, it was indicated there was a lack of reevaluations of the patient‘s clinical condition during the waiting time, which could worsen the patient‘s clinical condition and harm the nurses‘ practice. In conclusion, nurses represent professional, cognitive and emotional support to triage. The findings indicate that qualification allows nurses to continue conducting triage at emergency services and will continue performing this activity in the future.
La clasificación de riesgo se desplegó en los servicios de emergencia con el fin de priorizar la atención, teniendo en cuenta la gravedad de la situación clínica y la necesidad de atención inmediata por parte de los usuarios. Sin embargo, existen dificultades en relación con el desarrollo de esta actividad por las enfermeras. El objetivo del estudio es evaluar la clasificación de riesgo los servicios de emergencia desde la perspectiva de las enfermeras. Para lograr este propósito se realizó un estudio exploratorio, la medición cuantitativa de la opinión por la técnica Delphi. Se realizaron tres rondas de aplicación de cuestionarios interactivos, que circularon entre los participantes hasta obtenerse consenso. Para conformar el panel de especialistas se utilizó la técnica de la bola de nieve. Datos recolectados mediante cuestionario ingresado en plataforma informática SurveyMonkey®, disponible online, sometidos a tratamiento estadístico. Fue estipulado como consenso un porcentaje igual o superior al 70% de respuestas. Los resultados obtenidos indicaron que la Clasificación de Riesgo es un dispositivo orientador de flujo de usuarios y de priorización de gravedad clínica, contribuyendo a disminuir el tiempo de espera de pacientes en condiciones clínicas graves y permitiendo la reducción de agravamientos y secuelas en pacientes de urgencia. Además, los participantes concordaron en que la clasificación de riesgo organiza el trabajo de los enfermeros y del servicio de urgencias. La evaluación del estado clínico mediante el desarrollo de escucha calificada de quejas de pacientes fue señalada como una de las acciones de enfermería en la clasificación de riesgo, considerándose la autonomía en el ejercicio de la actividad como una de las potencialidades. Respecto a la formación necesaria para realización de clasificación de riesgo, se indicó el conocimiento clínico como base para toma de decisiones en priorización de atención del paciente. La experiencia profesional en clasificación de riesgo fue también mencionada para determinar la prioridad de atención del paciente, la capacidad intuitiva resultó señalada como facilitadora. Para ello, los enfermeros necesitan poseer habilidades comunicacionales y de enfrentamiento a los conflictos de los pacientes. Entre las fragilidades, hubo consenso de discordancia sobre que el ámbito de clasificación de riesgo sea capaz de promover la recepción del paciente y favorecer su privacidad. Se consideró que el dimensionamiento numerario de enfermeros por turno laboral es insuficiente para la realización de clasificación de riesgo en los servicios de urgencias, dado que la demanda excesiva de pacientes y la escasez de exponen a los enfermeros de clasificación de riesgo a una carga laboral elevada. También hubo consenso de discordancia respecto a la disponibilización de capacitación periódica para los enfermeros sobre la utilización de protocolos/escalas de clasificación de riesgo. Acerca de la fragilidad de acciones de los enfermeros en la clasificación de riesgo, se indicó la falta de reevaluación de la condición clínica del paciente durante el tiempo de espera previo a la atención, lo cual puede agravar la condición clínica del mismo y perjudicar el ejercicio profesional del enfermero. Se concluye en que los enfermeros representan soporte profesional, cognitivo y emocional en la Clasificación de Riesgo. Los resultados señalan que la calificación permite que los enfermeros continúen actuando en la evaluación y clasificación del riesgo en los servicios de urgencias, y continuarán realizando dicha actividad en el futuro.
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Danielsson, Mats. "Decision making in emergency management." Licentiate thesis, Luleå, 2002. http://epubl.luth.se/1402-1757/2002/25.

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Tissington, Patrick. "Emergency decision making by fire commanders." Thesis, University of Aberdeen, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.484299.

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Books on the topic "Emergency nursing Decision making"

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Walton, Jane. Management in the acute ward. Salisbury, Wilts: Quay Books, 1996.

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Raz, Manda, and Pourya Pouryahya, eds. Decision Making in Emergency Medicine. Singapore: Springer Singapore, 2021. http://dx.doi.org/10.1007/978-981-16-0143-9.

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H, Husted James, ed. Ethical decision making in nursing. 2nd ed. St. Louis: Mosby, 1995.

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Decision making in perioperative nursing. Toronto: B.C. Decker, 1987.

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Loftis, Paula A. Decision making in gerontologic nursing. St. Louis: Mosby, 1993.

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Husted, Gladys L. Bioethical decision making in nursing. New York: Springer Publishing Company, 2015.

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Husted, Gladys L., James H. Husted, Carrie J. Scotto, and Kimberly M. Wolf, eds. Bioethical Decision Making in Nursing. New York, NY: Springer Publishing Company, 2015. http://dx.doi.org/10.1891/9780826171443.

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H, Husted James, ed. Ethical decision making in nursing. St. Louis: Mosby Year Book, 1991.

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Decision making in pediatric nursing. Philadelphia, Pa: B.C. Decker, 1988.

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Decision making in oncology nursing. Toronto: B.C. Decker, 1988.

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Book chapters on the topic "Emergency nursing Decision making"

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Cooke, Mary. "Clinical Decision Making." In Foundations of Adult Nursing, 179–204. 1 Oliver’s Yard, 55 City Road London EC1Y 1SP: SAGE Publications Ltd, 2015. http://dx.doi.org/10.4135/9781529715071.n8.

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Swallow, Veronica, Joanna Smith, and Trish Smith. "Clinical Decision Making." In Clinical Leadership in Nursing and Healthcare, 149–65. Chichester, UK: John Wiley & Sons, Ltd, 2017. http://dx.doi.org/10.1002/9781119253785.ch8.

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Niven, Neil. "Decision Making and Communication." In The Psychology of Nursing Care, 315–41. London: Macmillan Education UK, 2006. http://dx.doi.org/10.1007/978-0-230-20944-2_10.

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Lee, Xiu Qing. "Decision Fatigue Effect." In Decision Making in Emergency Medicine, 103–10. Singapore: Springer Singapore, 2021. http://dx.doi.org/10.1007/978-981-16-0143-9_17.

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Schrijnen, Laurens M. "Decision Making for Emergency Response." In Chemical Spills and Emergency Management at Sea, 363–69. Dordrecht: Springer Netherlands, 1988. http://dx.doi.org/10.1007/978-94-009-0887-1_31.

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Schrijnen, Laurens M. "Decision Making for Emergency Response." In Chemical Spills and Emergency Management at Sea, 363–69. Dordrecht: Springer Netherlands, 1988. http://dx.doi.org/10.1007/978-94-011-7790-0_31.

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Mashlan, Wendy, Julie Hayes, Sue Wakefield-Newberry, Pippa Hutchings, Louise Roberts, Shiree Bissmire, Simon Williams, Ceri Thomas, and Jane Whittingham. "Advanced Assessment and Clinical Decision Making." In Advanced Nursing Practice, 139–67. London: Macmillan Education UK, 2015. http://dx.doi.org/10.1007/978-0-230-37812-4_6.

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Armstrong, Alan E. "Virtue-Based Moral Decision-Making in Nursing Practice." In Nursing Ethics, 125–56. London: Palgrave Macmillan UK, 2007. http://dx.doi.org/10.1057/9780230206458_8.

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Gurman, G. M. "Decision-Making during Anesthesia." In Anaesthesia, Pain, Intensive Care and Emergency Medicine — A.P.I.C.E., 795–807. Milano: Springer Milan, 2002. http://dx.doi.org/10.1007/978-88-470-2099-3_68.

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Michalsen, Andrej, and Hanne Irene Jensen. "Interprofessional Shared Decision-Making." In Compelling Ethical Challenges in Critical Care and Emergency Medicine, 57–64. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-43127-3_6.

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Conference papers on the topic "Emergency nursing Decision making"

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Dilmaghani, Raheleh B., and Ramesh R. Rao. "Supervisory decision making in emergency response application." In 2013 IEEE International Conference on Pervasive Computing and Communications Workshops (PerCom Workshops 2013). IEEE, 2013. http://dx.doi.org/10.1109/percomw.2013.6529557.

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Matsuzaki, Shuichi, Subha Fernando, and Ashu Marasinghe. "Decision Making Model Supporting Emergency Medical Care." In 2009 International Conference on Biometrics and Kansei Engineering, ICBAKE. IEEE, 2009. http://dx.doi.org/10.1109/icbake.2009.25.

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Sun, Qingfeng, Fansen Kong, Ling Zhang, and Xiangwen Dang. "Study on emergency distribution route decision making." In 2011 International Conference on Mechatronic Science, Electric Engineering and Computer (MEC 2011). IEEE, 2011. http://dx.doi.org/10.1109/mec.2011.6025470.

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Qi, Chao, and Hongwei Wang. "Emergency response decision-making based on HTN planning." In 2014 26th Chinese Control And Decision Conference (CCDC). IEEE, 2014. http://dx.doi.org/10.1109/ccdc.2014.6852835.

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Liang Liu, Yongzhi Wei, Yan Shen, and Xiaoming Wang. "Scenario-based research on unconventional emergency decision-making." In 2010 IEEE International Conference on Emergency Management and Management Sciences (ICEMMS). IEEE, 2010. http://dx.doi.org/10.1109/icemms.2010.5563386.

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Tang, Hong, and Lindu Zhao. "Knowledge Management System of Intercity Emergency Decision Making." In 2009 WRI World Congress on Software Engineering. IEEE, 2009. http://dx.doi.org/10.1109/wcse.2009.232.

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Hendricks, Joyce, Vicki Cope, and Deborah Sundin. "Factors Influencing Medical Decision- Making For Seriously Ill Patients In The Acute Care Hospital." In Annual Worldwide Nursing Conference (WNC 2017). Global Science & Technology Forum (GSTF), 2017. http://dx.doi.org/10.5176/2315-4330_wnc17.130.

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Zhong, Qiuyan, and Jian Du. "Research on Multi-Agent Coordination in Emergency Decision-Making." In 2010 International Conference on E-Product E-Service and E-Entertainment (ICEEE 2010). IEEE, 2010. http://dx.doi.org/10.1109/iceee.2010.5660296.

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Chen, Jiahui, Xingtong Ge, WeiChao Li, and Ling Peng. "Construction of Spatiotemporal Knowledge Graph for Emergency Decision Making." In IGARSS 2021 - 2021 IEEE International Geoscience and Remote Sensing Symposium. IEEE, 2021. http://dx.doi.org/10.1109/igarss47720.2021.9553867.

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Zhang, Julian. "The architecture of decision-making system of emergency operations." In International conference on Management Innovation and Information Technology. Southampton, UK: WIT Press, 2014. http://dx.doi.org/10.2495/miit130621.

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Reports on the topic "Emergency nursing Decision making"

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Newman-Toker, David E., Susan M. Peterson, Shervin Badihian, Ahmed Hassoon, Najlla Nassery, Donna Parizadeh, Lisa M. Wilson, et al. Diagnostic Errors in the Emergency Department: A Systematic Review. Agency for Healthcare Research and Quality (AHRQ), December 2022. http://dx.doi.org/10.23970/ahrqepccer258.

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Objectives. Diagnostic errors are a known patient safety concern across all clinical settings, including the emergency department (ED). We conducted a systematic review to determine the most frequent diseases and clinical presentations associated with diagnostic errors (and resulting harms) in the ED, measure error and harm frequency, as well as assess causal factors. Methods. We searched PubMed®, Cumulative Index to Nursing and Allied Health Literature (CINAHL®), and Embase® from January 2000 through September 2021. We included research studies and targeted grey literature reporting diagnostic errors or misdiagnosis-related harms in EDs in the United States or other developed countries with ED care deemed comparable by a technical expert panel. We applied standard definitions for diagnostic errors, misdiagnosis-related harms (adverse events), and serious harms (permanent disability or death). Preventability was determined by original study authors or differences in harms across groups. Two reviewers independently screened search results for eligibility; serially extracted data regarding common diseases, error/harm rates, and causes/risk factors; and independently assessed risk of bias of included studies. We synthesized results for each question and extrapolated U.S. estimates. We present 95 percent confidence intervals (CIs) or plausible range (PR) bounds, as appropriate. Results. We identified 19,127 citations and included 279 studies. The top 15 clinical conditions associated with serious misdiagnosis-related harms (accounting for 68% [95% CI 66 to 71] of serious harms) were (1) stroke, (2) myocardial infarction, (3) aortic aneurysm and dissection, (4) spinal cord compression and injury, (5) venous thromboembolism, (6/7 – tie) meningitis and encephalitis, (6/7 – tie) sepsis, (8) lung cancer, (9) traumatic brain injury and traumatic intracranial hemorrhage, (10) arterial thromboembolism, (11) spinal and intracranial abscess, (12) cardiac arrhythmia, (13) pneumonia, (14) gastrointestinal perforation and rupture, and (15) intestinal obstruction. Average disease-specific error rates ranged from 1.5 percent (myocardial infarction) to 56 percent (spinal abscess), with additional variation by clinical presentation (e.g., missed stroke average 17%, but 4% for weakness and 40% for dizziness/vertigo). There was also wide, superimposed variation by hospital (e.g., missed myocardial infarction 0% to 29% across hospitals within a single study). An estimated 5.7 percent (95% CI 4.4 to 7.1) of all ED visits had at least one diagnostic error. Estimated preventable adverse event rates were as follows: any harm severity (2.0%, 95% CI 1.0 to 3.6), any serious harms (0.3%, PR 0.1 to 0.7), and deaths (0.2%, PR 0.1 to 0.4). While most disease-specific error rates derived from mainly U.S.-based studies, overall error and harm rates were derived from three prospective studies conducted outside the United States (in Canada, Spain, and Switzerland, with combined n=1,758). If overall rates are generalizable to all U.S. ED visits (130 million, 95% CI 116 to 144), this would translate to 7.4 million (PR 5.1 to 10.2) ED diagnostic errors annually; 2.6 million (PR 1.1 to 5.2) diagnostic adverse events with preventable harms; and 371,000 (PR 142,000 to 909,000) serious misdiagnosis-related harms, including more than 100,000 permanent, high-severity disabilities and 250,000 deaths. Although errors were often multifactorial, 89 percent (95% CI 88 to 90) of diagnostic error malpractice claims involved failures of clinical decision-making or judgment, regardless of the underlying disease present. Key process failures were errors in diagnostic assessment, test ordering, and test interpretation. Most often these were attributed to inadequate knowledge, skills, or reasoning, particularly in “atypical” or otherwise subtle case presentations. Limitations included use of malpractice claims and incident reports for distribution of diseases leading to serious harms, reliance on a small number of non-U.S. studies for overall (disease-agnostic) diagnostic error and harm rates, and methodologic variability across studies in measuring disease-specific rates, determining preventability, and assessing causal factors. Conclusions. Although estimated ED error rates are low (and comparable to those found in other clinical settings), the number of patients potentially impacted is large. Not all diagnostic errors or harms are preventable, but wide variability in diagnostic error rates across diseases, symptoms, and hospitals suggests improvement is possible. With 130 million U.S. ED visits, estimated rates for diagnostic error (5.7%), misdiagnosis-related harms (2.0%), and serious misdiagnosis-related harms (0.3%) could translate to more than 7 million errors, 2.5 million harms, and 350,000 patients suffering potentially preventable permanent disability or death. Over two-thirds of serious harms are attributable to just 15 diseases and linked to cognitive errors, particularly in cases with “atypical” manifestations. Scalable solutions to enhance bedside diagnostic processes are needed, and these should target the most commonly misdiagnosed clinical presentations of key diseases causing serious harms. New studies should confirm overall rates are representative of current U.S.-based ED practice and focus on identified evidence gaps (errors among common diseases with lower-severity harms, pediatric ED errors and harms, dynamic systems factors such as overcrowding, and false positives). Policy changes to consider based on this review include: (1) standardizing measurement and research results reporting to maximize comparability of measures of diagnostic error and misdiagnosis-related harms; (2) creating a National Diagnostic Performance Dashboard to track performance; and (3) using multiple policy levers (e.g., research funding, public accountability, payment reforms) to facilitate the rapid development and deployment of solutions to address this critically important patient safety concern.
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Hess, Erik, Judd Hollander, Jason Schaffer, Jeffrey Kline, Carlos Torres, Deborah Diercks, Russell Jones, et al. Shared Decision Making in the Emergency Department: The Chest Pain Choice Trial. Patient-Centered Outcomes Research Institute (PCORI), March 2018. http://dx.doi.org/10.25302/3.2018.cer.952.

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Vingre, Anete, Peter Kolarz, and Billy Bryan. On your marks, get set, fund! Rapid responses to the Covid-19 pandemic. Fteval - Austrian Platform for Research and Technology Policy Evaluation, April 2022. http://dx.doi.org/10.22163/fteval.2022.538.

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This paper presents findings from an analysis of seven multidisciplinary national research funders’ responses to COVID-19. We posit that while some parts of research and innovation funding responses to COVID-19 were ‘pandemic responses’ in the conventional biomedical sense, other parts were thematically far broader and are better termed ‘societal emergency’ funding. This type of funding activity was unprecedented for many funders. Yet, it may signal a new/additional mission for research funders, which may be required to tackle future societal emergencies, medical or otherwise. Urgency (i.e., the need to deploy funding quickly) is a key distinguishing theme in these funding activities. This paper explores the different techniques that funders used to substantially speed up their application and assessment processes to ensure research on COVID-19 could commence as quickly as possible. Funders used a range of approaches, both before application submission (call design, application lengths and formats) and after (review and decision-making processes). Our research highlights a series of trade-offs, at the heart of which are concerns around simultaneously ensuring the required speed as well as the quality of funding-decisions. We extract some recommendations for what a generic ‘societal emergency’ funding toolkit might include to optimally manage these tensions in case national research funders are called upon again to respond to future crises.
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Hubbard, Sarah M., and Bryan Hubbard. Investigation of Strategic Deployment Opportunities for Unmanned Aerial Systems (UAS) at INDOT. Purdue University, 2020. http://dx.doi.org/10.5703/1288284317126.

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Unmanned aerial systems (UAS) are increasingly used for a variety of applications related to INDOT’s mission including bridge inspection, traffic management, incident response, construction and roadway mapping. UAS have the potential to reduce costs and increase capabilities. Other state DOTs and transportation agencies have deployed UAS for an increasing number of applications due to technology advances that provide increased capabilities and lower costs, resulting from regulatory changes that simplified operations for small UAS under 55 pounds (aka, sUAS). This document provides an overview of UAS applications that may be appropriate for INDOT, as well as a description of the regulations that affect UAS operation as described in 14 CFR Part 107. The potential applications were prioritized using Quality Function Deployment (QFD), a methodology used in the aerospace industry that clearly communicates qualitative and ambiguous information with a transparent framework for decision making. The factors considered included technical feasibility, ease of adoption and stakeholder acceptance, activities underway at INDOT, and contribution to INDOT mission and goals. Dozens of interviews with INDOT personnel and stakeholders were held to get an accurate and varied perspective of potential for UAVs at INDOT. The initial prioritization was completed in early 2019 and identified three key areas: UAS for bridge inspection safety as a part of regular operations, UAS for construction with deliverables provided via construction contracts, and UAS for emergency management. Descriptions of current practices and opportunities for INDOT are provided for each of these applications. An estimate of the benefits and costs is identified, based on findings from other agencies as well as projections for INDOT. A benefit cost analysis for the application of UAS for bridge inspection safety suggests a benefit cost over one for the analysis period.
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Johnson, Corey, Colton James, Sarah Traughber, and Charles Walker. Postoperative Nausea and Vomiting Implications in Neostigmine versus Sugammadex. University of Tennessee Health Science Center, July 2021. http://dx.doi.org/10.21007/con.dnp.2021.0005.

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Purpose/Background: Postoperative nausea and vomiting (PONV) is a frequent complaint in the postoperative period, which can delay discharge, result in readmission, and increase cost for patients and facilities. Inducing paralysis is common in anesthesia, as is utilizing the drugs neostigmine and sugammadex as reversal agents for non-depolarizing neuromuscular blockers. Many studies are available that compare these two drugs to determine if neostigmine increases the risk of PONV over sugammadex. Sugammadex has a more favorable pharmacologic profile and may improve patient outcomes by reducing PONV. Methods: This review included screening a total of 39 studies and peer-reviewed articles that looked at patients undergoing general anesthesia who received non-depolarizing neuromuscular blockers requiring either neostigmine or sugammadex for reversal, along with their respective PONV rates. 8 articles were included, while 31 articles were removed based on our exclusion criteria. These were published between 2014 and 2020 exclusively. The key words used were “neostigmine”, “sugammadex”, “PONV”, along with combinations “paralytic reversal agents and PONV”. This search was performed on the scholarly database MEDLINE. The data items were PONV rates in neostigmine group, PONV rates in sugammadex group, incidence of postoperative analgesic consumption in neostigmine group, and incidence of postoperative analgesic consumption in sugammadex group. Results: Despite numerical differences being noted in the incidence of PONV with sugammadex over reversal with neostigmine, there did not appear to be any statistically significant data in the multiple peer-reviewed trials included in our review, for not one of the 8 studies concluded that there was a higher incidence of PONV in one drug or the other of an y clinical relevance. Although the side-effect profile tended to be better in the sugammadex group than neostigmine in areas other than PONV, there was not sufficient evidence to conclude that one drug was superior to the other in causing a direct reduction of PONV. Implications for Nursing Practice: There were variable but slight differences noted between both drug groups in PONV rates, but it remained that none of the studies determined it was statically significant or clinically conclusive. This review did, however, note other advantages to sugammadex over neostigmine, including its pharmacologic profile of more efficiently reversing non-depolarizing neuromuscular blocking drugs and its more favorable pharmacokinetics. This lack of statistically significant evidence found within these studies consequentially does not support pharmacologic decision-making of one drug in favor of the other for reducing PONV; therefore, PONV alone is not a sufficient rationale for a provider to justify using one reversal over another at the current time until further research proves otherwise.
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6

Questioning hierarchies: Senior leaders’ views on how global civil services changed during the pandemic. People in Government Lab, July 2022. http://dx.doi.org/10.35489/bsg-peoplegov-rp_2022/003.

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Responding to the COVID-19 pandemic required dramatic changes and new ways of working from civil services around the world. Within this, the immediate pandemic response and shift to remote work have captured most attention, but there has been less analysis of the other ways in which civil services adapted, or of how these changes have shaped the post-pandemic reform agenda. To gain insight on these questions, we interviewed 14 heads of civil service (or other similarly senior officials) from countries on all six continents to understand how they interpret the transformations that have occurred, what they are doing to institutionalise and deepen them, and what they perceive as the next frontiers for change. We find that the pandemic imposed a dual imperative on civil services: the need for greater speed, flexibility, and decentralisation of decision-making on the one hand, and for greater coordination and collaboration on the other. These two imperatives sat in tension with each other and led them to make a range of changes, many of which revolved around the common theme of questioning, unpacking, and remaking the traditionally hierarchical structures and norms of their institutions. The specific changes made varied across countries and spanned from the adoption of agile ways of working to the creation of new coordination mechanisms, the adoption of new modes and styles of leadership, and intensified training systems focusing on a broader scope of skills. Senior leaders viewed these changes mainly as an acceleration of pre-existing trends rather than as new ideas, and saw technology as an enabler but not a driver of change. Looking past the emergency response phase of the pandemic, leaders are not unanimous in their views on which of these changes are likely to be permanent. However, many perceive an urgent need to change structural aspects of people management and leadership development – from training to personnel evaluation and career management – in order to resolve the challenges and tensions that emerged in this process, and this effort dominates their thinking about institutionalising and continuing change in the medium- to long-term.
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