Concept analysis of decision making

Parental Decision-Making in Pediatric Intensive Care: A Concept Analysis

The development of nursing knowledge requires a close relationship between theory, research, and practice. The purpose of the analysis of the concept of "parental decision-making in pediatric critical care" is to facilitate nurses' therapeutic care of critically ill children and their families. To construct, structure, and give meaning to the concept, we use our experience in the field, critical reading of the literature, and careful analysis of data that have emerged about parental decision-making in pediatric intensive care. Several factors affect parent's ability to act as decision-makers: the psychosocial and physical disorders they develop, the subordination of their parental roles by the health care team, and the child's critical state of health. While different disciplines, including nursing, have well described the decision-making concept, parental decision-making in the context of pediatric intensive care has not been as well delineated. Nursing science recognizes the importance of decision-making and has incorporated the concept as an essential domain of its philosophical and disciplinary interests. Following the method proposed by Walker and Avant, the concept was analyzed, attributes, background, and consequences described. A model case was presented and discussed. An operational definition emerges, providing knowledge for professional nursing practice and will be the basis for an essential theoretical development around this phenomenon. Parents' recognition, the promotion of family-centered care, and shared decisions are ideal for encouraging parental participation.

Decision-making on the location of care of the elderly: protocol for a systematic review of qualitative studies

INTRODUCTION

The elderly must take part in the management of their own health. One of the aspects they should be able to decide on is the place where they want to live. The aim of this review is to synthetise qualitative evidence in order to understand how decisions are made on the location of care of the elderly.

METHODS AND ANALYSIS

Systematic review of qualitative studies. Six databases have been consulted: Web of Science, PubMed, Scopus, CINAHL Complete, PsycINFO and SciELO Citation Index (from the beginning to 29 November 2017). The inclusion criteria will be: studies that deal with the decision-making process on the location of care of the elderly (already experienced by the participants), original studies, qualitative or mixed-method studies and studies written in English or Spanish. The obtained results will be exported to the Zotero bibliography manager. The references will be reviewed by title and abstract and, later, the complete texts will be reviewed for their inclusion. A tool created for this study will be used to extract the data. The quality will be assessed with Critical Appraisal Skills Programme Español. The data synthesis will be carried out using the constant comparative method. All this process will be performed independently by two reviewers. Enhancing transparency in reporting the synthesis of qualitative research has been used to draw up this protocol.

ETHICS AND DISSEMINATION

This protocol did not require ethical approval, since it is a protocol for a systematic review. The plans to disseminate our results include publishing a research paper in a high-impact journal in our study area. Also, if possible, our results will be presented in scientific conferences. Besides, the obtained results will complement and discuss the doctoral thesis of one of the authors of the review.

PROSPERO REGISTRATION NUMBER

CRD42018084826.

Clinical Reasoning in Experienced Nurses

As an essential component of nursing practice, clinical reasoning is used to assimilate information, analyze data, and make decisions regarding patient care. Little is known about the reasoning strategies of experienced nurses who are not yet experts. This qualitative descriptive study explored the cognitive strategies used by experienced nurses as they considered assessment findings of assigned patients. To date, few studies of nurses' clinical reasoning have been conducted in a practice setting during actual patient care. A small group research design was employed using the think-aloud (TA) method with protocol analysis. A total of 15 experienced nurses were asked to “think aloud” about patient assessment findings. Data were audiotaped, transcribed, and analyzed using the three steps of protocol analysis. The results suggest that experienced nurses used a conceptual language to reason about assessment findings and used heuristics to reason more quickly and efficiently.

Decision Making in Nursing Practice: A Concept Analysis

PURPOSE

The study aims to gain an understanding of the concept of decision making as it relates to the nurse practice environment.

METHODS

Rodgers' evolutionary method on concept analysis was used as a framework for the study of the concept. Articles from 1952 to 2014 were reviewed from PsycINFO, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), JSTOR, PubMed, and Science Direct.

FINDINGS

Findings suggest that decision making in the nurse practice environment is a complex process, integral to the nursing profession. The definition of decision making, and the attributes, antecedents, and consequences, are discussed. Contextual factors that influence the process are also discussed. An exemplar is presented to illustrate the concept.

CONCLUSION

Decision making in the nurse practice environment is a dynamic conceptual process that may affect patient outcomes. Nurses need to call upon ways of knowing to make sound decisions and should be self-reflective in order to develop the process further in the professional arena. The need for further research is discussed.

Enhancing clinical decision making: development of a contiguous definition and conceptual framework

Clinical decision making is a term frequently used to describe the fundamental role of the nurse practitioner; however, other terms have been used interchangeably. The purpose of this article is to begin the process of developing a definition and framework of clinical decision making. The developed definition was "Clinical decision making is a contextual, continuous, and evolving process, where data are gathered, interpreted, and evaluated in order to select an evidence-based choice of action." A contiguous framework for clinical decision making specific for nurse practitioners is also proposed. Having a clear and unique understanding of clinical decision making will allow for consistent use of the term, which is relevant given the changing educational requirements for nurse practitioners and broadening scope of practice.

The cognitive processes underpinning clinical decision in triage assessment: a theoretical conundrum?

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.

Patient decision making among older individuals with cancer

Patient decision making is an area of increasing inquiry. For older individuals experiencing cancer, variations in health and functional status, physiologic aspects of aging, and tension between quality and quantity of life present unique challenges to treatment-related decision making. We used the pragmatic utility method to analyze the concept of patient decision making in the context of older individuals with cancer. We first evaluated its maturity in existing literature and then posed analytical questions to clarify aspects found to be only partially mature. In this context, we found patient decision making to be an ongoing process, changing with time, reflecting individual and relational components, as well as analytical and emotional ones. Assumptions frequently associated with patient decision making were not consistent with the empirical literature. Careful attention to the multifaceted components of patient decision making among older individuals with cancer provides guidance for research, supportive interventions, and targeted follow-up care.

Development of data models for nursing assessment of cancer survivors using concept analysis

Objectives

Sharing of cancer-related information among healthcare professionals is crucial to ensuring the quality of long-term care for cancer survivors. Appropriate distribution of the essential facts can be achieved using data models. The purpose of this study was to develop and validate suitable data models for use in the nursing assessment of cancer survivors.

Methods

The models developed in this study were based on a modification of concept analysis developed by Walker and Avant. Our approach involved determining the purpose of the analysis, identifying data elements, defining these elements and their uses, determining critical attributes, value sets, and cardinalities, and ultimately constructing data models which were examined externally by domain experts.

Results

We developed 112 data models with 112 data elements, 29 critical attributes, 102 value sets, and 6 data types for the assessment of cancer survivors. External validation revealed that the data elements, critical attributes, and value sets proposed were comprehensive, relevant, and sufficiently useful to encompass nursing issues related to cancer survivors.

Conclusions

Data models developed in this study will contribute to ensuring the semantic consistency of data collected from cancer survivors, which will improve the quality of nursing assessments and in turn translate to improved long-term patient care.

Flight nursing expertise: towards a middle-range theory

AIM

This paper presents a middle-range Theory of Flight Nursing Expertise.

BACKGROUND

Rotary-wing (helicopter) medical transport has grown rapidly in the USA since its introduction, particularly during the past 5 years. Patients once considered too sick to transport are now being transported more frequently and over longer distances. Many limitations are imposed by the air medical transport environment and these require nurses to alter their practice.

DATA SOURCES

A literature search was conducted using Pubmed, Medline, CINAHL, secondary referencing and an Internet search from 1960 to 2008 for studies related to the focal concepts in flight nursing.

DISCUSSION

The middle-range Theory of Flight Nursing Expertise is composed of nine concepts (experience, training, transport environment of care, psychomotor skills, flight nursing knowledge, cue recognition, pattern recognition, decision-making and action) and their relationships. Five propositions describe the relationships between those concepts and how they apply to flight nursing expertise.

IMPLICATIONS FOR NURSING

After empirical testing, this theory may be a useful tool to assist novice flight nurses to attain the skills necessary to provide safe and competent care more efficiently, and may aid in designing curricula and programmes of research.

CONCLUSION

Research is needed to determine the usefulness of this theory in both rotary and fixed-wing medical transport settings, and to examine the similarities and differences related to expertise needed for different flight nurse team compositions. Curriculum and training innovations can result from increased understanding of the concepts and relationships proposed in this theory.

Clinical reasoning and its application to nursing: concepts and research studies

Clinical reasoning may be defined as "the process of applying knowledge and expertise to a clinical situation to develop a solution" [Carr, S., 2004. A framework for understanding clinical reasoning in community nursing. J. Clin. Nursing 13 (7), 850-857]. Several forms of reasoning exist each has its own merits and uses. Reasoning involves the processes of cognition or thinking and metacognition. In nursing, clinical reasoning skills are an expected component of expert and competent practise. Nurse research studies have identified concepts, processes and thinking strategies that might underpin the clinical reasoning used by pre-registration nurses and experienced nurses. Much of the available research on reasoning is based on the use of the think aloud approach. Although this is a useful method, it is dependent on ability to describe and verbalise the reasoning process. More nursing research is needed to explore the clinical reasoning process. Investment in teaching and learning methods is needed to enhance clinical reasoning skills in nurses.

Clinical Judgments About Endotracheal Suctioning: What Cues Do Expert Pediatric Critical Care Nurses Consider?

Making accurate and timely judgments based on multiple ways of knowing is an essential skill in critical care nursing practice. Studies have proposed that positive patient outcomes are linked to expert judgments in a variety of critical care situations; however, little is known about clinical judgments related to specific critical care nursing interventions. This article presents a qualitative nursing research study which examined the cues that expert pediatric critical care nurses used in making clinical judgments about suctioning intubated and ventilated, critically ill children. The participants' words and actions attest that the 'sensing' and 'thinking' of the process of cue use, are interwoven with, and integral to, the 'doing,' which is the process of skilled performance.

Medical and nursing clinical decision making: a comparative epistemological analysis

The aim of this article is to explore the complex forms of knowledge involved in diagnostic and interventional decision making by comparing the processes in medicine and nursing, including nurse practitioners. Many authors assert that the practice of clinical decision making involves the application of theoretical knowledge (acquired in the classroom and textbooks) as well as research evidence, upon concrete particular cases. This approach draws on various universal principles and algorithms to facilitate the task. On the other hand, others argue that this involves an intuitive form of judgement that is difficult to teach, one that is acquired principally through experience. In an exploration of these issues, this article consists of three sections. A clarification of terms commonly used when discussing decision making is provided in the first section. In the second section, an epistemological analysis of decision making is presented by examining several perspectives and comparing them for their use in the nursing and medical literature. Bunge's epistemological framework for decision making (based on scientific realism) is explored for its fit with the aims of medicine and nursing. The final section presents a discussion of knowledge utilization and decision making as it relates to the implications for the education and ongoing development of nurse practitioners. It is concluded that Donald Schön's conception of reflective practice best characterizes the skillful conduct of clinical decision making.

Characteristics, insights, decision making, and preparation of ED triage nurses

INTRODUCTION

The purpose of this study was to describe characteristics, insights, and decision making of expert emergency nurses practicing in a triage environment.

METHODS

A qualitative, descriptive study design was used. A purposive sample of 10 expert nurses from 2 midwestern emergency departments was recruited for 2 separate focus groups. After transcribing from audiotapes, the data were collapsed to reflect the responses of participants from each focus group to each of the 6 questions asked.

RESULTS

A variety of themes emerged from the data to describe the decision-making characteristics of triage nurses from the perspective of the expert emergency nurse.

DISCUSSION

Expert triage nurses discussed the characteristics that they deemed important in themselves and in those they worked with, such as intuition, assessment abilities, good communication, and critical thinking. The participants strongly verbalized the need for more formal education and emergency nursing experience for new triage nurses. Positive reinforcement from management for timely and accurate decision making was also an important topic.

Concept analysis of decision making

TOPIC

Client decision making in relation to health care.

PURPOSE

To develop a conceptual analysis of client decision making regarding health care that represents the current state of the science in order to better understand how clients make decisions.

SOURCES

Published literature.

CONCLUSIONS

A model of client decision making is presented with implications for nursing. Defining attributes, antecedents, consequences, and empirical referents of decision making are developed and illustrated by case presentations.

Exercise participation decisions of Jordanian myocardial infarction patients: application of the decisional conflict theory

This study examined the utility of Janis and Mann's [Janis, I. L. & Mann, L. (1977). Decision making: a psychological analysis conflict, choice and commitment. New York, NY: Free press.] decisional conflict theory (DCT) in predicting decisions to exercise following hospitalization for a myocardial infarction (MI). A structured interview of operationalized DCT variables was conducted with 88 MI patients attending cardiology clinics in two Jordanian military hospitals. Stress was viewed as an indicator of exercise benefits-barriers decisional conflict. The findings revealed that the benefits-barriers interaction significantly predicted stress for the 48 patients who did not exercise. Rehospitalization for cardiac events was a significant predictor of stress for the 40 exercisers. Preinfarction exercise behavior, stress and gender were significant predictors of MI patients' decisions to exercise. Results of this study indicated that decisional conflict and stress were characteristics of MI patients who delayed or avoided exercising.

Nebraska school nurses identify emotional maltreatment of school-age children: a replication of an Ohio study

PURPOSE

To determine how often school nurses identify emotional maltreatment using validated vignettes.

DESIGN

Survey, with 16 behavior vignettes, mailed to 550 Nebraska school nurses. Four forms represented nonwhite and white, male and female children. Demographic questionnaire included.

SETTING

Survey mailed with regular spring school nurses' newsletter.

PARTICIPANTS

One hundred twenty-one school nurses completed and returned surveys.

MAIN OUTCOME MEASURES

Each vignette was an example of emotional abuse; subjects indicated "refer" or "not refer" decisions about the vignette. All items were positive for emotional abuse.

RESULTS

Sixty-four of 121 (53%) respondents correctly identified 13 or more vignettes as referable for emotional maltreatment. No influence of child gender and race on reporting decision. No nurse characteristics correlated with referral rates.

CONCLUSIONS

None of the variables studied significantly influenced school nurses' identification of emotional abuse. Further research is needed to ascertain correlation between text vignettes and reporting, and to identify interventions to increase the rate of identifying emotional abuse.

Facilitation: a concept analysis

The term 'facilitation' appears to be open to a wide variety of definitions and interpretations. If teachers are to act as facilitators of learning they need a clearer understanding of facilitations as a strategy for nursing education. This concept analysis uses Walker and Avant's framework. Following a review of the literature related to facilitation, the paper postulates that there are four critical attributes for effective facilitation: genuine mutual respect; a partnership in learning; a dynamic, goal-orientated process; and critical reflection. The necessary antecedents and likely consequences are identified. Model and alternative cases are offered. A distinction is made between educational facilitation and facilitation in counselling. Recommendations are given regarding the future development of empirical referents. To enhance the reader's understanding of concept analysis, the paper incorporates a reflection on the process, together with a discussion of the way in which decisions regarding the attributes were reached.

Content domain for caregiver planning identified by adult offspring caregivers

The purpose of the study was to generate a description of caregiver planning and explain how the concept advanced knowledge of lay caregiver decision-making. Nearly 2,000 decisions of 168 adult offspring caregivers were classified into one of 12 categories using an a priori taxonomic structure for caregiver planning. Coefficient kappas for intra- and inter-rater reliability of the classifications ranged from .97 to .81. The computer program, Ethnograph, and existence theory then were used to organize the classifications in a more detailed manner given the a priori taxonomic structure. Findings from the study showed that the content of the subjects' decisions produced a relatively detailed, complete, and reliable description of caregiver planning. This information can help nurses and lay caregivers to further develop an ongoing pattern of decision-making about caregiving.