Comparing peripherally inserted central catheter-related practices across hospitals with different insertion models: a multisite qualitative study

2020 ◽  
pp. bmjqs-2020-011987
Author(s):  
Sarah L Krein ◽  
Molly Harrod ◽  
Lauren E Weston ◽  
Brittani R Garlick ◽  
Martha Quinn ◽  
...  
Keyword(s):  
Decision Making ◽  
Vascular Access ◽  
Qualitative Methodology ◽  
Management Practices ◽  
Patient Discharge ◽  
Healthcare Personnel ◽  
Appropriateness Criteria ◽  
Placement Decisions ◽  
Study Sites ◽  
Discharge Education

BackgroundPeripherally inserted central catheters (PICCs) provide reliable intravenous access for delivery of parenteral therapy. Yet, little is known about PICC care practices or how they vary across hospitals. We compared PICC-related processes across hospitals with different insertion delivery models.MethodsWe used a descriptive qualitative methodology and a naturalist philosophy, with site visits to conduct semistructured interviews completed between August 2018 and January 2019. Study sites included five Veterans Affairs Medical Centres, two with vascular access teams (VATs), two with PICC insertion primarily by interventional radiology (IR) and one without on-site PICC insertion capability. Interview participants were healthcare personnel (n=56), including physicians, bedside and vascular access nurses, and IR clinicians. Data collection focused on four PICC domains: use and decision-making process, insertion, in-hospital management and patient discharge education. We used rapid analysis and a summary matrix to compare practices across sites within each domain.ResultsOur findings highlight the benefits of dedicated VATs across all PICC-related process domains, including implementation of criteria to guide PICC placement decisions, timely PICC insertion, more robust management practices and well-defined patient discharge education. We also found areas with potential for improvement, such as clinician awareness of PICC appropriateness criteria and alternative devices, deployment of VATs and patient discharge education.ConclusionVascular access nurses play critical roles in all aspects of PICC-related care. There is variation in PICC decision-making, care and maintenance, and patient education across hospitals. Quality and safety improvement opportunities to reduce this variation are highlighted.

scholarly journals Age is just a number: Is frailty being ignored in vascular access planning for dialysis?

2021 ◽  
pp. 112972982198990
Author(s):  
Kulli Kuningas ◽  
Nicholas Inston
Keyword(s):  
Decision Making ◽  
Kidney Disease ◽  
Vascular Access ◽  
Clinical Condition ◽  
The Elderly ◽  
Dialysis Access ◽  
Adverse Health Outcomes ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
First Choice

Current international guidelines advocate fistula creation as first choice for vascular access in haemodialysis patients, however, there have been suggestions that in certain groups of patients, in particular the elderly, a more tailored approach is needed. The prevalence of more senior individuals receiving renal replacement therapy has increased in recent years and therefore including patient age in decision making regarding choice of vascular access for dialysis has gained more relevance. However, it seems that age is being used as a surrogate for overall clinical condition and it can be proposed that frailty may be a better basis to considering when advising and counselling patients with regard to vascular access for dialysis. Frailty is a clinical condition in which the person is in a vulnerable state with reduced functional capacity and has a higher risk of adverse health outcomes when exposed to stress inducing events. Prevalence of frailty increases with age and has been associated with an increased risk of mortality, hospitalisation, disability and falls. Chronic kidney disease is associated with premature ageing and therefore patients with kidney disease are prone to be frailer irrespective of age and the risk increases further with declining kidney function. Limited data exists on the relationship between frailty and vascular access, but it appears that frailty may have an association with poorer outcomes from vascular access. However, further research is warranted. Due to complexity in decision making in dialysis access, frailty assessment could be a key element in providing patient-centred approach in planning and maintaining vascular access for dialysis.

scholarly journals Analyzing Factors Affecting the Sustainability of Land Management Practices in Mecha Woreda, Northwestern Ethiopia

2021 ◽  
Vol 13 (13) ◽  
pp. 7007
Author(s):  
Habtamu Nebere ◽  
Degefa Tolossa ◽  
Amare Bantider
Keyword(s):  
Decision Making ◽  
Land Management ◽  
Land Degradation ◽  
Quantitative Data ◽  
Management Practices ◽  
Short Term ◽  
Factors Affecting ◽  
Decision Making Processes ◽  
Household Heads ◽  
The Impact

In Ethiopia, the practice of land management started three decades ago in order to address the problem of land degradation and to further boost agricultural production. However, the impact of land management practices in curbing land degradation problems and improving the productivity of the agricultural sector is insignificant. Various empirical works have previously identified the determinants of the adoption rate of land management practices. However, the sustainability of land management practices after adoption, and the various factors that control the sustainability of implemented land management practices, are not well addressed. This study analyzed the factors affecting the sustainability of land management practices after implementation in Mecha Woreda, northwestern Ethiopia. The study used 378 sample respondents, selected by a systematic random sampling technique. Binary logistic regression was used to analyze the quantitative data, while the qualitative data were qualitatively and concurrently analyzed with the quantitative data. The sustained supply of fodder from the implemented land management practices, as well as improved cattle breed, increases the sustainability of the implemented land management practices. While lack of agreement in the community, lack of enforcing community bylaws, open cattle grazing, lack of benefits of implemented land management practices, acting as barrier for farming practices, poor participation of household heads during planning and decision-making processes, as well as the lack of short-term benefits, reduce the sustainability of the implemented land management practices. Thus, it is better to allow for the full participation of household heads in planning and decision-making processes to bring practical and visible results in land management practices. In addition, recognizing short-term benefits to compensate the land lost in constructing land management structures must be the strategy in land management practices. Finally, reducing the number of cattle and practicing stall feeding is helpful both for the sustainability of land management practices and the productivity of cattle. In line with this, fast-growing fodder grass species have to be introduced for household heads to grow on land management structures and communal grazing fields for stall feeding.

scholarly journals Patient attitudes towards the arteriovenous fistula: a qualitative study on vascular access decision making

2011 ◽  
Vol 26 (10) ◽  
pp. 3302-3308 ◽  
Author(s):  
W. Xi ◽  
L. Harwood ◽  
M. J. Diamant ◽  
J. B. Brown ◽  
K. Gallo ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Patient Attitudes

Deciphering the rising attractiveness of Asian countries as destinations for Vietnamese students seeking international education: The effect of desire for studying abroad on Vietnamese students' career planning and decision-making processes in Taiwan

2021 ◽  
Author(s):  
Kuo Chen
Keyword(s):  
Decision Making ◽  
Study Abroad ◽  
International Education ◽  
Qualitative Methodology ◽  
Planning Process ◽  
Career Planning ◽  
Asian Countries ◽  
Studying Abroad ◽  
Planning Factor ◽  
The Impact

Nowadays, Vietnamese students choose to study abroad in Asian countries, with Taiwan being one of the most appealing locations so far. The purpose of this research is to explain the planning process used by Vietnamese students to study abroad (the host country is Taiwan), as well as to suggest an appropriate model for students' decision-making once the desire to study abroad is established, in which the impact of career path on school selection is clarified and the importance of motivation to study abroad is emphasized.This research used a mixed-methods approach. In-depth interviews with 30 Vietnamese students studying in Taiwan are conducted using a qualitative methodology. The data gathered during those interviews is utilized to build questionnaires that will be sent to over 300 samples for quantitative study.The research findings demonstrate the primary elements influencing students' desire to study abroad, career planning, and decision-making in Taiwan, as well as the model of students' decision-making process. It is obvious that students' desire to study abroad has a direct effect on their career-planning factor, while this factor acts as a mediator between the aforementioned motivation and the students' decision-making factor.

Exploring ethical aspects of elective surgery patients’ decision-making experiences

2012 ◽  
Vol 20 (6) ◽  
pp. 672-683 ◽  
Author(s):  
Mei-Ling Lin ◽  
Chuen-Teng Huang ◽  
Hsien-Hsien Chiang ◽  
Ching-Huey Chen
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Healthcare Professionals ◽  
Elective Surgery ◽  
Phenomenological Approach ◽  
Healthcare Personnel ◽  
Decision Making Process ◽  
Ethical Aspects ◽  
Southern Taiwan ◽  
Colaizzi's Method

The practice of respecting patients’ autonomy is rooted in the healthcare professionals’ empathy for patients’ situations, without which appropriate supports to the patients during the informed consent process may be remarkably moderated. The purpose of this study was to explore elective surgery patients’ experiences during their decision-making process. This research was conducted using a phenomenological approach, and the data analysis was guided by Colaizzi’s method. A total of 17 participants were recruited from a hospital in southern Taiwan. Two major themes emerged from the analyses: (a) a voluntary yet necessary alternative—to undergo a surgery and (b) alternatives compelled by the unalterable decision—the surgery. It was concluded that unless healthcare professionals can empathize with the distressed situation of their patients who are facing elective surgery, the practice of informed consent may become merely a routine. Nurses can be the best advocates for patients and facilitators to enhance communication between patients and healthcare personnel.

scholarly journals The correlation between polygamy and educational achievement of children

2021 ◽  
Vol 58 (1) ◽  
pp. 2532-2539
Author(s):  
Aeshah saif Alahmadi, Najla Mohamed Alqhtani
Keyword(s):  
Decision Making ◽  
Organizational Performance ◽  
Performance Appraisal ◽  
Work Performance ◽  
Management Practices ◽  
Educational Achievement ◽  
Recent Past ◽  
Appraisal System ◽  
Managerial Decision ◽  
Appraisal Systems

Among themost efficient employee related management practices identified in both the developed and the developing nations is performance appraisal system, which is alsorecognized as a strong motivator for employees. It also enables smooth functioning of managerial decision making, administrative decision making and the employee development. The present study reviews prominent and key studies conducted in recent past systematically in order to assess how organizational performance appraisal systems and competency management frameworks affect employees’ work performance in the telecomsector.

scholarly journals Digital Education, Work and Artificial Intelligence: Health and Law

2020 ◽  
pp. 277-288
Author(s):  
Abílio Azevedo ◽  
Patricia Anjos Azevedo
Keyword(s):  
Artificial Intelligence ◽  
Decision Making ◽  
Qualitative Methodology ◽  
Learning Methods ◽  
Digital Education ◽  
Ethical Concerns ◽  
Application Potential ◽  
New Challenges ◽  
Formal Application ◽  
Daily Application

The use and possibilities of artificial intelligence (AI) have been assuming great importance in recent years. This fact led to a greater attention on the topic in various fields, especially in health and law, both in its daily application potential and in learning methods. The aim of this article was to present a brief perspective of the challenges and effects of the AI use in teaching and application on health and law domains. Therefore, to better define the theme it was performed a qualitative methodology of bibliographic review. The applications of artificial intelligence have a great potential in clinical and legal use, facilitating the tasks of those involved by helping to reduce workflow, to avoid errors and in decision-making. However, despite these benefits and new opportunities, there are still obstacles regarding regulation and ethical concerns, as well as some reluctance from professionals in their adoption and formal application. In addition, there also the need to proper implement these technologies in learning to keep up the change and the new challenges currently posed, so there is a path that still needs to be followed.

scholarly journals Customer experience management: asking the right questions

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ian R. Hodgkinson ◽  
Thomas W. Jackson ◽  
Andrew A. West
Keyword(s):  
Decision Making ◽  
Business Models ◽  
Management Practices ◽  
Management Practice ◽  
Customer Experience ◽  
Content Type ◽  
Customer Data ◽  
Customer Experience Management ◽  
New Perspective ◽  
The Right

Purpose Customer experience is more critical than ever to firms’ successes and future growth opportunities. Typically measured through aggregate satisfaction scores, businesses have been criticized for oversimplifying what experience means. The purpose of this study is to provide a new perspective on experience management and offers a novel way forward for customer-centric strategizing. Design/methodology/approach Mapping the current digital technologies being used across businesses in all sectors to engage and connect with customers more effectively, this paper outlines some of the fundamental challenges of experience management and future opportunities to enhance business practice. Findings Businesses are capturing what they know about customers, rather than what a customer thinks and feels about the firm. Many experience management initiatives create customer pains (not gains), while for businesses, decision-making can be jeopardized by fake customer data. A framework based upon the five experience dimensions is presented for optimal customer-driven decision-making. Practical implications Going beyond aggregate satisfaction scores that serve as an output rather than an input into businesses strategizing, the paper presents an actionable framework for targeted investments and enhanced experience management practices. Originality/value Businesses are seeking to grow intelligent customer experience analysis capabilities to disrupt traditional business models toward greater customer-centricity and to track the digital spread of positive and negative experiences. Examining how this is being done and where the weaknesses lie by bridging management practice and the scientific literature, this paper provides new knowledge to advance customer-centric strategies for growth and profitability.

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