scholarly journals Navigating complexity through intuition and evidence-based guidelines: a mix-methods study among child and youth healthcare practitioners

2019 ◽  
Author(s):  
Jetske Charlotte Erisman ◽  
Kevin de Sabbata ◽  
Teun Zuiderent-Jerak ◽  
Elena V Syurina
Keyword(s):  
Child Abuse ◽  
Well Being ◽  
Evidence Based ◽  
Structured Interviews ◽  
Daily Work ◽  
Tunnel Vision ◽  
Dutch Child ◽  
Secondary Information ◽  
Evidence Based Guidelines ◽  
Based Medicine

Abstract Background: Dutch child and youth health care (CYHC) practitioners monitor and assess the well-being of all children. One of their main concerns is identifying cases of child abuse, which is an arduous and sensitive task. They use both evidence-based guidelines aimed at increasing the quality of care through rationalised decision-making and intuition. These two practices are seen as being at odds with each other, yet empirical research has shown that both are needed in healthcare. This study aims to understand how Dutch CYHC-practitioners perceive the role of intuition in their work and in relation to evidence-based medicine, in the case of child abuse.Methods: A sequential exploratory mixed-methods design. In-depth semi-structured interviews with CYHC-practitioners focused on perceptions on intuition, which was followed by a survey amongst CYHC-professionals on the recognition and use of the concept.Results: The majority of CYHC-practitioners and professionals recognise and use intuition in their daily work, stating that it is necessary in their profession. CYHC-practitioners use intuition: 1) to sense that something is off, 2) to differentiate between ‘normal’ and ‘abnormal’, 3) to assess risks, 4) to weigh secondary information and 5) to communicate with parents. At the same time, they warn for its dangers as it may lead to tunnel vision and false accusations. Their ways of working with intuition show parallels to the practices that evidence-based guidelines try to support.Conclusion: Intuition is experienced as an integral part of the work of CYHC-practitioners. It is stated to be particularly useful in the case of child abuse, which is inherently complex as signs and evidence of abuse are hidden, subtle and unique in each case. CYHC-practitioners use intuition to manage and navigate this complexity. As there is a lack of guidance on how to practice intuition, there is a need for support through guidelines.

scholarly journals Navigating complexity through intuition and evidence-based guidelines: a mix-methods study among child and youth healthcare practitioners

2019 ◽  
Author(s):  
Jetske Charlotte Erisman ◽  
Kevin de Sabbata ◽  
Teun Zuiderent-Jerak ◽  
Elena V Syurina
Keyword(s):  
Child Abuse ◽  
Well Being ◽  
Evidence Based ◽  
Structured Interviews ◽  
Daily Work ◽  
Tunnel Vision ◽  
Dutch Child ◽  
Secondary Information ◽  
Evidence Based Guidelines ◽  
Based Medicine

Abstract Background Dutch child and youth health care (CYHC) practitioners monitor and assess the well-being of all children. One of their main concerns is identifying cases of child abuse, which is an arduous and sensitive task. They use both evidence-based guidelines aimed at increasing the quality of care through rationalised decision-making and intuition. These two practices are seen as being at odds with each other, yet empirical research has shown that both are needed in healthcare. This study aims to understand how Dutch CYHC-practitioners perceive the role of intuition in their work and in relation to evidence-based medicine, in the case of child abuse.Methods A sequential exploratory mixed-methods design. In-depth semi-structured interviews with CYHC-practitioners focused on perceptions on intuition, which was followed by a survey amongst CYHC-professionals on the recognition and use of the concept.Results The majority of CYHC-practitioners and professionals recognise and use intuition in their daily work, stating that it is necessary in their profession. CYHC-practitioners use intuition: 1) to sense that something is off, 2) to differentiate between ‘normal’ and ‘abnormal’, 3) to assess risks, 4) to weigh secondary information and 5) to communicate with parents. At the same time, they warn for its dangers as it may lead to tunnel vision and false accusations. Their ways of working with intuition show parallels to the practices that evidence-based guidelines try to support.Conclusion Intuition is experienced as an integral part of the work of CYHC-practitioners. It is stated to be particularly useful in the case of child abuse, which is inherently complex as signs and evidence of abuse are hidden, subtle and unique in each case. CYHC-practitioners use intuition to manage and navigate this complexity. As there is a lack of guidance on how to practice intuition, there is a need for support through guidelines.

scholarly journals Navigating complexity through intuition and evidence-based guidelines: a mix-methods study among child and youth healthcare practitioners

2020 ◽  
Author(s):  
Jetske Charlotte Erisman ◽  
Kevin de Sabbata ◽  
Teun Zuiderent-Jerak ◽  
Elena V Syurina
Keyword(s):  
Child Abuse ◽  
Well Being ◽  
Evidence Based ◽  
Structured Interviews ◽  
Daily Work ◽  
Tunnel Vision ◽  
Dutch Child ◽  
Secondary Information ◽  
Evidence Based Guidelines ◽  
Based Medicine

Abstract Background Dutch child and youth health care (CYHC) practitioners monitor and assess the well-being of all children. One of their main concerns is identifying cases of child abuse, which is an arduous and sensitive task. They use both evidence-based guidelines aimed at increasing the quality of care through rationalised decision-making, and intuition. These two practices are seen as being at odds with each other, yet empirical research has shown that both are needed in healthcare. This study aims to understand how Dutch CYHC-practitioners perceive the role of intuition in their work and in relation to evidence-based medicine, in the case of child abuse. Methods A sequential exploratory mixed-methods design: in-depth semi-structured interviews with CYHC-practitioners focused on perceptions on intuition, which were followed by a survey amongst CYHC-professionals on the recognition and use of the concept. Results The majority of CYHC-practitioners and professionals recognise and use intuition in their daily work, stating that it is necessary in their profession. CYHC-practitioners use intuition: 1) to sense that something is off, 2) to differentiate between ‘normal’ and ‘abnormal’, 3) to assess risks, 4) to weigh secondary information and 5) to communicate with parents. At the same time, they warn for its dangers as it may lead to tunnel vision and false accusations. Their ways of working with intuition show parallels to the practices that evidence-based guidelines try to support. Conclusion Intuition is experienced as an integral part of the work of CYHC-practitioners. It is stated to be particularly useful in the case of child abuse, which is inherently complex as signs and evidence of abuse are hidden, subtle and unique in each case. CYHC-practitioners use intuition to manage and navigate this complexity. As there is a lack of guidance on how to practice intuition, there is a need for support through guidelines.

scholarly journals Navigating complexity of child abuse through intuition and evidence-based guidelines: a mix-methods study among child and youth healthcare practitioners

2020 ◽  
Author(s):  
Jetske Charlotte Erisman ◽  
Kevin de Sabbata ◽  
Teun Zuiderent-Jerak ◽  
Elena V Syurina
Keyword(s):  
Child Abuse ◽  
Well Being ◽  
Care Practice ◽  
Evidence Based ◽  
Structured Interviews ◽  
Daily Work ◽  
Tunnel Vision ◽  
Dutch Child ◽  
Secondary Information ◽  
Evidence Based Guidelines

Abstract Background: Dutch child and youth health care (CYHC) practitioners monitor and assess the well-being of children. One of their main concerns is identifying cases of child abuse, which is an arduous and sensitive task. In these contexts, CYHC-practitioners use both evidence-based guidelines aimed at increasing the quality of care through rationalised decision-making, and intuition. These two practices are seen as being at odds with each other, yet empirical research has shown that both are necessary in healthcare. This study aims to unravel how intuition is perceived and used by Dutch CYHC-practitioners when identifying and working with cases of child abuse, and how this relates to their evidence-based guidelines.Methods: A sequential exploratory mixed-methods design: in-depth semi-structured interviews with CYHC-physicians focused on perceptions on intuition, which were followed by a survey amongst CYHC-practitioners on the recognition and use of the concept.Results: The majority of CYHC-practitioners recognise and use intuition in their daily work, stating that it is necessary in their profession. CYHC-practitioners use intuition to 1) sense that something is ‘off’, 2) differentiate between ‘normal’ and ‘abnormal’, 3) assess risks, 4) weigh secondary information and 5) communicate with parents. At the same time, they warn of its dangers, as it may lead to ‘tunnel vision’ and false accusations. Conclusion: Intuition is experienced as an integral part of the work of CYHC-practitioners. It is understood as particularly useful in cases of child abuse, which are inherently complex, as signs and evidence of abuse are often hidden, subtle and unique in each case. CYHC-practitioners use intuition to manage and navigate this complexity. There is an opportunity for guidelines to support reflection and intuition as a ‘good care’ practice.

scholarly journals Navigating complexity through intuition and evidence-based guidelines: a mix-methods study among child and youth healthcare professionals

2020 ◽  
Author(s):  
Jetske Charlotte Erisman ◽  
Kevin de Sabbata ◽  
Teun Zuiderent-Jerak ◽  
Elena V Syurina
Keyword(s):  
Child Abuse ◽  
Well Being ◽  
Care Practice ◽  
Evidence Based ◽  
Structured Interviews ◽  
Daily Work ◽  
Tunnel Vision ◽  
Dutch Child ◽  
Secondary Information ◽  
Evidence Based Guidelines

Abstract Background: Dutch child and youth health care (CYHC) professionals monitor and assess the well-being of children. One of their main concerns is identifying cases of child abuse, which is an arduous and sensitive task. In these contexts, CYHC-professionals use both evidence-based guidelines aimed at increasing the quality of care through rationalised decision-making, and intuition. These two practices are seen as being at odds with each other, yet empirical research has shown that both are needed in healthcare. This study aims to unravel how intuition is perceived and used by Dutch CYHC-professionals when identifying and working with cases of child abuse, and how this relates to their evidence-based guidelines.Methods: A sequential exploratory mixed-methods design: in-depth semi-structured interviews with CYHC-practitioners focused on perceptions on intuition, which were followed by a survey amongst CYHC-professionals on the recognition and use of the concept.Results: The majority of CYHC-professionals recognise and use intuition in their daily work, stating that it is necessary in their profession. CYHC-professionals use intuition to: 1) sense that something is off, 2) differentiate between ‘normal’ and ‘abnormal’, 3) assess risks, 4) weigh secondary information and 5) communicate with parents. At the same time, they warn for its dangers as it may lead to ‘tunnel vision’ and false accusations. Conclusion: Intuition is experienced as an integral part of the work of CYHC-professionals. It is stated to be particularly useful in the case of child abuse, which is inherently complex as signs and evidence of abuse are hidden, subtle and unique in each case. CYHC- professionals use intuition to manage and navigate this complexity. There is an opportunity for guidelines to support reflection and intuition as a ‘good care’ practice.

scholarly journals Navigating complexity of child abuse through intuition and evidence-based guidelines: a mix-methods study among child and youth healthcare practitioners

2020 ◽  
Author(s):  
Jetske Charlotte Erisman ◽  
Kevin de Sabbata ◽  
Teun Zuiderent-Jerak ◽  
Elena V Syurina
Keyword(s):  
Child Abuse ◽  
Well Being ◽  
Care Practice ◽  
Evidence Based ◽  
Structured Interviews ◽  
Daily Work ◽  
Tunnel Vision ◽  
Dutch Child ◽  
Secondary Information ◽  
Evidence Based Guidelines

Abstract Background: Dutch child and youth health care (CYHC) practitioners monitor and assess the well-being of children. One of their main concerns is identifying cases of child abuse, which is an arduous and sensitive task. In these contexts, CYHC-practitioners use both evidence-based guidelines aimed at increasing the quality of care through rationalised decision-making, and intuition. These two practices are seen as being at odds with each other, yet empirical research has shown that both are necessary in healthcare. This study aims to unravel how intuition is perceived and used by Dutch CYHC-practitioners when identifying and working with cases of child abuse, and how this relates to their evidence-based guidelines. Methods: A sequential exploratory mixed-methods design: in-depth semi-structured interviews with CYHC-physicians focused on perceptions on intuition, which were followed by a survey amongst CYHC-practitioners on the recognition and use of the concept. Results: The majority of CYHC-practitioners recognise and use intuition in their daily work, stating that it is necessary in their profession. CYHC-practitioners use intuition to 1) sense that something is ‘off’, 2) differentiate between ‘normal’ and ‘abnormal’, 3) assess risks, 4) weigh secondary information and 5) communicate with parents. At the same time, they warn of its dangers, as it may lead to ‘tunnel vision’ and false accusations. Conclusion: Intuition is experienced as an integral part of the work of CYHC-practitioners. It is understood as particularly useful in cases of child abuse, which are inherently complex, as signs and evidence of abuse are often hidden, subtle and unique in each case. CYHC-practitioners use intuition to manage and navigate this complexity. There is an opportunity for guidelines to support reflection and intuition as a ‘good care’ practice.

Intensive Diabetes Management: Negotiating Evidence-based Practice

2010 ◽  
Vol 71 (2) ◽  
pp. 62-68 ◽  
Author(s):  
Ann Fox
Keyword(s):  
Stages Of Change ◽  
Diabetes Care ◽  
Health Professionals ◽  
Diabetes Management ◽  
Evidence Based Practice ◽  
Opinion Leaders ◽  
Evidence Based ◽  
Structured Interviews ◽  
Evidence Based Guidelines ◽  
Based Medicine

Purpose: An exploration was completed of health professionals’ experiences implementing evidence-based guidelines that promote intensive management (IM) for people with diabetes. Methods: In-depth, semi-structured interviews were conducted with 50 health professionals from across Canada. These professionals are considered to be opinion leaders in diabetes care. Interviews were audiotaped, transcribed verbatim, and coded with the assistance of NVivo software. Transcripts were analyzed using Potter and Wetherell's approach to discourse analysis. Results: Participants noted that recent clinical trials validated intensive approaches to diabetes management. While they viewed the evidence as sound, they did not feel that it justified IM approaches in all situations. Evidence-based practice therefore gave way to individual patient considerations. Implementing behavioural strategies, such as the stages of change model, allowed participants to modify their practices in ways that accommodated both evidence-based and patient-focused practice paradigms. Conclusions: While evidence-based medicine influenced practice, it was only one discourse that shaped the way health professionals approached diabetes care.

The Care Triangle: Determining the Gaps in the Management of Atopic Dermatitis

2013 ◽  
Vol 17 (4) ◽  
pp. 276-282 ◽  
Author(s):  
Ashley O'Toole ◽  
Bjorn Thomas ◽  
Richard Thomas
Keyword(s):  
Atopic Dermatitis ◽  
Response To Treatment ◽  
Care Process ◽  
Evidence Based ◽  
Previous Response ◽  
Children And Young Adults ◽  
The Individual ◽  
Evidence Based Guidelines ◽  
Based Medicine

Background: Atopic dermatitis (AD) is a chronic, relapsing, intensely pruritic dermatosis that usually affects infants, children, and young adults. The treatment of AD entails an individualized regimen that depends on the age of the patient, the stage and variety of lesions present, the sites and extent of involvement, the presence of infection, and the previous response to treatment. Objectives: To identify the evidence surrounding potential strategies for closing these gaps—ultimately improving the quality of care, the care process itself, and patient outcomes—and to encourage discussions that help develop tools to bridge the gap between suggested therapy and what is done by the patient. Methods: Review of the literature including searches on PubMed Central and Medline and in seminal dermatology texts. Results: There are several disconnections between the evidence-based guidelines in the management of AD, what the individual dermatologist recommends, and what the patient does. Conclusion: Applying the concept of the care triangle requires a balance of evidence-based medicine, the physician's experiences and the patient's needs and expectations in the decisions surrounding appropriate management of the disease.

Evidence-based causation in toxicology

2015 ◽  
Vol 34 (12) ◽  
pp. 1245-1252 ◽  
Author(s):  
RC James ◽  
JK Britt ◽  
NC Halmes ◽  
PS Guzelian
Keyword(s):  
Decision Making ◽  
Evidence Based Medicine ◽  
Weight Of Evidence ◽  
Evidence Based ◽  
Definition Of ◽  
Evidence Based Guidelines ◽  
Available Information ◽  
Based Medicine ◽  
Lay Public ◽  
Reproducible Manner

We introduced Evidence-based Toxicology (EBT) in 2005 to address the disparities that exist between the various Weight-of-Evidence (WOE) methods typically applied in the regulatory hazard decision-making arena and urged toxicologists to adopt the evidence-based guidelines long-utilized in medicine (i.e., Evidence-Based Medicine or EBM). This review of the activities leading to the adoption of evidence-based methods and EBT during the last decade demonstrates how fundamental concepts that form EBT, such as the use of systematic reviews to capture and consider all available information, are improving toxicological evaluations performed by various groups and agencies. We reiterate how the EBT framework, a process that provides a method for performing human chemical causation analyses in an objective, transparent and reproducible manner, differs significantly from past and current regulatory WOE approaches. We also discuss why the uncertainties associated with regulatory WOE schemes lead to a definition of the term “risk” that contains unquantifiable uncertainties not present in this term as it is used in epidemiology and medicine. We believe this distinctly different meaning of “risk” should be clearly conveyed to those not familiar with this difference (e.g., the lay public), when theoretical/nomologic risks associated with chemical-induced toxicities are presented outside of regulatory and related scientific parlance.

Using Web-Enabled Technology to Promote the Adoption of Practice Guidelines

2011 ◽  
pp. 172-185
Author(s):  
James G. Anderson ◽  
Linda L Casebeer ◽  
Robert E. Kristofco ◽  
Angela S. Carillo
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Rapid Expansion ◽  
Evidence Based ◽  
Information And Communications Technologies ◽  
Physician Uncertainty ◽  
Educational Applications ◽  
Evidence Based Guidelines ◽  
Based Medicine

The rapid expansion of scientific knowledge brings increased physician uncertainty in clinical decisionmaking. Clinical practice guidelines have been developed to reduce physician uncertainty. The broad movement to develop and disseminate clinical practice guidelines is rooted in evidence-based medicine. Although the development and dissemination of evidence-based guidelines has increased dramatically over the past decade, studies indicate serious deficiencies in the adoption of guidelines into practice. Developments such as client/server networks, the Internet, and the World Wide Web are rapidly expanding potential educational applications for information and communications technologies and the capacity for introducing strategies to promote guideline adoption. Web-enabled computer technology can enhance the capability of healthcare information systems to reduce variation in clinical decisionmaking.

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