Naturalistic Decision Making: A Model to Overcome Methodological Challenges in the Study of Critical Care Nurses’ Decision Making About Patients’ Hemodynamic Status

2003 ◽  
Vol 12 (3) ◽  
pp. 206-211 ◽  
Author(s):  
Judy Currey ◽  
Mari Botti
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Well Being ◽  
Critical Care Nurses ◽  
Naturalistic Decision Making ◽  
Hemodynamic Status ◽  
Hemodynamic Assessment ◽  
Assessment And Treatment ◽  
Methodological Approaches

The quality of critical care nurses’ decision making about patients’ hemodynamic status in the immediate period after cardiac surgery is important for the patients’ well-being and, at times, survival. The way nurses respond to hemodynamic cues varies according to the nurses’ skills, experiences, and knowledge. Variability in decisions is also associated with the inherent complexity of hemodynamic monitoring. Previous methodological approaches to the study of hemodynamic assessment and treatment decisions have ignored the important interplay between nurses, the task, and the environment in which these decisions are made. The advantages of naturalistic decision making as a framework for studying the manner in which nurses make decisions are presented.

scholarly journals Lessons Learned From an Early Hotspot During the COVID-19 Pandemic

2021 ◽  
pp. 000313482199475
Author(s):  
Brett M. Chapman ◽  
George M. Fuhrman
Keyword(s):  
Decision Making ◽  
Surgical Education ◽  
Clinical Care ◽  
Well Being ◽  
Educational Environment ◽  
Lessons Learned ◽  
Residency Programs ◽  
Surgical Residency ◽  
The Impact

The Covid-19 pandemic has provided challenges for surgical residency programs demanding fluid decision making focused on providing care for our patients, maintaining an educational environment, and protecting the well-being of our residents. This brief report summarizes the impact of the impact on our residency programs clinical care and education. We have identified opportunities to improve our program using videoconferencing, managing recruitment, and maintaining a satisfactory caseload to ensure the highest possible quality of surgical education.

Improving the Perception of Patient-Centered Wellness in a Virtual Population During the COVID-19 Pandemic

2021 ◽  
pp. JDNP-D-20-00078
Author(s):  
Sybilla Myers ◽  
Christopher Kennedy
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Shared Decision Making ◽  
Cognitive Theory ◽  
Well Being ◽  
Mobile App ◽  
Shared Decision ◽  
Patient Centered ◽  
The Social

BackgroundPerceived health-related quality of life (HRQOL) is fundamental to well-being and is a meaningful way to measure physical and mental health.Local ProblemNo standard method exists for measuring perceived HRQOL during the COVID-19 pandemic in participants as they attempt to improve their self-determined wellness goals. An implementation plan that considers the social distancing limitations imposed can be used to predict an individual’s likelihood of long-term success.MethodsDuring the four, 2-week plan-do-study-act (PDSA) cycles, the Social Cognitive Theory model informed the implementation of the four core interventions. To guide iterative changes, the data was analyzed through Excel and run charts.InterventionsThe four core interventions were the shared decision-making tool (SDMT), health mobile app tool (HMAT), wellness tracker tool (WTT), and the team engagement plan.ResultsAmong 28 participants, perceived quality of life increased by 70%, engagement in shared decision-making increased to 82%, app use and confidence increased to 85%, and goal attainment reached 81%.ConclusionsThe SDMT, health app, and wellness tracker created a methodical plan of accountability for increasing participant wellness. The contextual barrier of the COVID-19 pandemic added a negative wellness burden which was mitigated by creating a patient-centered culture of wellness.

Caring for Gravely Ill Children

PEDIATRICS ◽  
1994 ◽  
Vol 94 (4) ◽  
pp. 433-439 ◽  
Author(s):  
Alan R. Fleischman ◽  
Kathleen Nolan ◽  
Nancy N. Dubler ◽  
Michael F. Epstein ◽  
Mary Ann Gerben ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health Care Professionals ◽  
Treatment Plan ◽  
Ethics Committees ◽  
Well Being ◽  
Pediatric Health Care ◽  
Spiritual Well Being ◽  
Primary Focus

Background. Much has been written about the care of the hopelessly ill adult, but there is little guidance for pediatric health care professionals in the management of children who are critically or terminally ill. Methods. Through a 3-day meeting in Tarrytown, NY, attended by a group of pediatricians and others directly involved in these issues, a principled approach was developed for the treatment of, and health care decision-making for, children who are gravely ill. Results. The group agreed that the needs and interests of the child must be the central focus of any treatment plan and that the child should be involved to as great extent possible, consistent with developmental maturity, in the decision-making process. Quality of future life should be viewed as being relevant in all decisions. Parents are believed to be the natural guardians of children and ought to have great latitude in making decisions for them. However, parental discretion is not absolute and professionals must maintain an independent obligation to protect the child's interests. Conclusions. Decision-making should be collaborative among patient, parents, and professionals. When conflict arises, consultation and ethics committees may assist in resolution. When cure or restoration of function is no longer possible, or reasonable, promotion of comfort becomes the primary goal of management. Optimal use of pain medication and compassionate concern for the physical, psychological, and spiritual well-being of the child and family should be the primary focus of the professionals caring for the dying child.

IV inotropic agents: dopamine, dobutamine, and amrinone

1990 ◽  
Vol 10 (2) ◽  
pp. 54-62 ◽  
Author(s):  
J Budny ◽  
K Anderson-Drevs
Keyword(s):  
Critical Care ◽  
Quality Of Care ◽  
Side Effects ◽  
Mechanisms Of Action ◽  
Critical Care Nurses ◽  
Inotropic Agents ◽  
Individual Actions

Three commonly used IV inotropic agents--dopamine, dobutamine, and amrinone--have been discussed in this article. Knowledge of their common mechanisms of action, individual actions, dosages, methods of preparation, precautions, and side effects can only help critical care nurses maintain or improve the quality of care given to patients receiving these medications.

Reimagining the Humble but Mighty Pen: Quality Measurement and Naturalistic Decision Making

2018 ◽  
Vol 12 (3) ◽  
pp. 198-201 ◽  
Author(s):  
Eric C. Schneider
Keyword(s):  
Decision Making ◽  
Best Practices ◽  
Pay For Performance ◽  
Quality Measurement ◽  
Daily Practice ◽  
Cost Of Care ◽  
Naturalistic Decision Making ◽  
Joint Decisions ◽  
The Cost

Much of the health system’s avoidable spending may be driven by doctors’ decision making. Past studies demonstrated potentially consequential and costly inconsistencies between the actual decisions that clinicians make in daily practice and optimal evidence-based decisions. This commentary examines the “best practices regimen” through the lens of the quality measurement movement.  Although quality measures have proliferated via public reporting and pay-for-performance programs, evidence for their impact on quality of care is scant; the cost of care has continued to rise; and the environment for clinical decisions may not have improved. Naturalistic decision making offers a compelling alternative conceptual frame for quality measurement. An alternative quality measurement system could build on insights from naturalistic decision making to optimize doctors’ and patients’ joint decisions, improve patients’ health outcomes, and perhaps slow the growth of health care spending in the future.

Compassion Satisfaction, Burnout, and Secondary Traumatic Stress Among Critical Care Nurses in Iran

2019 ◽  
Vol 31 (1) ◽  
pp. 59-66 ◽  
Author(s):  
Sedigheh Salimi ◽  
Vahid Pakpour ◽  
Azad Rahmani ◽  
Marian Wilson ◽  
Hossein Feizollahzadeh
Keyword(s):  
Quality Of Life ◽  
Critical Care ◽  
Compassion Fatigue ◽  
Traumatic Stress ◽  
Secondary Traumatic Stress ◽  
Compassion Satisfaction ◽  
Critical Care Nurses ◽  
Professional Quality Of Life ◽  
Professional Quality

Introduction: This study investigated the relationship between compassion fatigue and compassion satisfaction among Iranian nurses working in critical care units. Method: A cross-sectional, descriptive survey using the Professional Quality of Life instrument was administered to 400 nurses working in the intensive care units of Iranian hospitals. Results: High risk levels of burnout and secondary traumatic stress existed among 42% and 96% of participants, respectively. Significant positive relationships were detected between burnout and secondary traumatic stress. An inverse relationship was detected between measures of compassion fatigue and compassion satisfaction. Discussion: To ensure culturally congruent care, it is important to evaluate professional quality of life within the context of specific cultures and societies. Iranian critical care nurses are at risk for burnout and secondary traumatic stress. Personal self-care and organizational wellness approaches that consider cultural norms should be designed to boost compassion satisfaction and reduce negative effects of stressful work environments.

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