A qualitative descriptive inquiry of the influences on nurses’ missed care decision‐making processes in acute hospital paediatric care

2020 ◽  
Vol 28 (8) ◽  
pp. 1929-1939
Author(s):  
Annamaria Bagnasco ◽  
Nicoletta Dasso ◽  
Silvia Rossi ◽  
Fiona Timmins ◽  
Giuseppe Aleo ◽  
...  
Keyword(s):  
Decision Making ◽  
Acute Hospital ◽  
Paediatric Care ◽  
Decision Making Processes ◽  
Qualitative Descriptive ◽  
Missed Care ◽  
Care Decision

Implementation pilot of a novel electronic bedside nursing chart: a mixed-methods case study

2020 ◽  
Vol 44 (5) ◽  
pp. 672
Author(s):  
Kasia Bail ◽  
Rachel Davey ◽  
Marian Currie ◽  
Jo Gibson ◽  
Eamon Merrick ◽  
...  
Keyword(s):  
Decision Making ◽  
Nursing Care ◽  
Clinical Decision Making ◽  
Acute Hospital ◽  
Shared Understanding ◽  
Clinical Ward ◽  
Patient Reported ◽  
Bedside Nursing ◽  
Missed Care

The aim of this study was to investigate the implementation of a novel electronic bedside nursing chart in an acute hospital setting. The case study used multiple data sources captured within a real-life clinical ward context. Quantitative findings included significant reductions in nurse-reported missed care (P<0.05) and increased mean time spent at the bedside (from 21 to 28min h−1; P<0.0001); reductions in patient-reported missed care and nurses’ walking distances were not significant. Qualitative themes included: (1) inconsistent expectations (perceptions about potential vs actual functionality and benefits of the technology); (2) decisional conflict between managers and end-user nurses (discordance between governance decisions and clinical operations; 30% of beds were closed and six of the eight trained nurse ‘super-users’ were moved from the pilot ward); and (3) workflow effects (ergonomic set-up of the digital interface). This study highlights the complex challenges of implementing and examining the effects of technology to support nursing care. Shared understanding of the technology goals and project scope in relation to nursing care and flexible and adaptive project and contingency planning are fundamental considerations. Complexity, unpredictability and uncertainty of ‘usual business’ are common confounders in acute hospital settings. What is known about the topic?Although much has been written about the implementation of electronic records into hospital systems, there is little research evaluating the effect of information technology systems that support the complex clinical decision making and documentation required to meet nurse and patient needs at the point of care. What does this paper add?This study highlights the potential to reduce missed care through better nursing workflow. Contributing factors to low nurse adoption of new technology have been identified, including inconsistent expectations and goals for the design of systems to support quality nursing care, incongruous decision making in design, adaptation and implementation processes and constrained physical workability in relation to nursing workflow. What are the implications for practitioners?The design of information systems to support nursing work requires a shared understanding of ‘good practice’ for high-quality nursing care that is consistent with theories of nursing practice, best evidence and professional practice standards. Recognition of effective and ineffective sociotechnical interactions that occur during complex nursing processes can help avoid ‘disruption without benefit’ and ‘amplification of errors already in the system’ during acute care technology implementation. Ongoing dynamic input from individuals and groups with different expertise and perspectives, as well as iterative, generative processes for moving towards a shared goal, are critical for effective and efficient implementation.

Health-care decision-making processes in Latin America: Problems and prospects for the use of economic evaluation

2005 ◽  
Vol 21 (1) ◽  
pp. 1-14 ◽  
Author(s):  
Cynthia P. Iglesias ◽  
Michael F. Drummond ◽  
Joan Rovira ◽  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Economic Evaluation ◽  
Health Care Systems ◽  
Evaluation Studies ◽  
Health Care Decision ◽  
Formal Tool ◽  
Care Systems ◽  
Decision Making Processes ◽  
Care Decision

Objectives: The use of economic evaluation studies (EE) in the decision-making process within the health-care system of nine Latin American (LA) and three European countries was investigated. The aim was to identify the opportunities, obstacles, and changes needed to facilitate the introduction of EE as a formal tool in health-care decision-making processes in LA.Methods: A comparative study was conducted based on existing literature and information provided through a questionnaire applied to decision makers in Argentina, Brazil, Colombia, Cuba, Mexico, Nicaragua, Peru, Portugal Spain, United Kingdom, Uruguay, and Venezuela. Systematic electronic searches of HEED, NHS EED, and LILACS were conducted to identify published economic evaluation studies in LA from 1982 onward.Results: There is relatively little evidence of the conduct and use of EE within the health care systems in LA. Electronic searches retrieved 554 records; however, only 93 were EE. In the nine LA participating countries, broad allocation of health-care resources is primarily based on political criteria, historical records, geographical areas, and specific groups of patients and diseases. Public-health provision and inclusion of services in health-insurance package are responsibilities of the Ministry of Health. Decisions regarding the purchase of medicines are primarily made through public tenders, and mainly based on differences in clinical efficacy and the price of health technologies of interest.Conclusions: To expedite the process of incorporating EE as a formal tool to inform decision-making processes within the health-care systems in LA countries, two main conditions need to be fulfilled. First, adequate resources and skills need to be available to conduct EE of good quality. Second, decision-making procedures need to be modified to accommodate “evidence-based” approaches such as EE.

scholarly journals Cancer Care Decision Making in Multidisciplinary Meetings

2020 ◽  
Author(s):  
Kevin Dew ◽  
M Stubbe ◽  
L Signal ◽  
J Stairmand ◽  
E Dennett ◽  
...  
Keyword(s):  
Decision Making ◽  
New Zealand ◽  
Observational Study ◽  
Cancer Care ◽  
Decision Making Process ◽  
Multidisciplinary Meetings ◽  
Sources Of Authority ◽  
Decision Making Processes ◽  
Care Decision ◽  
Actual Decision

© The Author(s) 2014. Little research has been undertaken on the actual decision-making processes in cancer care multidisciplinary meetings (MDMs). This article was based on a qualitative observational study of two regional cancer treatment centers in New Zealand. We audiorecorded 10 meetings in which 106 patient cases were discussed. Members of the meetings categorized cases in varying ways, drew on a range of sources of authority, expressed different value positions, and utilized a variety of strategies to justify their actions. An important dimension of authority was encountered authority - the authority a clinician has because of meeting the patient. The MDM chairperson can play an important role in making explicit the sources of authority being drawn on and the value positions of members to provide more clarity to the decision-making process. Attending to issues of process, authority, and values in MDMs has the potential to improve cancer care decision making and ultimately, health outcomes.

scholarly journals Cancer Care Decision Making in Multidisciplinary Meetings

2020 ◽  
Author(s):  
Kevin Dew ◽  
M Stubbe ◽  
L Signal ◽  
J Stairmand ◽  
E Dennett ◽  
...  
Keyword(s):  
Decision Making ◽  
New Zealand ◽  
Observational Study ◽  
Cancer Care ◽  
Decision Making Process ◽  
Multidisciplinary Meetings ◽  
Sources Of Authority ◽  
Decision Making Processes ◽  
Care Decision ◽  
Actual Decision

© The Author(s) 2014. Little research has been undertaken on the actual decision-making processes in cancer care multidisciplinary meetings (MDMs). This article was based on a qualitative observational study of two regional cancer treatment centers in New Zealand. We audiorecorded 10 meetings in which 106 patient cases were discussed. Members of the meetings categorized cases in varying ways, drew on a range of sources of authority, expressed different value positions, and utilized a variety of strategies to justify their actions. An important dimension of authority was encountered authority - the authority a clinician has because of meeting the patient. The MDM chairperson can play an important role in making explicit the sources of authority being drawn on and the value positions of members to provide more clarity to the decision-making process. Attending to issues of process, authority, and values in MDMs has the potential to improve cancer care decision making and ultimately, health outcomes.

scholarly journals The controversy over the restructuring of perinatal emergency services in Portugal and the importance of citizen participation in health care decision-making processes

2015 ◽  
Vol 22 (3) ◽  
pp. 705-722 ◽  
Author(s):  
Ana Raquel Matos
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Citizen Participation ◽  
Emergency Services ◽  
Health Policies ◽  
Democratic Process ◽  
Health Care Decision ◽  
Decision Making Processes ◽  
Care Decision ◽  
Forms Of Knowledge

This article explores the controversial decision made by the Ministry of Health to restructure the perinatal emergency services in Portugal in 2006. Particular emphasis is given to the protests held across the country against, the actors involved, and the arguments put forward for and against the measure, in an attempt to understand the forms of knowledge and experiences brought to the discussion about the issues raised by the decision, and how different forms of knowledge are reconciled under a democratic process. In addition, this article explores the importance of citizen participation, including that which emerges from conflicting relations, in the formulation of health policies.

Cognitive Processing of Miscommunication in Interactive Listening: An Evaluation of Listener Indecision and Cognitive Effort

2021 ◽  
pp. 1-17
Author(s):  
Jennifer M. Roche ◽  
Arkady Zgonnikov ◽  
Laura M. Morett
Keyword(s):  
Decision Making ◽  
Cognitive Processing ◽  
Language Processing ◽  
Cognitive Effort ◽  
Mouse Tracking ◽  
Computer Mouse ◽  
Decision Making Processes ◽  
Computer Mouse Tracking ◽  
Listening Task ◽  
Processing Effort

Purpose The purpose of the current study was to evaluate the social and cognitive underpinnings of miscommunication during an interactive listening task. Method An eye and computer mouse–tracking visual-world paradigm was used to investigate how a listener's cognitive effort (local and global) and decision-making processes were affected by a speaker's use of ambiguity that led to a miscommunication. Results Experiments 1 and 2 found that an environmental cue that made a miscommunication more or less salient impacted listener language processing effort (eye-tracking). Experiment 2 also indicated that listeners may develop different processing heuristics dependent upon the speaker's use of ambiguity that led to a miscommunication, exerting a significant impact on cognition and decision making. We also found that perspective-taking effort and decision-making complexity metrics (computer mouse tracking) predict language processing effort, indicating that instances of miscommunication produced cognitive consequences of indecision, thinking, and cognitive pull. Conclusion Together, these results indicate that listeners behave both reciprocally and adaptively when miscommunications occur, but the way they respond is largely dependent upon the type of ambiguity and how often it is produced by the speaker.

“It's Not Humanly Possible to Do Everything”: Perspectives on Intervention Decision-Making Processes of Parents of Children with Autism Spectrum Disorders

2015 ◽  
Vol 22 (1) ◽  
pp. 13-21 ◽  
Author(s):  
Erinn Finke ◽  
Kathryn Drager ◽  
Elizabeth C. Serpentine
Keyword(s):  
Decision Making ◽  
Individualized Education Program ◽  
Children With Autism ◽  
Autism Spectrum ◽  
Sources Of Information ◽  
Individual Decision ◽  
Decision Making Processes ◽  
Spectrum Disorders ◽  
Interview Methodology ◽  
Communication Interventions

Purpose The purpose of this investigation was to understand the decision-making processes used by parents of children with autism spectrum disorder (ASD) related to communication-based interventions. Method Qualitative interview methodology was used. Data were gathered through interviews. Each parent had a child with ASD who was at least four-years-old; lived with their child with ASD; had a child with ASD without functional speech for communication; and used at least two different communication interventions. Results Parents considered several sources of information for learning about interventions and provided various reasons to initiate and discontinue a communication intervention. Parents also discussed challenges introduced once opinions of the school individualized education program (IEP) team had to be considered. Conclusions Parents of children with ASD primarily use individual decision-making processes to select interventions. This discrepancy speaks to the need for parents and professionals to share a common “language” about interventions and the decision-making process.

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