scholarly journals Decision-making in crisis resolution and home treatment teams: The AWARE framework

2018 ◽  
Vol 43 (2) ◽  
pp. 61-66 ◽  
Author(s):  
Chiara Lombardo ◽  
Mónica Santos ◽  
Tine Van Bortel ◽  
Robert Croos ◽  
Ella Arensman ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Improve Patient Safety ◽  
Clinical Decision ◽  
Home Treatment ◽  
Theory Approach ◽  
Structured Interviews ◽  
Crisis Resolution ◽  
Primary Driver ◽  
Grounded Theory Approach

Aims and methodThe aim of the study is to improve patient safety by identifying factors influencing gatekeeping decisions by crisis resolution and home treatment teams. A theoretical sampling method was used to recruit clinicians. Semi-structured interviews to elicit various aspects of clinical decision-making were carried out. The transcripts were thematically analysed using a grounded theory approach.ResultsPatient needs (safety and treatment) was the primary driver behind decisions. The research also revealed that information gathered was processed using heuristics. We identified five key themes (anxiety, weighting, agenda, resource and experience), which were constructed into an acronym ‘AWARE’.Clinical implicationsAWARE provides a framework to make explicit drivers for decision-making that are often implicit. Incorporating these drivers into reflective practice will help staff be more mindful of undue influences and result in improved clinical decisions.Declaration of interestNone.

scholarly journals Shared clinical decision-making experiences in nursing: A qualitative study

2021 ◽  
Author(s):  
Fen-Fang Chung ◽  
Shu-Chuan Lin ◽  
Yu-Hsia Lee ◽  
Pao-Yu Wang ◽  
Hon-Yen Wu ◽  
...  
Keyword(s):  
Decision Making ◽  
Nursing Education ◽  
Nursing Staff ◽  
Cultural Sensitivity ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Information Communication ◽  
Structured Interviews ◽  
Clinical Nursing ◽  
Basic Ability

Abstract Background Shared decision making (SDM) is a patient-centred nursing concept that emphasises the autonomy of the patient. It is a co-operative process of exchanging information, communication and response, and treatment decisions made between medical staff and patients. In this study, we explored the experience of clinical nursing staff participating in SDM. Methods We adopted a qualitative research method. Semi-structured interviews were conducted with 21 nurses at a medical centre in northern Taiwan. The data obtained from interview recordings were transferred to verbatim manuscripts. Content analysis was used to analyse and summarise the data. Results Clinical nursing staff should have basic professional skills, communication and response skills, respect and cultural sensitivity, the ability to form a co-operative team, the ability to search for and integrate empirical data, and the basic ability to edit media to participate in SDM. Conclusions The results of this study describe the experiences of clinical nursing staff participating in SDM, which can be used as a reference for nursing education and nursing administrative supervisors to plan and enhance professional nursing SDM in nursing education.

scholarly journals 35. Acceptability of Proposed Stewardship Interventions to Reduce Preoperative Screening and Treatment of Asymptomatic Bacteriuria

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S140-S140
Author(s):  
Kimberly Dukes ◽  
Julia Walhof ◽  
Madisen Brown ◽  
Kalpana Gupta ◽  
Judith Strymish ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Asymptomatic Bacteriuria ◽  
Clinical Decision ◽  
Audit And Feedback ◽  
Structured Interviews ◽  
Research Support ◽  
Independent Contractor ◽  
Urine Screening ◽  
Urine Testing

Abstract Background In 2019, the IDSA Clinical Practice guidelines on asymptomatic bacteriuria (ASB) recommended that clinicians no longer screen or treat patients for ASB before non-urological surgeries. However, it remains to be seen whether these guideline recommendations alone will produce changes in practice. Understanding clinical decision-making about preoperative urine screening and treatment can help design effective interventions to facilitate guideline concordance and support antibiotic stewardship. Our project objective was to qualitatively assess barriers and facilitators to reducing preoperative urine testing and treatment. Methods We conducted semi-structured interviews with 24 participants (surgeons, advance practice providers, pharmacists, infectious disease physicians, epidemiologists) at 4 Veterans Administration hospitals. We solicited feedback on 4 proposed interventions (substitution, lab restrictions, audit and feedback, interactive workshop), and invited suggestions on other interventions. Three researchers separately coded 20% of interview notes to sort responses to each intervention into acceptable, possibly acceptable, and not acceptable. The team then compared coding, resolved differences by consensus, and refined the code dictionary to ensure intercoder agreement; then each member coded one third of remaining notes. Results Participants expressed concerns about de-implementing routine urine testing and treatment for specific procedures and specialties (e.g., cardiothoracic). Some actively sought to identify and treat ASB. Participants found audit and feedback and substitution of different infection-control practices most acceptable. Participants suggested changes to make interventions more acceptable or feasible (e.g., tailoring to procedure, educational tailoring). Participants also identified new potential interventions (e.g. order set changes, collaborative decision making, education on potential harms, identification of testing costs). Table 1. Acceptability of Proposed Interventions by Percentage of Participants. Percentages Do Not Add up to 100% Because Some Interviewees Did Not Answer Every Question. Conclusion Interventions to optimize urine screening and treatment for patients undergoing surgeries may require tailoring for surgical specialties, and should address clinical concerns about intervention feasibility. Disclosures Kalpana Gupta, MD, MPH, Abbott (Shareholder)DBC Pri-Med (Consultant)Glaxo Smith Kline (Consultant)Moderna (Shareholder)Nabriva Therapeutics (Consultant)Pfizer (Other Financial or Material Support, Grant to the institution)Qiagen (Consultant)Rebiotix (Consultant)Spero Therapeutics (Consultant)Utility Therapeutics (Consultant) Daniel Suh, MS MPH, General Electric (Shareholder)Merck (Shareholder)Moderna (Shareholder)Smile Direct Club (Shareholder) Bruce Alexander, PharmD, Bruce Alexander Consulting (Independent Contractor) Marin Schweizer, PhD, 3M (Grant/Research Support)PDI (Grant/Research Support)

scholarly journals Perceptions and experiences of wrist surgeons on the management of triangular fibrocartilage complex tears: a qualitative study

2019 ◽  
Vol 44 (6) ◽  
pp. 572-581
Author(s):  
Vanessa I. Robba ◽  
Alexia Karantana ◽  
Andrew P. G. Fowler ◽  
Claire Diver
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Triangular Fibrocartilage Complex ◽  
Classification Systems ◽  
Structured Interviews ◽  
Level Of Evidence ◽  
Related Factors ◽  
Data Saturation ◽  
Triangular Fibrocartilage

There is lack of consensus on the management of triangular fibrocartilage injuries. The aim of this study was to investigate wrist surgeons’ experiences and perceptions regarding treatment of triangular fibrocartilage complex injuries and to explore the rationale behind clinical decision-making. A purposive sample of consultant wrist surgeons ( n = 10) was recruited through ‘snow-balling’ until data saturation was reached. Semi-structured interviews were conducted, digitally recorded and transcribed verbatim. Two researchers independently analysed data using an iterative/thematic approach. Findings suggest that surgeons rely more on their own training and experience, and patient-related factors such as individual expectations, to inform their decision-making, rather than on published material. Current classification systems are largely considered to be unhelpful. Level of evidence: V

scholarly journals Factors That Influence the Clinical Decision Making of Physical Therapists in Choosing a Balance Assessment Approach

2009 ◽  
Vol 89 (3) ◽  
pp. 233-247 ◽  
Author(s):  
Patricia Q McGinnis ◽  
Laurita M Hack ◽  
Kim Nixon-Cave ◽  
Susan L Michlovitz
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Clinical Decision Making ◽  
Inpatient Rehabilitation ◽  
Clinical Decision ◽  
Assessment Methods ◽  
Testing Time ◽  
Theory Approach ◽  
Balance Assessment ◽  
Balance Deficits

BackgroundMany methods for examining patients with balance deficits are supported by the literature. How or why therapists choose specific balance assessment methods during examination of patients remains unclear.ObjectivesThe aims of this study were: (1) to explore decision making during examination of patients with balance deficits, (2) to understand the selection and use of assessment methods from the clinician's perspective, and (3) to explore why specific methods were selected.DesignA qualitative design using a grounded theory approach permitted exploration of clinical decision making.MethodsEleven therapists were purposefully selected (6 from outpatient offices, 5 from inpatient rehabilitation settings) to participate in repeated interviews. Credibility of the findings was established through low-inference data, member check, and triangulation among participants and multiple data sources.ResultsA highly individualized approach to patient examination based on therapists’ practical knowledge emerged from the data, with limited influence of the literature. Movement observation was the primary assessment and diagnostic tool. When selecting assessment approaches for specific patients, the perceived value of information gathered mattered more than testing time. A 3-stage model of assessment decision making portrayed both the process and reasons influencing therapists’ choices.ConclusionsIn the context of the complex and busy nature of clinical practice, therapists gathered data that they considered meaningful during patient examination. The findings provide insight into factors influencing assessment decisions and suggest mechanisms to foster translation of research into clinical practice.

scholarly journals Moral-uncertainty-distress related to Advance Directives: a qualitative study

2020 ◽  
Author(s):  
Uiara Raiana Vargas de Castro Oliveira Ribeiro ◽  
Liliane Mayumi Swiech ◽  
Waldir Souza ◽  
Úrsula Bueno do Prado Guirro ◽  
Carla Corradi-Perini
Keyword(s):  
Decision Making ◽  
Advance Directives ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Decision Making Process ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Moral Uncertainty ◽  
Patient’S Autonomy ◽  
The Impact

Abstract Background: moral-uncertainty-distress (MUD) is defined as moral distress related to moral conflict about best course of action, impacting the clinical decision making process in morally complex situations. This study aims to correlate physician’s perception about advance directives (AD) with presence or absence of MUD, identifying the impact that AD promotes on clinical decision making.Methods: this is a qualitative, cross-sectional, exploratory study. Data was collected through semi-structured interviews with physicians of a hospital in southern Brazil. Interviews content was submitted to categorization analysis content technique by Laurence Bardin.Results: eight physicians were interviewed. The analysis contend identified two categories: (1) AD as a morally challenging element and (2) recognition of AD as instruments that exercises patient’s autonomy. In the first, paternalistic attitude; insecurities in uncertain prognoses; uncertainty about patient values and motivations to write the document; and little previous knowledge about AD, were elements of MUD for physicians. In second category, autonomy in AD was seen as prima facie principle and as shared autonomy.Conclusion: although AD were comprehended as instruments of exercise of patient’s autonomy by the participants, some elements were morally challenging for them, which can be a source of MUD to physician during decision making process.

scholarly journals Barriers and Facilitators Affecting Implementation of a Clinical Decision aid for the Diagnosis of Acute Aortic Syndrome: A Qualitative Study

2020 ◽  
Author(s):  
Caitlin Dmitriew ◽  
Robert Ohle
Keyword(s):  
Decision Making ◽  
Decision Aid ◽  
Clinical Decision Making ◽  
Theoretical Domains Framework ◽  
Clinical Decision ◽  
Barriers And Facilitators ◽  
Acute Aortic Syndrome ◽  
Structured Interviews ◽  
Potential Barriers ◽  
D Dimer

Abstract Background: Acute aortic syndrome (AAS) is an uncommon, life-threatening emergency that is frequently misdiagnosed. The Canadian clinical practice guidelines for the diagnosis of AAS were developed to improve patient outcomes and include a clinical decision aid designed to facilitate clinician decision-making. The objective of this study was to prospectively identify barriers and facilitators among physicians prior to implementation of the decision aid.Methods: We conducted semi-structured interviews with emergency room physicians working at five sites distributed between urban academic and rural settings. We used purposive sampling, contacting physicians until data saturation was reached. Interview questions were designed to understand potential barriers and facilitators to decision aid uptake and use. Responses were analysed according to the Theoretical Domains Framework, and overarching themes describing these barriers and facilitators were identified. Results: A majority of interviewees anticipated that the decision aid would support clinical decision making and risk stratification. Potential facilitators identified included guideline validation and publication and endorsement by peers. Barriers to implementation and application of the aid included the fact that the use of D-dimer and knowledge of the rationale for its use in the investigation of AAS were not widespread. The complexity of the decision aid and insufficient specificity of D-dimer were also identified as potential barriers to use. Conclusion: Physicians were amenable to using the AAS decision aid to support clinical decision-making and to reduce resource use. The barriers identified should be addressed prior to implementation in order to support decision aid uptake and use.

scholarly journals Investigating the Decision-Making Process of Physicians in Rural Ontario: The Perspectives and Attitudes on Medical Cannabis

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Asiful Islam
Keyword(s):  
Decision Making ◽  
Rural Areas ◽  
Clinical Decision Making ◽  
Medical Condition ◽  
Clinical Decision ◽  
Decision Making Process ◽  
Medical Cannabis ◽  
Structured Interviews ◽  
Health Communities ◽  
Media Reports

This thesis will guide health communities to better understand the clinical decision-making process that physicians from rural Ontario undergo when considering whether to prescribe medical cannabis to patients for their medical condition. Very few studies have been conducted which examine the perspectives of physicians on medical cannabis, especially in rural areas, and these studies have found that most physicians are skeptical towards medical cannabis. This skeptical perspective of physicians has complicated the clinical decision-making process as “recent changes in media reports and changing trends in social media propose a change in the attitudes towards cannabis (Zolotov et al., 2018, p.5).” Physicians practicing in rural Ontario are currently being recruited to participate in semi-structured interviews to explore the issues which they prioritize the most. Once completed, the findings from this study will identify common themes and trends that could help influence change in physician practice and healthcare policy.

scholarly journals MP40: What are the factors contributing to medico-legal risk of procedural interventions performed by physicians practicing emergency medicine?

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S57-S57
Author(s):  
K. Lemay ◽  
P. Finestone ◽  
R. Liu ◽  
R. De Gorter ◽  
L. Calder
Keyword(s):  
Decision Making ◽  
Emergency Medicine ◽  
Patient Safety ◽  
Clinical Decision Making ◽  
Life Support ◽  
Improve Patient Safety ◽  
Clinical Decision ◽  
Wound Management ◽  
Contributing Factors ◽  
Orthopedic Injury

Introduction: Physicians who practice emergency medicine (EM) often perform procedural interventions, which can occasionally result in unintended patient harm. Our study's objective was to identify and describe the interventions and contributing factors associated with medico-legal (ML) cases involving emergency physicians performing procedural interventions. Methods: The Canadian Medical Protective Association (CMPA) is a not-for-profit, ML organization which represented over 99,000 physicians at the time of this study. We extracted five years (2014-2018) of CMPA data describing closed ML cases involving procedural interventions (e.g. suturing, reducing a dislocated joint) and excluding interventions related to pharmacotherapy (e.g. injection of local anesthetic), diagnosis (electrocardiograms) and physical assessments (e.g. ear exams), performed by physicians practicing EM. We then applied an internal contributing factor framework to identify themes. We analysed the data using descriptive statistics. Results: We identified 145 cases describing 145 patients who had 205 procedures performed in the course of their EM care. The three most common interventions were orthopedic injury management (47/145, 32.4%), wound management (43/145, 29.7%), and Advanced Cardiac Life Support (24/145, 16.6%). Out of 145 patients, 93.8% (136/145) experienced a patient safety event, and 55.9% (76/136) suffered an avoidable harmful incident. One quarter of patients suffered mild harm (34/76, 25.0%), 18.4% of patients died, 14.5% suffered severe harm, and 13.2% moderate harm. Peer experts were critical of 86/145 cases (59.3%) where the following provider contributing factors were found: a lack of situational awareness (20/68, 29.4%), and deficient physician clinical decision-making (54/68, 79.7%). Clinical decision-making issues included a lack of thoroughness of assessment (33/54, 61.1%), failure to perform tests or interventions (21/54, 38.9%), and a delay or failure to seek help from another physician (17/54, 31.2%). Peer experts were also critical of 48.8% of cases containing team factors (42/86) due to deficient medical record keeping (26/42, 61.9%), and communication breakdown with patients or other team members (25/42, 59.5%). Conclusion: Both provider and team factors contributed to ML cases involving EM physicians performing procedural interventions. Addressing these factors may improve patient safety and reduce ML risk for physicians.

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