Factors Associated With Mode of Transport Decision Making for Pediatric-Neonatal Interfacility Transport

2015 ◽  
Vol 34 (1) ◽  
pp. 44-51 ◽  
Author(s):  
Janis M. Quinn ◽  
Mary Clyde Pierce ◽  
Mark Adler
Author(s):  
Iris E. Beldhuis ◽  
Ramesh S. Marapin ◽  
You Yuan Jiang ◽  
Nádia F. Simões de Souza ◽  
Artemis Georgiou ◽  
...  

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e047247
Author(s):  
Emily J Tomlinson ◽  
Helen Rawson ◽  
Elizabeth Manias ◽  
Nicole (Nikki) M Phillips ◽  
Peteris Darzins ◽  
...  

ObjectivesTo explore factors associated with decision-making of nurses and doctors in prescribing and administering as required antipsychotic medications to older people with delirium.DesignQualitative descriptive.SettingTwo acute care hospital organisations in Melbourne, Australia.ParticipantsNurses and doctors were invited to participate. Semi-structured focus groups and individual interviews were conducted between May 2019 and March 2020. Interviews were audio-recorded and transcribed verbatim. Data were analysed using thematic analysis.ResultsParticipants were 42 health professionals; n=25 nurses and n=17 doctors. Themes relating to decisions to use antipsychotic medication were: safety; a last resort; nursing workload; a dilemma to medicate; and anticipating worsening behaviours. Nurses and doctors described experiencing pressures when trying to manage hyperactive behaviours. Safety was a major concern leading to the decision to use antipsychotics. Antipsychotics were often used as chemical restraints to ‘sedate’ a patient with delirium because nurses ‘can’t do their job’. Results also indicated that nurses had influence over doctors’ decisions despite nurses being unaware of this influence. Health professionals’ descriptions are illustrated in a decision-making flowchart that identifies how nurses and doctors navigated decisions regarding prescription and administration of antipsychotic medications.ConclusionsThe decision to prescribe and administer antipsychotic medications for people with delirium is complex as nurses and doctors must navigate multiple factors before making the decision. Collaborative support and multidisciplinary teamwork are required by both nurses and doctors to optimally care for people with delirium. Decision-making support for nurses and doctors may also help to navigate the multiple factors that influence the decision to prescribe antipsychotics.


2021 ◽  
Vol 6 (1) ◽  
pp. 238146832098477
Author(s):  
Ya-Chen Tina Shih ◽  
Ying Xu ◽  
Lisa M. Lowenstein ◽  
Robert J. Volk

Introduction. The Centers for Medicare & Medicaid Services requires a written order of shared decision making (SDM) visit in its coverage policy for low-dose computed tomography (LDCT) for lung cancer screening (LCS). With screening eligibility starting at age 55, private insurance plans will likely adopt this coverage policy. This study examined the implementation of SDM in the context of LCS among the privately insured. Methods. We constructed two study cohorts from MarketScan Commercial Claims and Encounters database 2016-2017: a LDCT cohort who received LDCT for LCS and an SDM cohort who had an LCS-related SDM visit. For the LDCT cohort, we examined the trend and factors associated with the receipt of SDM within 3 months prior to LDCT. For the SDM cohort, we studied the trend and factors associated with LDCT within 3 months after an SDM visit. Results. For privately insured adults aged <64, 93% (19,681/21,084) of the LDCT cohort did not have a billing claim indicating SDM, although the uptake of SDM increased from 3.1% in 1Q2016 to 8.2% in 4Q2017 ( P < 0.0001). For the SDM cohort, 46% (948/2048) did not have a claim for an LDCT for lung cancer screening in the 3 months after the SDM visit; this percentage increased from 29.5% in 1Q2016 to 61.8% in 3Q2017 ( P < 0.0001). Limitations. Findings cannot be generalized to other nonelderly adults without private insurance. Additionally, the rate of SDM identified from claims may be underreported. Conclusions. We found a growing but low uptake of SDM among privately insured individuals who underwent LDCT. The higher rate of LDCT in the SDM cohort than the rate reported in national studies emphasized the importance of patient awareness.


2014 ◽  
Vol 34 (1) ◽  
pp. 16-28 ◽  
Author(s):  
Scott Swickard ◽  
Wendy Swickard ◽  
Andrew Reimer ◽  
Deborah Lindell ◽  
Chris Winkelman

Today’s health care delivery system relies heavily on interhospital transfer of patients who require higher levels of care. Although numerous tools and algorithms have been used for the prehospital determination of mode of transport, no tool for the transfer of patients between hospitals has been widely accepted. Typically, the interfacility transport decision is left to the discretion of the referring provider, who may or may not be aware of the level of care provided or the means of transport available. A need exists to determine the appropriate level of care required to meet the needs of patients during transport. The American Association of Critical-Care Nurses (AACN) Synergy Model for Patient Care is a patient-centered model that focuses on optimizing patient care by matching the characteristics of the patient with the competencies of the nurse. This model shows significant promise in providing the theoretical backing to guide the decision on the level of care necessary to complete interfacility transfers safely and effectively. This article describes a new tool inspired by the AACN Synergy Model for Patient Care to determine the appropriate level of care required for interfacility transport.


2020 ◽  
Vol 11 (1) ◽  
pp. 34-49 ◽  
Author(s):  
S. V. Gerasimov

Since the British philosopher John Austin, narratives and performatives have been con­sidered as opposite concepts covered by the generic concept of speech act. At the same time, these concepts were separated according to whether a narrative, inducement, a description, or an imperative was present in the text. Similar to the narrative, the performative is created under pressure from various external factors associated with the system of public communica­tions, to which the author is exposed, and a multitude of reasons that reflect in his or her mind external processes. All these factors and influences transmute in the course of text crea­tion; the viewer/reader consumes ready-made information, which invariably bears an imprint of the author's habitus. When creating a text, the author conveys his or her desires and ex­presses his or her attitude to the chosen problem. This study aims to answers two questions. Can a narrative have at its core an explicit manipulative basis or a hidden motive? Can the picture of the world, which develops, inter alia, under the influence of narratives, serve as a pattern for decision-making by the viewer/reader? It is necessary to this end to identify the relationship between the performative and the narrative (there are several types of these rela­tionships). To answer the above question, the genesis of narratives is considered, possible nar­rative–performative combinations analysed, and the effects of performatives on the formation of the intentional component of the narrative established. The findings suggest that each nar­rative contains at least one performative and that the narrative is based on the performative and contains a manipulative component.


2018 ◽  
Vol 29 (9) ◽  
pp. 908-916 ◽  
Author(s):  
Deborah L Jones ◽  
Violeta J Rodriguez ◽  
Suat Babayigit ◽  
Antonio Chahine ◽  
Stephen M Weiss ◽  
...  

Despite pregnancy spacing recommendations to optimize health outcomes among mothers and neonates, unplanned pregnancy in sub-Saharan Africa is common among women living with human immunodeficiency virus (HIV) (WLHIV). This study examined factors associated with reproductive decision-making among WLHIV to inform pregnancy-planning interventions. WLHIV in rural South Africa (n = 165) were assessed at 12 months postpartum. The relative importance of factors associated with reproductive decision-making was estimated. Women were a mean of 28 years old (SD = 5.71). Risk of mother-to-child transmission (MTCT) of HIV (Mean = 0.43; SD = 0.33) had the greatest impact on decision-making, followed by partners’ desires (M = 0.22; SD = 0.18), family preferences (M = 0.18; SD = 0.13), and community opinion (M = 0.17; SD = 0.13). MTCT was most important to women with greater HIV knowledge. However, WLHIV who had been diagnosed with HIV for a longer time placed more emphasis on partner preference and community opinion, and less importance on MTCT risk. Prevention of mother-to-child transmission (PMTCT) was less important to women experiencing intimate partner violence and those with depression. Findings highlight the need for tailored, focused interventions to support the unique circumstances of WLHIV and support the inclusion of families and/or partners in the counseling process. Results underscore the need for perinatal preconception counseling for women during routine HIV care.


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