4 ‘‘Unlike Calculating Rules’’? Clinical Judgment, Formalized Decision Making, andWittgenstein

2020 ◽  
pp. 48-69
Keyword(s):  
Decision Making ◽  
Clinical Judgment

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

Clinical Judgment Revisited

1999 ◽  
Vol 38 (04/05) ◽  
pp. 279-286 ◽  
Author(s):  
L. L. Weed
Keyword(s):  
Decision Making ◽  
Medical Practice ◽  
Clinical Judgment ◽  
Medical Information ◽  
Patient Records ◽  
Practice Of Medicine ◽  
The Way

AbstractIt is widely recognised that accessing and processing medical information in libraries and patient records is a burden beyond the capacities of the physician’s unaided mind in the conditions of medical practice. Physicians are quite capable of tremendous intellectual feats but cannot possibly do it all. The way ahead requires the development of a framework in which the brilliant pieces of understanding are routinely assembled into a working unit of social machinery that is coherent and as error free as possible – a challenge in which we ourselves are among the working parts to be organized and brought under control.Such a framework of intellectual rigor and discipline in the practice of medicine can only be achieved if knowledge is embedded in tools; the system requiring the routine use of those tools in all decision making by both providers and patients.

The Contextual Nature of Critical Care Judgment

1994 ◽  
Vol 9 (2) ◽  
pp. 58-63 ◽  
Author(s):  
Gilbert M. Goldman ◽  
Thyyar M. Ravindranath
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Clinical Practice ◽  
Clinical Judgment ◽  
Retrospective Review ◽  
Medical Decision Making ◽  
Formal Analysis ◽  
Medical Decision ◽  
Time Constraints ◽  
Care Decision

Critical care decision-making involves principles common to all medical decision-making. However, critical care is a remarkably distinctive form of clinical practice and therefore it may be useful to distinguish those elements particularly important or unique to ICU decision-making. The peculiar contextuality of critical care decision-making may be the best example of these elements. If so, attempts to improve our understanding of ICU decision-making may benefit from a formal analysis of its remarkable contextual nature. Four key elements of the context of critical care decisions can be identified: (1) costs, (2) time constraints, (3) the uncertain status of much clinical data, and (4) the continually changing environment of the ICU setting. These 4 elements comprise the context for the practice of clinical judgment in the ICU. The fact that intensivists are severely constrained by teh context of each case has important ramifications both for practice and for retrospective review. During retrospective review, the contextual nature of ICU judgment may be unfairly neglected by ignoring one or more of the key elements. Such neglect can be avoided if intensivists demand empathetic evaluation from reviewers.

scholarly journals Critical thinking: concept analysis from the perspective of Rodger's evolutionary method of concept analysis

2016 ◽  
Vol 24 (0) ◽  
Author(s):  
Fábio da Costa Carbogim ◽  
Larissa Bertacchini de Oliveira ◽  
Vilanice Alves de Araújo Püschel
Keyword(s):  
Decision Making ◽  
Critical Thinking ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Concept Analysis ◽  
Cognitive Skill ◽  
Related Factor ◽  
Evolutionary Perspective ◽  
Analytical Thinking

ABSTRACT Objective: to analyze the concept of critical thinking (CT) in Rodger's evolutionary perspective. Method: documentary research undertaken in the Cinahl, Lilacs, Bdenf and Dedalus databases, using the keywords of 'critical thinking' and 'Nursing', without limitation based on year of publication. The data were analyzed in accordance with the stages of Rodger's conceptual model. The following were included: books and articles in full, published in Portuguese, English or Spanish, which addressed CT in the teaching and practice of Nursing; articles which did not address aspects related to the concept of CT were excluded. Results: the sample was made up of 42 works. As a substitute term, emphasis is placed on 'analytical thinking', and, as a related factor, decision-making. In order, the most frequent preceding and consequent attributes were: ability to analyze, training of the student nurse, and clinical decision-making. As the implications of CT, emphasis is placed on achieving effective results in care for the patient, family and community. Conclusion: CT is a cognitive skill which involves analysis, logical reasoning and clinical judgment, geared towards the resolution of problems, and standing out in the training and practice of the nurse with a view to accurate clinical decision-making and the achieving of effective results.

Clinical Decision-Making for a Person Centered Medicine: the necessity of casuistic reasoning

2014 ◽  
Vol 2 (1) ◽  
pp. 71
Author(s):  
Mark Tonelli
Keyword(s):  
Decision Making ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Patient Choice ◽  
Clinical Expertise ◽  
Patient Centered ◽  
Patient Centered Medicine ◽  
The Individual ◽  
Based Medicine

In their call to develop a consistent, coherent and comprehensive notion of person-centered medicine, Miles and Mezzich have elucidated several specific challenges that need to be urgently addressed. One of these foundational tasks is the development of a more complete understanding of person-centered clinical decision-making. Miles and Mezzich note that while the emphasis on clinical research in evidence-based medicine has served to de-emphasize the importance of the individual patient, the alternative of patient-centered medicine has the potential to de-emphasize the judgment of the clinician by making unfettered patient choice paramount. A practice of medicine that reduces professional healers to an informational role only, one where they lay out potential interventions devoid of context and allow patients to choose from amongst them, undervalues clinical expertise and will clearly not lead to better outcomes. Person-centered medicine (PCM), then, must be able to develop and defend a model of clinical judgment and practice that strikes the correct balance between the science of medicine and the personal experience of the individual in search of care.

The importance of clinically and ethically fine-tuning decision-making about cesarean delivery

2017 ◽  
Vol 45 (5) ◽  
Author(s):  
Michelle T. Nguyen ◽  
Laurence B. McCullough ◽  
Frank A. Chervenak
Keyword(s):  
Decision Making ◽  
Cesarean Delivery ◽  
Clinical Judgment ◽  
Fetal Heart ◽  
Breech Presentation ◽  
Organizational Factors ◽  
Fine Tuning ◽  
Ethical Framework ◽  
Training Experience ◽  
Significant Harm

AbstractIn obstetric practice, each pregnant woman presents with a composite of maternal and fetal characteristics that can alter the risk of significant harm without cesarean intervention. The hospital’s availability of resources and the obstetrician’s training, experience, and skill level can also alter the risk of significant harm without cesarean intervention. This paper proposes a clinical ethical framework that takes these clinical and organizational factors into account, to promote a deliberative rather than simplistic approach to decision-making and counseling about cesarean delivery. The result is a clinical ethical framework that should guide the obstetrician in fine-tuning his or her evidence-based, beneficence-based analysis of specific clinical and organizational factors that can affect the strength of the beneficence-based clinical judgment about cesarean delivery. We illustrate the clinical application of this framework for three common obstetric conditions: Category II fetal heart rate tracing, prior non-classical cesarean delivery, and breech presentation.

scholarly journals Intuition: An Important Tool in the Practice of Nursing

2016 ◽  
Vol 1 (2) ◽  
Keyword(s):  
Decision Making ◽  
Clinical Judgment ◽  
Nursing Practice ◽  
Nursing Knowledge ◽  
Theoretical Approaches ◽  
Clinical Nursing ◽  
Humanistic Approach ◽  
Effective Decision ◽  
Nursing Literature ◽  
Effective Decision Making

Intuition is a quality that nurses have traditionally valued, but nowadays evidence-based research climate is often denigrated. Because it is difficult to investigate and quantify, intuition has tended to be seen as unreliable, unscientific and unsuitable for nursing practice. However, intuition, like caring, cannot be subjected to measurement and should not be overlooked as an important tool. Intuition is identified as a useful tool that needs to be recognized in nursing. At the same time, intuition is described as an important type of nursing knowledge and a valid way of knowing in clinical nursing practice. It is knowing something or deciding to do something without having a logical explanation. Intuition in practice has been linked to enhanced clinical judgment, effective decision making and crisis aversion. The inability to provide rationale for an action or decision makes intuition challenging for nurses to describe, explain or openly acknowledge. In the nursing literature, intuition is recognized as an important component of decision-making theories. In the literate outlines the two predominant theoretical approaches to decision making: the systematic positivistic approach and the intuitive humanistic approach. Both approaches are valuable and emphasise the need to investigate quantitatively the intuitive humanistic approach in decision making. To understand the intuitive approach to decision making, nurses need to first identify intuitive feelings and intuition use in their clinical practice. Qualitative studies demonstrate intuition use in expert decision making and label it as a source of knowledge coming from feelings, sensations and connections. Intuition is a component of decision-making models applied in nursing practice. Empirical research which requires nurses to recognize intuition and utilize it effectively in nursing practice.

Conflict in the Pediatric Setting: Clinical Judgment vs. Parental Autonomy

1995 ◽  
Vol 4 (1) ◽  
pp. 36-43 ◽  
Author(s):  
Amnon Goldworth
Keyword(s):  
Decision Making ◽  
Clinical Judgment ◽  
Decision Making Process ◽  
The Past ◽  
Pediatric Setting ◽  
Withdrawal Of Treatment ◽  
Healthcare It ◽  
Parental Autonomy

Over the past several decades, conflicts between physicians and patients or patient surrogates concerning continued treatment or the withdrawal of treatment have received public and legal attention. In more recent years, there have been several prominent Instances in which physicians have refused to provide treatment requested by patient surrogates because such treatment was judged to be futile. The claim that a treatment is futile has far reaching consequences. It serves to justify the withholding or withdrawal of treatment and thus, perhaps, to also justify the rationing of healthcare. It limits the autonomy of the patient or patient surrogate by reducing their participation in the decision making process.

Sign in / Sign up

Export Citation Format

Share Document