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Watson JL. A New Paradigm for Nurse Leader Decision-Making Within Complex Adaptive Systems. Nurs Adm Q 2024; 48:209-217. [PMID: 38848482 DOI: 10.1097/naq.0000000000000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Health care is a complex and ever-changing environment for nurse leaders and other health care industry decision-makers. The prevailing leadership and decision-making models, rooted in Industrial Age principles, often struggle to adapt to the complexities of modern health care. This article explores the foundations of complexity science and its application to health care decision-making, highlighting the importance of understanding systems dynamics and embracing complexity. Drawing from systems knowledge, the Cynefin Sensemaking Framework, and understanding how to develop enabling constraints, nurse leaders can navigate the complexities of health care by identifying the nature of the problem and applying appropriate decision-making strategies, fostering agility and innovation. By embracing complexity and adopting adaptive leadership approaches, nurse leaders can pragmatically navigate the complexities of modern health care and drive transformative change. This manuscript provides methods for nurse leaders to enhance decision-making within the dynamic landscape of health care as a complex adaptive system.
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Affiliation(s)
- Joni L Watson
- The Creating Collective, LLC, Rockwall, Texas; and Duke University School of Nursing, Durham, North Carolina
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2
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Hou Y, Corbally M, Timmins F. Violence against nurses by patients and visitors in the emergency department: A concept analysis. J Nurs Manag 2022; 30:1688-1699. [PMID: 35700325 PMCID: PMC9795924 DOI: 10.1111/jonm.13721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 12/30/2022]
Abstract
AIM This analysis investigates the concept of violence against nurses by patients and visitors in the emergency department. It aims to differentiate, clarify, and clearly identify this specific concept, which will facilitate more apt measurement and reporting, ultimately to contribute violence reduction measures. BACKGROUND Due to contextual factors, occupational risk and patient characteristics, violence against nurses by patients and visitors in the emergency department varies from other types of violence against other health care staff. METHODS This study employed Walker and Avant's concept analysis technique. RESULTS The analysis found that violence against nurses by patients and visitors in the emergency department is primarily an occurrence of interpersonal violence based on the working relationship, whereby the patient and/or visitor becomes an assailant, and a nurse becomes a target in the absence of capable guardianship. There is also an intentional use of physical force or power, which results in or has a high chance of causing harm. CONCLUSION A clearer understanding of the antecedents, attributes, and consequences of violence against nurses by patients and visitors arising from this concept analysis provides a framework that will assist in the understanding, measurement, reporting, and prevention of violence and inform future research. IMPLICATIONS FOR NURSING MANAGEMENT Nursing managers are encouraged to adopt strategies that act on the factors related to attributes and antecedents that will serve to reduce the occurrence of intentional violent acts.
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Affiliation(s)
- Yongchao Hou
- Emergency DepartmentShanXi Provincial People's HospitalTaiyuanShanXiChina
| | - Melissa Corbally
- School of Nursing and MidwiferyTrinity College DublinDublinIreland
| | - Fiona Timmins
- School of Nursing, Midwifery & Health SystemsUniversity College DublinDublinIreland
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Sloss EA, Jones TL. Nurse Cognition, Decision Support, and Barcode Medication Administration: A Conceptual Framework for Research, Practice, and Education. Comput Inform Nurs 2021; 39:851-857. [PMID: 33935198 DOI: 10.1097/cin.0000000000000724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article synthesizes theoretical perspectives related to nurse cognition. We present a conceptual model that can be used by multiple stakeholders to study and contemplate how nurses use clinical decision support systems, and specifically, Barcode-Assisted Medication Administration, to make decisions during the delivery of care. Theoretical perspectives integrated into the model include dual process theory, the Cognitive Continuum Theory, human factors engineering, and the Recognition-Primed Decision model. The resulting framework illustrates the process of nurse cognition during Barcode-Assisted Medication Administration. Additionally, the model includes individual or human and environmental factors that may influence nurse cognition and decision making. It is important to consider the influence of individual, human, and environmental factors on the process of nurse cognition and decision making. Specifically, it is necessary to explore the impact of heuristics and biases on clinician decision making, particularly related to the development of alarm and alert fatigue. Aided by the proposed framework, stakeholders may begin to identify heuristics and cognitive biases that influence the decision of clinicians to accept or override a clinical decision support system alert and whether heuristics and biases are associated with inappropriate alert override.
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Affiliation(s)
- Elizabeth Ann Sloss
- Author Affiliations: Department of Professional Nursing Practice, Georgetown University (Ms Sloss), Washington, DC; and Department of Adult Health and Nursing Systems, Virginia Commonwealth University (Dr Jones), Richmond
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Cartron E, Lefebvre S, Jovic L. Le savoir expérientiel : exploration épistémologique d’une expression répandue dans le domaine de la santé. Rech Soins Infirm 2021; 144:76-86. [DOI: 10.3917/rsi.144.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Dowding D, Russell D, McDonald MV, Trifilio M, Song J, Brickner C, Shang J. "A catalyst for action": Factors for implementing clinical risk prediction models of infection in home care settings. J Am Med Inform Assoc 2021; 28:334-341. [PMID: 33260204 PMCID: PMC7883974 DOI: 10.1093/jamia/ocaa267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/05/2020] [Accepted: 10/19/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The study sought to outline how a clinical risk prediction model for identifying patients at risk of infection is perceived by home care nurses, and to inform how the output of the model could be integrated into a clinical workflow. MATERIALS AND METHODS This was a qualitative study using semi-structured interviews with 50 home care nurses. Interviews explored nurses' perceptions of clinical risk prediction models, their experiences using them in practice, and what elements are important for the implementation of a clinical risk prediction model focusing on infection. Interviews were audio-taped and transcribed, with data evaluated using thematic analysis. RESULTS Two themes were derived from the data: (1) informing nursing practice, which outlined how a clinical risk prediction model could inform nurse clinical judgment and be used to modify their care plan interventions, and (2) operationalizing the score, which summarized how the clinical risk prediction model could be incorporated in home care settings. DISCUSSION The findings indicate that home care nurses would find a clinical risk prediction model for infection useful, as long as it provided both context around the reasons why a patient was deemed to be at high risk and provided some guidance for action. CONCLUSIONS It is important to evaluate the potential feasibility and acceptability of a clinical risk prediction model, to inform the intervention design and implementation strategy. The results of this study can provide guidance for the development of the clinical risk prediction tool as an intervention for integration in home care settings.
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Affiliation(s)
- Dawn Dowding
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - David Russell
- Department of Sociology, Appalachian State University, Boone, North Carolina, USA
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, New York, USA
| | - Margaret V McDonald
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, New York, USA
| | - Marygrace Trifilio
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, New York, USA
| | - Jiyoun Song
- Columbia University School of Nursing, New York, New York, USA
| | - Carlin Brickner
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, New York, USA
- Business Intelligence and Analytics, Visiting Nurse Service of New York, New York, New York, USA
| | - Jingjing Shang
- Columbia University School of Nursing, New York, New York, USA
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Apophenia, unconscious bias and reflexivity in nursing qualitative research. Int J Nurs Stud 2019; 89:8-13. [DOI: 10.1016/j.ijnurstu.2018.09.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 11/17/2022]
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Wright AI, Hurst NM. Personal Infant Feeding Experiences of Postpartum Nurses Affect How They Provide Breastfeeding Support. J Obstet Gynecol Neonatal Nurs 2018; 47:342-351. [DOI: 10.1016/j.jogn.2018.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2018] [Indexed: 11/27/2022] Open
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Expert Nurses' Perceptions of the Relevance of Carper's Patterns of Knowing to Junior Nurses. ANS Adv Nurs Sci 2017; 40:85-102. [PMID: 27525963 DOI: 10.1097/ans.0000000000000142] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study explored with expert nurses in the UK how nursing wisdom can be developed in new and junior nurses. Carper's patterns of knowing and Benner's novice-to-expert continuum formed the theoretical framework. Employing a constructionist research methodology with participant engagement in co-construction of findings, data were collected via 2 separate cycles comprising 4 consecutive sessions followed by a nationally advertised miniconference. Empirical, ethical, personal, and esthetic knowing was considered evident in junior nurses. Junior nurses in the UK seem to lack a previously unrecognized domain of organizational knowing without which they cannot overcome hegemonic barriers to the successful development of nursing praxis.
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Lean Keng S, AlQudah HNI. Assessment of cognitive bias in decision-making and leadership styles among critical care nurses: a mixed methods study. J Adv Nurs 2016; 73:465-481. [PMID: 27601180 DOI: 10.1111/jan.13142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2016] [Indexed: 11/30/2022]
Abstract
AIMS To raise awareness of critical care nurses' cognitive bias in decision-making, its relationship with leadership styles and its impact on care delivery. BACKGROUND The relationship between critical care nurses' decision-making and leadership styles in hospitals has been widely studied, but the influence of cognitive bias on decision-making and leadership styles in critical care environments remains poorly understood, particularly in Jordan. DESIGN Two-phase mixed methods sequential explanatory design and grounded theory. SETTING critical care unit, Prince Hamza Hospital, Jordan. Participant sampling: convenience sampling Phase 1 (quantitative, n = 96), purposive sampling Phase 2 (qualitative, n = 20). METHODS Pilot tested quantitative survey of 96 critical care nurses in 2012. Qualitative in-depth interviews, informed by quantitative results, with 20 critical care nurses in 2013. Descriptive and simple linear regression quantitative data analyses. Thematic (constant comparative) qualitative data analysis. RESULTS Quantitative - correlations found between rationality and cognitive bias, rationality and task-oriented leadership styles, cognitive bias and democratic communication styles and cognitive bias and task-oriented leadership styles. Qualitative - 'being competent', 'organizational structures', 'feeling self-confident' and 'being supported' in the work environment identified as key factors influencing critical care nurses' cognitive bias in decision-making and leadership styles. Two-way impact (strengthening and weakening) of cognitive bias in decision-making and leadership styles on critical care nurses' practice performance. CONCLUSION There is a need to heighten critical care nurses' consciousness of cognitive bias in decision-making and leadership styles and its impact and to develop organization-level strategies to increase non-biased decision-making.
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Affiliation(s)
- Soon Lean Keng
- School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
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How best practices are copied, transferred, or translated between health care facilities: A conceptual framework. Health Care Manage Rev 2016; 40:193-202. [PMID: 24787750 DOI: 10.1097/hmr.0000000000000023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION In spite of significant investment in quality programs and activities, there is a persistent struggle to achieve quality outcomes and performance improvements within the constraints and support of sociopolitical parsimonies. Equally, such constraints have intensified the need to better understand the best practice methods for achieving quality improvements in health care organizations over time.This study proposes a conceptual framework to assist with strategies for the copying, transferring, and/or translation of best practice between different health care facilities. PURPOSE Applying a deductive logic, the conceptual framework was developed by blending selected theoretical lenses drawn from the knowledge management and organizational learning literatures. FINDINGS The proposed framework highlighted that (a) major constraints need to be addressed to turn best practices into everyday practices and (b) double-loop learning is an adequate learning mode to copy and to transfer best practices and deuteron learning mode is a more suitable learning mode for translating best practice. We also found that, in complex organizations, copying, transferring, and translating new knowledge is more difficult than in smaller, less complex organizations. We also posit that knowledge translation cannot happen without transfer and copy, and transfer cannot happen without copy of best practices. Hence, an integration of all three learning processes is required for knowledge translation (copy best practice-transfer knowledge about best practice-translation of best practice into new context). In addition, the higher the level of complexity of the organization, the more best practice is tacit oriented and, in this case, the higher the level of K&L capabilities are required to successfully copy, transfer, and/or translate best practices between organizations. PRACTICE IMPLICATIONS The approach provides a framework for assessing organizational context and capabilities to guide copy/transfer/translation of best practices. A roadmap is provided to assist managers and practitioners to select appropriate learning modes for building success and positive systemic change.
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A Survey to Determine Decision-Making Styles of Working Paramedics and Student Paramedics. CAN J EMERG MED 2016; 18:213-22. [PMID: 26832320 DOI: 10.1017/cem.2015.95] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Two major processes underlie human decision-making: experiential (intuitive) and rational (conscious) thinking. The predominant thinking process used by working paramedics and student paramedics to make clinical decisions is unknown. METHODS A survey was administered to ground ambulance paramedics and to primary care paramedic students. The survey included demographic questions and the Rational Experiential Inventory-40, a validated psychometric tool involving 40 questions. Twenty questions evaluated each thinking style: 10 assessed preference and 10 assessed ability to use that style. Responses were provided on a five-point Likert scale, with higher scores indicating higher affinity for the style in question. Analysis included both descriptive statistics and t tests to evaluate differences in thinking style. RESULTS The response rate was 88.4% (1172/1326). Paramedics (n=904) had a median age of 36 years (IQR 29-42) and most were male (69.5%) and primary or advanced care paramedics (PCP=55.5%; ACP=32.5%). Paramedic students (n=268) had a median age of 23 years (IQR 21-26), most were male (63.1%) and had completed high school (31.7%) or an undergraduate degree (25.4%) prior to paramedic training. Both groups scored their ability to use and favourability toward rational thinking significantly higher than experiential thinking. The mean score for rational thinking was 3.86/5 among paramedics and 3.97/5 among paramedic students (p<0.001). The mean score for experiential thinking was 3.41/5 among paramedics and 3.35/5 among paramedic students (p=0.06). CONCLUSION Working paramedics and student paramedics prefer and perceive that they have the ability to use rational over experiential thinking. This information adds to our current knowledge on paramedic decision-making and is potentially important for developing continuing education and clinical support tools.
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Logan G. Clinical judgment and decision making in wound assessment and management: is experience enough? Br J Community Nurs 2015; Suppl Wound Care:S21-S28. [PMID: 25790510 DOI: 10.12968/bjcn.2015.20.sup3.s21] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The assessment and management of wounds forms a large proportion of community nurses' workload, often requiring judgment and decision-making in complex, challenging and uncertain circumstances. The processes through which nurses form judgments and make decisions within this context are reviewed in this article against existing theories on these on these subjects. There is variability in wound assessment and management practice which may be attributed to uncertainties within the context, a lack of knowledge in appropriate treatment choices and the inability to correctly value the importance of the clinical information presented. Nurses may be required to draw on intuition to guide their judgments and decision-making by association with experience and expertise. In addition, a step-by-step analytical approach underpinned by an evidence base may be required to ensure accuracy in practice. Developing an understanding of the different theories of judgment and decision-making may facilitate nurses' abilities to reflect on their own decision tasks, thereby enhancing the care provided.
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Lis GA, Hanson P, Burgermeister D, Banfield B. Transforming Graduate Nursing Education in the Context of Complex Adaptive Systems: Implications for Master's and DNP Curricula. J Prof Nurs 2014; 30:456-62. [DOI: 10.1016/j.profnurs.2014.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Indexed: 11/27/2022]
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van Bekkum JE, Hilton S. Primary care nurses' experiences of how the mass media influence frontline healthcare in the UK. BMC FAMILY PRACTICE 2013; 14:178. [PMID: 24267614 PMCID: PMC4222829 DOI: 10.1186/1471-2296-14-178] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 11/19/2013] [Indexed: 11/18/2022]
Abstract
Background Mass media plays an important role in communicating about health research and services to patients, and in shaping public perceptions and decisions about health. Healthcare professionals also play an important role in providing patients with credible, evidence-based and up-to-date information on a wide range of health issues. This study aims to explore primary care nurses’ experiences of how mass media influences frontline healthcare. Methods In-depth telephone interviews were carried out with 18 primary care nurses (nine health visitors and nine practice nurses) working in the United Kingdom (UK). Interviews were recorded and transcribed. The data was analysed using thematic analysis, with a focus on constant comparative analysis. Results Three themes emerged from the data. First, participants reported that their patients were frequently influenced by controversial health stories reported in the media, which affected their perceptions of, and decisions about, care. This, in turn, impinged upon participants’ workloads as they had to spend additional time discussing information and reassuring patients. Second, participants also recalled times in their own careers when media reports had contributed to a decline in their confidence in current healthcare practices and treatments. Third, the participants in this study suggested a real need for additional resources to support and expand their own media literacy skills, which could be shared with patients. Conclusion In an ever expanding media landscape with greater reporting on health, nurses working in the primary care setting face increasing pressure to effectively manage media stories that dispute current health policies and practices. These primary care nurses were keen to expand their media literacy skills to develop critical autonomy in relation to all media, and to facilitate more meaningful conversations with their patients about their health concerns and choices.
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Morgan A. Call yourself a nurse! Defending the clinical credibility of educators and managers in intensive care. Nurs Crit Care 2013; 17:271-4. [PMID: 23061615 DOI: 10.1111/j.1478-5153.2012.00535.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Noon AJ. The cognitive processes underpinning clinical decision in triage assessment: a theoretical conundrum? Int Emerg Nurs 2013; 22:40-6. [PMID: 23685041 DOI: 10.1016/j.ienj.2013.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 01/13/2013] [Accepted: 01/18/2013] [Indexed: 10/26/2022]
Abstract
High quality clinical decision-making (CDM) has been highlighted as a priority across the nursing profession. Triage nurses, in the Accident and Emergency (A&E) department, work in considerable levels of uncertainty and require essential skills including: critical thinking, evaluation and decision-making. The content of this paper aims to promote awareness of how triage nurses make judgements and decisions in emergency situations. By exploring relevant literature on clinical judgement and decision-making theory, this paper demonstrates the importance of high quality decision-making skills underpinning the triage nurse's role. Having an awareness of how judgements and decisions are made is argued as essential, in a time where traditional nurse boundaries and responsibilities are never more challenged. It is hoped that the paper not only raises this awareness in general but also, in particular, engages the triage nurse to look more critically at how they make their own decisions in their everyday practice.
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Affiliation(s)
- Amy J Noon
- King's College Hospital Foundation Trust, Accident and Emergency Department, Denmark Hill, SE5 9RS, United Kingdom.
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Kay Hogan B. Caring as a scripted discourse versus caring as an expression of an authentic relationship between self and other. Issues Ment Health Nurs 2013; 34:375-9. [PMID: 23663025 DOI: 10.3109/01612840.2013.768734] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
As health care has become increasingly complex, the human caring associated with nursing has become eclipsed by financial bottom lines and managed care initiatives. Because patients and others expect a caring health care system, hospitals have responded in varying ways to re-infuse caring into the patient's experience. This article examines two approaches (the Jean Watson Caring Science Approach and the Studer Group Approach) and considers the effect of each on the authenticity of the nurse patient relationship.
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Affiliation(s)
- Beverly Kay Hogan
- Medical Sociology, University of Alabama at Birmingham, Birmingham, Alabama 35294-1152, USA.
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Affiliation(s)
- Jan Jensen
- Provincial Research Leader, Emergency Health Services and Lecturer, Dalhousie University Nova Scotia, US
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Clinical decision making of nurses working in hospital settings. Nurs Res Pract 2011; 2011:524918. [PMID: 21994830 PMCID: PMC3182333 DOI: 10.1155/2011/524918] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 07/28/2011] [Indexed: 11/17/2022] Open
Abstract
This study analyzed nurses' perceptions of clinical decision making (CDM) in their clinical practice and compared differences in decision making related to nurse demographic and contextual variables. A cross-sectional survey was carried out with 2095 nurses in four hospitals in Norway. A 24-item Nursing Decision Making Instrument based on cognitive continuum theory was used to explore how nurses perceived their CDM when meeting an elective patient for the first time. Data were analyzed with descriptive frequencies, t-tests, Chi-Square test, and linear regression. Nurses' decision making was categorized into analytic-systematic, intuitive-interpretive, and quasi-rational models of CDM. Most nurses reported the use of quasi-rational models during CDM thereby supporting the tenet that cognition most often includes properties of both analysis and intuition. Increased use of intuitive-interpretive models of CDM was associated with years in present job, further education, male gender, higher age, and working in predominantly surgical units.
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Abstract
Approaches in assessment of process improvements by nurses are a timely issue, given a growing focus on changes in care delivery. Nineteen semistructured phone interviews with nurse managers whose units participated in a process improvement intervention were completed. The most prominent among assessment strategies was observation. Other strategies included quantitative data measurement, informal and formal feedback, and auditing processes. Understanding how nurses are evaluating interventions may contribute to improved measurement in the future.
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Bonner A, Lloyd A. What information counts at the moment of practice? Information practices of renal nurses. J Adv Nurs 2011; 67:1213-21. [DOI: 10.1111/j.1365-2648.2011.05613.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Beringer AJ, Fletcher ME. Developing practice and staff: enabling improvement in care delivery through participatory action research. J Child Health Care 2011; 15:59-70. [PMID: 21451011 DOI: 10.1177/1367493510395639] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We describe the process and outcomes of a programme to enable improvement in care coordination in a children's hospital. Staff identified care coordination issues they wanted to improve and were facilitated to achieve change using a participatory action research (PAR) approach. The seven participating wards were each offered the same opportunity and yet the degree to which they were able to engage in the process, and the level to which they achieved outcomes, varied considerably. The most successful wards were those with proactive leadership and stable management and where a trusting relationship was established between the staff and the programme facilitator. The least successful were those experiencing ward closure, mergers or changes in management structure. We consider how the different levels of achievement can be understood and what implications this has for using participatory action research to promote service improvement and to facilitate staff development.
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Affiliation(s)
- Antonia J Beringer
- Faculty of Health & Life Sciences, University of the West of England, Bristol, UK.
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Jenicek M, Croskerry P, Hitchcock DL. Evidence and its uses in health care and research: the role of critical thinking. Med Sci Monit 2011; 17:RA12-7. [PMID: 21169920 PMCID: PMC3524675 DOI: 10.12659/msm.881321] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 10/15/2010] [Indexed: 12/02/2022] Open
Abstract
Obtaining and critically appraising evidence is clearly not enough to make better decisions in clinical care. The evidence should be linked to the clinician's expertise, the patient's individual circumstances (including values and preferences), and clinical context and settings. We propose critical thinking and decision-making as the tools for making that link. Critical thinking is also called for in medical research and medical writing, especially where pre-canned methodologies are not enough. It is also involved in our exchanges of ideas at floor rounds, grand rounds and case discussions; our communications with patients and lay stakeholders in health care; and our writing of research papers, grant applications and grant reviews. Critical thinking is a learned process which benefits from teaching and guided practice like any discipline in health sciences. Training in critical thinking should be a part or a pre-requisite of the medical curriculum.
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Affiliation(s)
- Milos Jenicek
- Department of Clinical Epidemiology & Biostatistics, Michael G. de Groote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Pat Croskerry
- Department of Emergency Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David L. Hitchcock
- David L. Hitchcock, Department of Philosophy, Faculty of Humanities, McMaster University, Hamilton, Ontario, Canada
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Abstract
Our patients depend on us to do the best on their behalf. If we do not take accountability for our practice, continually examining what is the best way to deliver care, we are limiting our role to technical skills and not fully actualizing our professional role. [Evidence-based practice] is essential to practicing safely as nurses (p. 53).1.
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Mastrian K, McGonigle D. Cognitive informatics: An essential component of nursing technology design. Nurs Outlook 2008; 56:332-3. [DOI: 10.1016/j.outlook.2008.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Nyatanga B, Vocht HD. Intuition in clinical decision-making: a psychological penumbra. Int J Palliat Nurs 2008; 14:492-6. [DOI: 10.12968/ijpn.2008.14.10.31493] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Brian Nyatanga
- Institute of Health, Social Care and Psychology, University of Worcester, UK
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Paley J, Cheyne H, Dalgleish L, Duncan E, Niven C. In response to: Rolfe G. (2008) In response to Paley J., Cheyne H., Dalgleish L., Duncan E. & Niven C. (2007) Nursing’s ways of knowing and dual process theories of cognition. Journal of Advanced Nursing 62(2), 268-269. J Adv Nurs 2008; 64:209-10. [DOI: 10.1111/j.1365-2648.2008.04848.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Thorne S. The role of qualitative research within an evidence-based context: can metasynthesis be the answer? Int J Nurs Stud 2008; 46:569-75. [PMID: 18617173 DOI: 10.1016/j.ijnurstu.2008.05.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 05/14/2008] [Accepted: 05/20/2008] [Indexed: 02/08/2023]
Abstract
The increasing emphasis on evidence in the health care planning and policy context has fuelled considerable discussion and debate in nursing circles on the appropriate place of the less favourably placed knowledge forms within the conventional evidentiary hierarchy. In this paper, nursing's affinity for qualitative methods, and the species of knowledge they generate, are considered within the context of this evolving evidence-based practice movement. Noting conceptual and terminological confusions around the notion of evidence such as have arisen within the nursing literature, the author argues for clarity in our collective thinking about the role of research in a nursing or any other applied practice discipline. Toward this end, she points to some of the newer approaches to research synthesis and integration that may hold particular promise for enhancing our confidence about what might properly constitute a qualitatively-derived evidentiary knowledge claim. Such approaches may assist nurses to work more comfortably within the evidence-based movement, assured that reliance upon scientifically sound reference points need not compromise the complexity, richness and diversity they recognize as inherent in practice context excellence.
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Affiliation(s)
- Sally Thorne
- University of British Columbia School of Nursing, T201-2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5.
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Rolfe G. In response to: Paley J., Cheyne H., Dalgleish L., Duncan E. & Niven C. (2007) Nursing’s ways of knowing and the dual process theories of cognition. Journal of Advanced Nursing 60(6), 692–701. J Adv Nurs 2008; 62:268-9. [DOI: 10.1111/j.1365-2648.2008.04664.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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