What kind of support and training do junior qualified nurses working with women with learning disabilities in a secure setting require when dealing with violence and aggression?

2016 ◽  
Vol 7 (3) ◽  
pp. 140-150
Author(s):  
Helen Goulding ◽  
Sharon A. Riordan
Keyword(s):  
Decision Making ◽  
Learning Disabilities ◽  
Thematic Analysis ◽  
Clinical Decision Making ◽  
Small Sample Size ◽  
Clinical Decision ◽  
Small Sample ◽  
Home Office ◽  
Peer Supervision ◽  
Content Type

Purpose The purpose of this paper is to explore the perceived needs of junior nurses working with women with learning disabilities in a secure setting who display violence and aggression; and to contribute to this specialised area of research and to identify potential areas for further post registration education. Design/methodology/approach The study adopted a qualitative design using thematic analysis. Initial questionnaires were distributed and the results analysed in order to form initial themes. These initial themes were then used to carry out a one-off focus group and this was transcribed verbatim and then analysed using Braun and Clarke thematic analysis to develop final themes. Findings The findings identified a need for staff to be able to access effective immediate support following incidents of violence and aggression and support be offered within a clear structured environment. Staff indicated that peer supervision be made available and that they also receive adequate education relating to gender specific issues and the use of seclusion. Research limitations/implications The research had several limitations. These included a small sample size which was also largely self-selected. Bias may have to be acknowledged in respect of completion of questionnaires depending on their view of participation and what they might be contributing to. Despite this the results do raise further questions such as staff decision making around the use of seclusion. Practical implications Implications centred around the organisation’s delivery of education to staff in relation to the clinical decision-making skills they require in order to effectively support women with learning disabilities who display violent and/or aggressive behaviour. The study also has implications for potential supervision structures currently offered within these services. Originality/value This paper fulfils a need to explore services for women with a learning disability further and how services can be shaped using current perspective and up to date research in line with recent policy, e.g. Corston Report (Home Office, 2007).

Decision-making under pressure: medical errors in uncertain and dynamic environments

2018 ◽  
Vol 42 (4) ◽  
pp. 395 ◽  
Author(s):  
Alicia M. Zavala ◽  
Gary E. Day ◽  
David Plummer ◽  
Anita Bamford-Wade
Keyword(s):  
Decision Making ◽  
Human Factors ◽  
Clinical Outcomes ◽  
Medical Errors ◽  
Thematic Analysis ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Dynamic Environments ◽  
Emergency Situations ◽  
Case Complexity

Objective This paper provides a narrative overview of the literature concerning clinical decision-making processes when staff come under pressure, particularly in uncertain, dynamic and emergency situations. Methods Studies between 1980 and 2015 were analysed using a six-phase thematic analysis framework to achieve an in-depth understanding of the complex origins of medical errors that occur when people and systems are under pressure and how work pressure affects clinical performance and patient outcomes. Literature searches were conducted using a Summons Search Service platform; search criteria included a variety of methodologies, resulting in the identification of 95 papers relevant to the present review. Results Six themes emerged in the present narrative review using thematic analysis: organisational systems, workload, time pressure, teamwork, individual human factors and case complexity. This analysis highlights that clinical outcomes in emergency situations are the result of a variety of interconnecting factors. These factors may affect the ability of clinical staff in emergency situations to provide quality, safe care in a timely manner. Conclusions The challenge for researchers is to build the body of knowledge concerning the safe management of patients, particularly where clinicians are working under pressure. This understanding is important for developing pathways that optimise clinical decision making in uncertain and dynamic environments. What is known about the topic? Emergency departments (EDs) are characterised by high complexity, high throughput and greater uncertainty compared with routine hospital wards or out-patient situations, and the ED is therefore prone to unpredictable workflows and non-replicable conditions when presented with unique and complex cases. What does this paper add? Clinical decision making can be affected by pressures with complex origins, including organisational systems, workload, time constraints, teamwork, human factors and case complexity. Interactions between these factors at different levels of the decision-making process can increase the complexity of problems and the resulting decisions to be made. What are the implications for practitioners? The findings of the present study provide further evidence that consideration of medical errors should be seen primarily from a ‘whole-of-system’ perspective rather than as being primarily the responsibility of individuals. Although there are strategies in place in healthcare organisations to eliminate errors, they still occur. In order to achieve a better understanding of medical errors in clinical practice in times of uncertainty, it is necessary to identify how diverse pressures can affect clinical decisions, and how these interact to influence clinical outcomes.

Combined data mining techniques based patient data outlier detection for healthcare safety

2016 ◽  
Vol 9 (1) ◽  
pp. 42-68 ◽  
Author(s):  
Gebeyehu Belay Gebremeskel ◽  
Chai Yi ◽  
Zhongshi He ◽  
Dawit Haile
Keyword(s):  
Data Mining ◽  
Decision Making ◽  
Patient Safety ◽  
Outlier Detection ◽  
Clinical Data ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Healthcare Services ◽  
Content Type ◽  
Outliers Detection

Purpose – Among the growing number of data mining (DM) techniques, outlier detection has gained importance in many applications and also attracted much attention in recent times. In the past, outlier detection researched papers appeared in a safety care that can view as searching for the needles in the haystack. However, outliers are not always erroneous. Therefore, the purpose of this paper is to investigate the role of outliers in healthcare services in general and patient safety care, in particular. Design/methodology/approach – It is a combined DM (clustering and the nearest neighbor) technique for outliers’ detection, which provides a clear understanding and meaningful insights to visualize the data behaviors for healthcare safety. The outcomes or the knowledge implicit is vitally essential to a proper clinical decision-making process. The method is important to the semantic, and the novel tactic of patients’ events and situations prove that play a significant role in the process of patient care safety and medications. Findings – The outcomes of the paper is discussing a novel and integrated methodology, which can be inferring for different biological data analysis. It is discussed as integrated DM techniques to optimize its performance in the field of health and medical science. It is an integrated method of outliers detection that can be extending for searching valuable information and knowledge implicit based on selected patient factors. Based on these facts, outliers are detected as clusters and point events, and novel ideas proposed to empower clinical services in consideration of customers’ satisfactions. It is also essential to be a baseline for further healthcare strategic development and research works. Research limitations/implications – This paper mainly focussed on outliers detections. Outlier isolation that are essential to investigate the reason how it happened and communications how to mitigate it did not touch. Therefore, the research can be extended more about the hierarchy of patient problems. Originality/value – DM is a dynamic and successful gateway for discovering useful knowledge for enhancing healthcare performances and patient safety. Clinical data based outlier detection is a basic task to achieve healthcare strategy. Therefore, in this paper, the authors focussed on combined DM techniques for a deep analysis of clinical data, which provide an optimal level of clinical decision-making processes. Proper clinical decisions can obtain in terms of attributes selections that important to know the influential factors or parameters of healthcare services. Therefore, using integrated clustering and nearest neighbors techniques give more acceptable searched such complex data outliers, which could be fundamental to further analysis of healthcare and patient safety situational analysis.

Evaluation of offending behaviour programme selection: the PNA

2019 ◽  
Vol 21 (4) ◽  
pp. 264-277
Author(s):  
Laura Ramsay ◽  
Jamie S. Walton ◽  
Gavin Frost ◽  
Chloe Rewaj ◽  
Gemma Westley ◽  
...  
Keyword(s):  
Decision Making ◽  
High Intensity ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Policy Makers ◽  
Content Type ◽  
Maximum Security ◽  
Research Findings ◽  
Probation Service ◽  
Offending Behaviour

Purpose The purpose of this paper is to outline the qualitative research findings of the effectiveness of Her Majesty’s Prison and Probation Service Programme Needs Assessment (PNA) in supporting decision making regarding selection onto high-intensity offending behaviour programmes. Design/methodology/approach Qualitative data analysis was used through the application of thematic analysis. Results were pooled using principles from meta-synthesis in order to draw conclusions as to whether the PNA was operating as designed. Findings Four overarching themes were identified, which have meaning in guiding decision making into, or out of high-intensity programmes. These were risk, need and responsivity, the importance of attitudes, motivation and formulation and planning. Research limitations/implications The majority of data were collected from category C prisons. Generalisability of findings to high-intensity programmes delivered in maximum security prisons and prisons for younger people aged 18–21 years is limited. The research team had prior knowledge of the PNA, whether through design or application. Procedures were put in place to minimise researcher biases. Practical implications Findings suggest that the PNA is effective in guiding clinical decision making. Practitioners and policy makers can be assured that the processes in place to select into high-intensity programmes are effective, and aligned with the What Works in reducing re-offending. Originality/value This is the first evaluation into the effectiveness of the PNA designed to support clinical decision making regarding participant selection onto accredited offending behaviour programmes. Implications for practice have been discussed.

Understanding critical care nurses’ autonomy in Jordan

2017 ◽  
Vol 30 (4) ◽  
pp. 432-442 ◽  
Author(s):  
Mahmoud Maharmeh
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Clinical Practice ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Critical Care Nurses ◽  
Cross Sectional Survey ◽  
Eligibility Criteria ◽  
Cross Sectional ◽  
Content Type

Purpose The aim of this study was to describe Jordanian critical care nurses’ experiences of autonomy in their clinical practice. Design/methodology/approach A descriptive correlational design was applied using a self-reported cross-sectional survey. A total of 110 registered nurses who met the eligibility criteria participated in this study. The data were collected by a structured questionnaire. Findings A majority of critical care nurses were autonomous in their decision-making and participation in decisions to take action in their clinical settings. Also, they were independent to develop their own knowledge. The study identified that their autonomy in action and acquired knowledge were influenced by a number of factors such as gender and area of practice. Practical implications Nurse’s autonomy could be increased if nurses are made aware of the current level of autonomy and explore new ways to increase empowerment. This could be offered through classroom lectures that concentrate on the concept of autonomy and its implication in practice. Nurses should demonstrate autonomous nursing care at the same time in the clinical practice. This could be done through collaboration between educators and clinical practice to help merge theory to practice. Originality/value Critical care nurses were more autonomous in action and knowledge base. This may negatively affect the quality of patient care and nurses’ job satisfaction. Therefore, improving nurses’ clinical decision-making autonomy could be done by the support of both hospital administrators and nurses themselves.

Learning disability and challenges in male prisons: programme screening evaluation

2019 ◽  
Vol 11 (1) ◽  
pp. 49-59
Author(s):  
Helen Wakeling ◽  
Laura Ramsay
Keyword(s):  
Decision Making ◽  
Learning Disability ◽  
Design Methodology ◽  
Screening Tool ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Decision Makers ◽  
Screening Tools ◽  
Content Type ◽  
Effective Use

Purpose The purpose of this paper is to validate the learning screening tool (LST) and the adapted functioning checklist-revised (AFC-R) as screening tools to aid programme allocation, and to investigate whether programme decision makers were using the tools as per the guidance provided by HMPPS Interventions Services. Design/methodology/approach LST and AFC-R data were gathered for 555 men who had been assessed for programmes between 2015 and 2018 across eight prisons and one probation area. WAIS-IV IQ data were also gathered if completed. Findings The findings provide support for the use of the LST, and AFC-R in helping to make decisions about programme allocation. The LST and AFC-R correlate well with each other, and a measure of intellectual functioning (WAIS-IV). Those who were allocated to learning disability or challenges (LDC) programmes scored higher on the LST (greater problems) and lower on the AFC-R (lower functioning) compared to those allocated to mainstream programmes. The LST had adequate predictive validity. In the majority of cases, the correct procedures were followed in terms of using the tools for programme allocation. Research limitations/implications The sample size for examining the relationships between all three tools was limited. The research was also unable to take into consideration the clinical decision making involved in how the tools were interpreted. Originality/value This research contributes to the growing evidence about the effective use of LDC screening tools in forensic settings.

Discerning product benefits through visual thematic analysis

2013 ◽  
Vol 22 (1) ◽  
pp. 30-39 ◽  
Author(s):  
Abhilash Ponnam ◽  
Jagrook Dawra
Keyword(s):  
Thematic Analysis ◽  
Data Reduction ◽  
Small Sample Size ◽  
Well Being ◽  
Small Sample ◽  
Categorical Variables ◽  
Group Method ◽  
Content Type ◽  
Focus Group Method ◽  
Practical Implications

PurposeThere is a lack of a framework that explicates how to determine the benefits that consumers desire from a product. The purpose of this article is to formulate a scientific procedure for discerning the benefits that consumers seek from a product. The authors term this procedure as visual thematic analysis (VTA). VTA procedure is illustrated through discerning the benefits of mainstream (non‐financial) English newspapers.Design/methodology/approachThe focus group method was used to collect data. These data were analyzed using visual thematic analysis which involves using multiple investigators and multi‐dimensional scaling techniques in stages.FindingsA total of 26 newspaper attributes combined to form eight distinct newspaper benefits namely ease of comprehension, journalistic values, critical insights, general news, entertainment, well‐being, classifieds and offers.Practical implicationsObtained results may be used further: to segment the newspaper market based upon benefits sought, to position newspapers within the desired segment(s) and to fashion product mix in a way that appeals to the targeted segment(s).Originality/valueThis paper proposes a new method called “visual thematic analysis” for data reduction. One such application of VTA is “discerning product benefits” which is discussed in detail. Other applications of this technique that are mentioned in the paper are in the areas of data reduction when researcher confronts small sample size, data reduction of categorical variables and scale development.

scholarly journals Impact of implementing a category 1 external quality assurance scheme for monitoring harmonization of clinical laboratories in Spain

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Carmen Ricós ◽  
Pilar Fernández-Calle ◽  
Fernando Marqués ◽  
Joana Minchinela ◽  
Ángel Salas ◽  
...  
Keyword(s):  
Decision Making ◽  
Quality Assurance ◽  
Clinical Decision Making ◽  
Clinical Laboratory ◽  
Reference Value ◽  
Clinical Decision ◽  
Thyroid Stimulating Hormone ◽  
External Quality Assurance ◽  
External Quality ◽  
Content Type

AbstractBackgroundThe objective of the present study was to examine the evolution of the analytical performance specifications (APS) used in External Quality Assurance (EQA) schemes, as well as the efficacy of a category 1 EQA scheme in monitoring the harmonization of clinical laboratory results in Spain.MethodsA review of the literature on the types of quality specifications used in schemes in other countries and their evolution was performed. In addition, a comparative analysis of the potential impact that different APS from eight countries had on clinical decision-making was made based on three measurands: sodium, thyroid-stimulating hormone (TSH), and activated partial thromboplastin time (aPTT).ResultsHarmonization of analytical methods was demonstrated by assessing whether average results deviated from the certified reference value of control materials within the APS derived from biological variation (BV). The APS used in EQA have evolved from state-of-the-art models to BV. Poor clinical decision-making would occur if the results accepted by some APS were applied.ConclusionsIn Spain, only 2 of the 18 measurands studied are considered to be well harmonized. Closer collaboration between laboratories and analytical system providers would be required to resolve discrepancies.

Commentary on “Positive Behavioural Support as an alternative to medication”

2019 ◽  
Vol 24 (1) ◽  
pp. 9-12
Author(s):  
Dave Robinson
Keyword(s):  
Learning Disabilities ◽  
Psychotropic Medication ◽  
Best Practice ◽  
Clinical Decision Making ◽  
Negative Impact ◽  
Clinical Decision ◽  
Psychotropic Medications ◽  
Content Type ◽  
Behavioural Support ◽  
Significant Negative Impact

Purpose The purpose of this paper is to provide a commentary on the article by Lee and colleagues, entitled “Positive Behavioural Support as an alternative to medication”, from the perspective of Dimensions, a national provider of social care support to people with learning disabilities and/or autism. As a supporter of the NHS England STOMP campaign, Dimensions recognises that people with learning disabilities and/or autism who have displayed “challenging behaviours” are at risk of being wrongly or over prescribed psychotropic medications intended to control that behaviour, and encourages the use of non-medical support strategies as an effective alternative to psychotropic medications. Design/methodology/approach Dimensions surveyed the approximately 1,400 people with learning disabilities and/or autism for whom they provide 24-h support. The survey was intended to assess the extent of use of psychotropic medications and the level of adherence to NICE “best practice” guidelines. The survey was the precursor to an awareness raising campaign and development of an operational toolkit intended to inform and empower people supported, families and colleagues to take a more proactive role in the prescription and review of psychotropic medications. Findings In total, 54 per cent of people surveyed were being prescribed psychotropic medication, of whom 97 per cent had been prescribed one or more medications for at least six months. Around 51 per cent were having six monthly multi-disciplinary reviews and around 31 per cent had not had a multi-disciplinary review within the preceding 12 months. Only 13 per cent of people taking psychotropic medication had a plan in place that was specifically aimed at reducing or stopping the medication. Originality/value Empowering people to participate in and challenge clinical decision making can have a transformative effect on the lives of a group of people who have experienced a significant negative impact from prolonged use of psychotropic medications.

scholarly journals Anchoring and adjustment effects on audit judgments: experimental evidence from Switzerland

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Philipp Henrizi ◽  
Dario Himmelsbach ◽  
Stefan Hunziker
Keyword(s):  
Decision Making ◽  
Cognitive Biases ◽  
Small Sample Size ◽  
Small Sample ◽  
Professional Judgment ◽  
Content Type ◽  
Professional Skepticism ◽  
Anchoring And Adjustment ◽  
Audit Judgment ◽  
The Impact

PurposeThe purpose of this study is to illustrate the potentially detrimental effects on audit decision-making of certain judgmental heuristics, which can lead to systematic judgmental biases. This paper provides background on the heuristics and biases approaches to decision-making to increase auditors' awareness of the anchoring and adjustment effects affecting audit judgments adversely.Design/methodology/approachThis study reports the results of an experimental research design analyzing the audit judgment of 85 auditors in Switzerland.FindingsBased on the results of the experiment, the results indicate evidence on the existence of the anchoring and adjustment heuristic in Swiss audit judgments. The authors could identify an influence of the audit company size, the auditors' experience and the auditors' knowledge about behaviorism and anchor heuristic with regard to the anchoring and adjustment effect on audit judgment.Research limitations/implicationsThe experimental tasks were relatively simple abstractions from the more complex analytical review situations faced by practicing auditors. Due to the small sample size, the authors cannot ensure representativeness of the results.Practical implicationsProfessional judgment is a skill that auditor acquires overtime, combined with experience and knowledge, that allows him to achieve reasonable judgments, being independent of other opinions and free from material biases in a given circumstance. Our results show that auditors who are aware of biases and heuristics are less prone to judgment biases.Originality/valueThis paper is the first to analyze the impact of auditors' explicit experience and knowledge about behaviorism and anchor heuristic on the anchoring and adjustment effect on audit judgment. Through a stronger awareness of cognitive biases, a professional skepticism can be enhanced.

scholarly journals “Flipping or flapping?” investigating engineering students’ experience in flipped classrooms

2018 ◽  
Vol 26 (4) ◽  
pp. 307-316 ◽  
Author(s):  
Esyin Chew ◽  
Lim Jen Nee Jones ◽  
Scott Wordley
Keyword(s):  
Engineering Education ◽  
Thematic Analysis ◽  
Flipped Classroom ◽  
Engineering Students ◽  
Small Sample Size ◽  
Small Sample ◽  
Theoretical Development ◽  
Content Type ◽  
Education Innovation ◽  
Flipped Classrooms

Purpose This study has explored the flipped classroom model in a private university in Malaysia. It aims to present a flipped classroom intervention for engineering education innovation. Design/methodology/approach The research (1) revisited prominent educational theories for a flipping or flapping pedagogy, (2) implemented and explored the flipped classroom experiences in one engineering subject using the action inquiry method with thematic analysis and (3) reflectively evaluated both students’ and educators’ “flipping or flapping experience”. Findings The responses of the research participants are analysed and used to develop the flipping or flapping classroom principles and an ideal flipped classroom model. From passive lectures to active learning with collaborative discourse and reflective communication, flipping the classroom can offer a seamless learning experience. Research limitations/implications The flipped classroom model can provide good reference for other educational researchers who intended to conduct a flipped classroom. However, the small sample size with qualitative method and thematic analysis useds led to considerable theoretical development, but it may not achieve the validity standards to generalise the findings. Further empirical investigation with a systematic controlled group is recommended for future work across disciplines for extrapolation. Originality/value This is a genuine case study with an identified innovative teaching need to investigate how flipped classrooms can be enabled and enhanced in engineering education innovation.

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