Nudging in nursing

2018 ◽  
Vol 26 (6) ◽  
pp. 1601-1610
Author(s):  
Anne Helene Mortensen ◽  
Marita Nordhaug ◽  
Vibeke Lohne
Keyword(s):  
Decision Making ◽  
Medical Ethics ◽  
Free Will ◽  
Political Theory ◽  
Patient Autonomy ◽  
Current Knowledge ◽  
Decision Making Process ◽  
Patient Relationship ◽  
Behavioural Science ◽  
Ongoing Debate

Nudging is a concept in behavioural science, political theory and economics that proposes indirect suggestions to try to achieve non-forced compliance and to influence the decision making and behaviour of groups and individuals. Researchers in medical ethics are currently discussing whether nudging is ethically permissible in healthcare. In this article, we examine current knowledge about how different decisions (rational and pre-rational decisions, major and minor decisions) are made and how this decision-making process pertains to patients. We view this knowledge in light of the nursing project and the ongoing debate regarding the ethical legitimacy of nudging in healthcare. We argue that it is insufficient to discuss nudging in nursing and healthcare in light of free will and patient autonomy alone. Sometimes, nurses must take charge and exhibit leadership in the nurse–patient relationship. From the perspective of nursing as leadership, nudging becomes a useful tool for directing and guiding patients towards the shared goals of health, recovery and independence and away from suffering. The use of nudging in nursing to influence patients’ decisions and actions must be in alignment with the nursing project and in accordance with patients’ own values and goals.

scholarly journals Pet owners’ and veterinarians’ perceptions of information exchange and clinical decision-making in companion animal practice

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0245632
Author(s):  
Natasha Janke ◽  
Jason B. Coe ◽  
Theresa M. Bernardo ◽  
Cate E. Dewey ◽  
Elizabeth A. Stone
Keyword(s):  
Decision Making ◽  
Focus Groups ◽  
Information Exchange ◽  
Clinical Decision Making ◽  
Current Knowledge ◽  
Exchange Process ◽  
Clinical Decision ◽  
Decision Making Process ◽  
Pet Owners ◽  
Pet Owner

One of the most complex aspects of the veterinarian-client-patient interaction is the clinical decision-making process. Research suggests that the approach to communication used by veterinarians can impact veterinary clients’ involvement in the decision-making process and their ultimate satisfaction. Using different approaches to the decision-making process may affect how information is exchanged and consequently how decisions are made. The objective of this study was to determine pet owners’ expectations with respect to information exchange and decision-making during veterinarian-client-patient interactions and to compare veterinarians’ perceptions of those expectations and the challenges they face in meeting them. Five pet owner focus groups (27 owners) and three veterinarian focus groups (24 veterinarians) were conducted with standardized open-ended questions and follow-up probes. Thematic analysis of the transcribed data was conducted to identify trends and patterns that emerged during the focus groups. Three pet owner-based themes were identified: 1) understanding the client; 2) providing information suitable for the client; and 3) decision-making. In addition, three barriers for veterinarians affecting information exchange and decision-making were identified: 1) time constraints; 2) involvement of multiple clients; and 3) language barriers. Results suggest that pet owners expect to be supported by their veterinarian to make informed decisions by understanding the client’s current knowledge, tailoring information and educating clients about their options. Breakdowns in the information exchange process can impact pet owners’ perceptions of veterinarians’ motivations. Pet owners’ emphasis on partnership suggests that a collaborative approach between veterinarians and clients may improve client satisfaction.

Respiratory Failure in the Patient with AIDS: Is Critical Care Warranted?

1990 ◽  
Vol 1 (1) ◽  
pp. 215-224
Author(s):  
Nancy L. Szaflarski
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Respiratory Failure ◽  
Patient Autonomy ◽  
Medical Futility ◽  
Decision Making Process ◽  
Aids Epidemic ◽  
Futile Care ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome

The issue of whether or not the life-sustaining treatments (LST) of critical care is warranted for patients with the acquired immunodeficiency syndrome (AIDS) experiencing acute respiratory failure has been raised. Factors that have contributed to this issue include the AIDS epidemic, the high costs of critical care, limited intensive care resources, high mortality, prolonged suffering, and the effects on caregivers in delivering futile care. This article examines this issue from the ethicality of the decision-making process regarding LST in context with medical futility, patient autonomy, and discussion among patients and caregivers. The allocation of critical care resources for AIDS patients with respiratory failure is analyzed from the viewpoint of distributive justice. The nursing implications of providing critical care to these patients and their families are discussed as well as needed areas of research.

Decision of palliative chemotherapy in late-stage cancer: The doctor-patient relationship and the decision-making process as seen by an oncologist.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 48-48
Author(s):  
Florian Scotte ◽  
Marie Pechard ◽  
Ivan Krakowski ◽  
Christophe Tournigand ◽  
marcel-Louis Viallard
Keyword(s):  
Decision Making ◽  
Late Stage ◽  
Palliative Chemotherapy ◽  
Specific Treatment ◽  
Decision Making Process ◽  
Patient Relationship ◽  
University Hospitals ◽  
Doctor Patient Relationship ◽  
Medical Progress ◽  
Late Stage Cancer

48 Background: We conducted a literature review on the administration of palliative chemotherapy in cancer patients at advanced stage. We wondered about ethical tensions encountered by the oncologists during the decision process to meet or not the patients' demand to have access to a palliative chemotherapy at a late stage of the disease. Methods: We conducted a multicenter, qualitative study of senior oncologists in university hospitals and cancer centers in France, by carrying out interviews with eleven oncologists. Results: The study are consistent with the literature showing that factors are in favor of treatment continuation: the patient's age, his desire to continue treatment and his life expectancy. The decision making process of chemotherapy discontinuation is marked by uncertainties, personal representations of the doctor and subjectivity in front of the objective facts that could make this decision difficult. The working conditions in cancer care and the valuation of the chemotherapy prescription can impact the decision. The constant medical progress in oncology make more complex the decision of stopping specific treatments. This study showed the singularity of the doctor-patient relationship in oncology. This can explain the difficulty to stop chemotherapy. Conclusions: The oncologist can use the collegiality which are necessary for decision to limit specific treatment. The objective is to propose the adequate care to the patient in all its dimensions. Some actions can be proposed to improve our practice: early use of palliative care for patients, analysis of practices and training to deal with uncertainty and the limits of possibilities in clinical practice.

scholarly journals A Turing test for free will

2012 ◽  
Vol 370 (1971) ◽  
pp. 3597-3610 ◽  
Author(s):  
Seth Lloyd
Keyword(s):  
Decision Making ◽  
Quantum Mechanics ◽  
Free Will ◽  
Decision Maker ◽  
Turing Test ◽  
Decision Making Process ◽  
Theory Of Computation ◽  
Alan Turing ◽  
The World ◽  
Decision Making Processes

Before Alan Turing made his crucial contributions to the theory of computation, he studied the question of whether quantum mechanics could throw light on the nature of free will. This paper investigates the roles of quantum mechanics and computation in free will. Although quantum mechanics implies that events are intrinsically unpredictable, the ‘pure stochasticity’ of quantum mechanics adds randomness only to decision-making processes, not freedom. By contrast, the theory of computation implies that, even when our decisions arise from a completely deterministic decision-making process, the outcomes of that process can be intrinsically unpredictable, even to—especially to—ourselves. I argue that this intrinsic computational unpredictability of the decision-making process is what gives rise to our impression that we possess free will. Finally, I propose a ‘Turing test’ for free will: a decision-maker who passes this test will tend to believe that he, she, or it possesses free will, whether the world is deterministic or not.

scholarly journals Forcing techniques & Neuroscience

2021 ◽  
Author(s):  
David Bestue
Keyword(s):  
Decision Making ◽  
Free Will ◽  
Cognitive Processes ◽  
General Concept ◽  
Extreme Value ◽  
Final Outcome ◽  
Decision Making Process ◽  
Transfer Of Knowledge ◽  
Complex Mechanisms

Although we might think our decisions determine the final outcome of certain situations, magicians show us this is not always the case. Over the centuries, magicians have developed numerous forcing techniques to determine the final outcome of certain decisions that are perceived as “free choices'' by the spectators. It has been hypothesized that forcing techniques could be of extreme value to explore both decision making process and free will. Unfortunately, the knowledge of forcing techniques is restricted to magicians, who usually study them from a practical perspective instead of a psychological one. As this hinders the transfer of knowledge between the fields, in this work, I present an accurate explanation of the general concept of “forcing technique” together with a discussion of their possible applications to neuroscience. Moreover, I present a framework of cognitive processes exploited by forcing techniques to illustrate they are complex mechanisms that different branches of neuroscience can study. This work provides a background for the application of this ecological tool in the neuroscience of decision making and the sense of free will.

scholarly journals Autonomy-based criticisms of the patient preference predictor

2021 ◽  
pp. medethics-2021-107629
Author(s):  
EJ Jardas ◽  
David Wasserman ◽  
David Wendler
Keyword(s):  
Decision Making ◽  
Patient Preference ◽  
Patient Autonomy ◽  
Treatment Decisions ◽  
Treatment Preferences ◽  
Decision Making Process ◽  
Number Of Factors ◽  
Computer Based ◽  
Incapacitated Patients ◽  
Substituted Judgement

The patient preference predictor (PPP) is a proposed computer-based algorithm that would predict the treatment preferences of decisionally incapacitated patients. Incorporation of a PPP into the decision-making process has the potential to improve implementation of the substituted judgement standard by providing more accurate predictions of patients’ treatment preferences than reliance on surrogates alone. Yet, critics argue that methods for making treatment decisions for incapacitated patients should be judged on a number of factors beyond simply providing them with the treatments they would have chosen for themselves. These factors include the extent to which the decision-making process recognises patients’ freedom to choose and relies on evidence the patient themselves would take into account when making treatment decisions. These critics conclude that use of a PPP should be rejected on the grounds that it is inconsistent with these factors, especially as they relate to proper respect for patient autonomy. In this paper, we review and evaluate these criticisms. We argue that they do not provide reason to reject use of a PPP, thus supporting efforts to develop a full-scale PPP and to evaluate it in practice.

Patient Satisfaction With Treatment of Breast Cancer: Does Surgeon Specialization Matter?

2007 ◽  
Vol 25 (24) ◽  
pp. 3694-3698 ◽  
Author(s):  
Jennifer F. Waljee ◽  
Sarah Hawley ◽  
Amy K. Alderman ◽  
Monica Morrow ◽  
Steven J. Katz
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Patient Satisfaction ◽  
Cancer Patients ◽  
High Volume ◽  
Breast Disease ◽  
Decision Making Process ◽  
Patient Relationship ◽  
Breast Cancer Patients ◽  
Low Volume

Purpose Experience and practice setting vary greatly among surgeons who treat breast cancer patients. However, less is known about how these factors influence patient satisfaction with their care. Patients and Methods We surveyed all ductal carcinoma in situ patients and a 20% random sample of invasive breast cancer patients diagnosed in 2002 reported to the Detroit, MI, and Los Angeles, CA, Surveillance, Epidemiology, and End Results registries. Attending surgeons were surveyed, yielding dyad information for 64.6% of patients (n = 1,539) and 69.7% of surgeons (n = 318). Logistic regression was used to examine the associations between surgeon specialization (percentage of practice devoted to breast disease) and hospital cancer program status, with four domains of patient satisfaction: (1) the surgical decision, (2) decision-making process, (3) surgeon-patient relationship, and (4) surgeon-patient communication, adjusting for patient and surgeon demographics and disease stage. Results In this sample, 34.5% of patients were treated by surgeons who devoted less than 30% (low volume) of their practice to breast disease, 32.5% by surgeons who devoted 30% to 60% (medium volume) of their practice to breast disease, and 33.0% by surgeons who devoted more than 60% (high volume) of their practice to breast disease. Compared to patients treated by low-volume surgeons, patients treated by higher volume surgeons were more satisfied with the decision-making process (medium volume, odds ratio [OR], 1.16; 95% CI, 0.80 to 1.67; high volume: OR, 1.79; 95% CI, 1.14 to 2.80) and with the surgeon-patient relationship (medium volume: OR, 1.13; 95% CI, 0.72 to 1.76; high volume: OR, 1.98; 95% CI, 1.08 to 3.61). Treatment setting was not associated with patient satisfaction after controlling for other factors. Conclusion Surgeon specialization is correlated with patient satisfaction. Examining the processes underlying these associations can inform strategies to improve breast cancer care.

Involving Minors in Medical Decision Making: Understanding Ethical Issues in Assent and Refusal of Care by Minors

2018 ◽  
Vol 38 (05) ◽  
pp. 533-538 ◽  
Author(s):  
Abigail Lang ◽  
Erin Paquette
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Pediatric Patients ◽  
Ethical Issues ◽  
Medical Decision ◽  
Decision Making Process ◽  
Patient Relationship

AbstractWhen caring for minors, the clinician–patient relationship becomes more ethically complex by the inclusion of parents in the clinician–parent–patient triad. As they age, children become more capable of participating in the decision-making process. This involvement may lead them to either accept or refuse proposed care, both of which are ethically acceptable positions when the minor's capacity to participate in decision making is carefully considered in the context of their age, development, and overall health. Certain conditions may be more likely to impact their capacity for participation, but it is important for clinicians to avoid categorical presumption that minors of a certain age or with certain conditions are incapable of participating in decisions regarding their care. Understanding the ethical bases for decision making in pediatric patients and considerations for the involvement of minors who both assent to and refuse proposed treatment will equip clinicians to respect the growing autonomy of minor patients.

scholarly journals Practice and Attitudes of Physicians Regarding Disclosure of Information to Patients With Serious Illness

2019 ◽  
Vol 11 (5) ◽  
pp. 33
Author(s):  
Ghufran Jassim ◽  
Alaa Alakri ◽  
Rawaa Alsayegh ◽  
David Misselbrook
Keyword(s):  
Decision Making ◽  
Information Disclosure ◽  
Patient Autonomy ◽  
Middle Eastern ◽  
Cross Sectional Study ◽  
Decision Making Process ◽  
Cross Sectional ◽  
Serious Illness ◽  
Truth Disclosure ◽  
Disclosure Of Information

BACKGROUND: Health Information disclosure is the cornerstone in respecting the patients’ autonomy and beneficence, particularly in the context of serious illness. Some Middle Eastern cultures prioritise beneficence over patient autonomy. This may be used as a justification when patient’s family takes over the decision-making process. Although guidelines and protocols regarding information disclosure are fast evolving, there are no sufficient data regarding the application of these guidelines in the clinical context. The objective of this study is to explore the truth disclosure practices of physicians in Bahrain. METHOD: In this cross sectional study, a random sample of 234 physicians was obtained from the database of Salmaniya Medical Complex (the largest public hospital in Bahrain). We used self-administered 21-item questionnaire to assess the practices and attitudes of physicians regarding disclosure of information to patients with serious illnesses. RESULTS: A total of 200 physicians completed the questionnaire with a response rate of 69.6%. The question about the usual policy of disclosure revealed that 62.5% (125) of the doctors would always disclose the diagnosis to the patients, 26% (52) would often disclose the diagnosis and only 1% would never disclose the real diagnosis to a competent adult. Only 15% of the physicians would never make exceptions to their policy of “telling the patient” while all remaining physicians (85%) made exceptions to their policy either often, occasionally or rarely. The most common reason for not disclosing the diagnosis was family request (39.5%). About 64.5% of the physicians were not aware of any existing protocol or policy for diagnosis disclosure to patients. There was no statistically significant association between doctors’ policy of disclosure and other demographic variables. CONCLUSION: Most physicians opt to disclose the truth; however, the majority would make exceptions at some point particularly upon family request. Regional truth disclosure policies should take into consideration the interplay and balance between patient autonomy and the role played by the family in the decision-making process.

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