ORCID Profile
0000-0002-5318-0784
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Wiley
Date: 12-2006
Publisher: Elsevier BV
Date: 04-2012
DOI: 10.1016/J.IJNURSTU.2011.10.015
Abstract: Decision making embedded in clinical situations is studied to inform nursing and midwifery practice and to enhance clinical effectiveness. To date this knowledge has mainly been derived from classical decision-making research approaches that are limited in capturing cognition in rapidly changing 'real-world' clinical environments. A naturalistic decision making approach can strengthen the ecological validity of descriptive investigations in certain dynamic clinical decision situations that include urgency and complexity. This paper presents a discussion about naturalistic decision making, its relevance for studying certain clinical decision situations in the 'real world' of nursing and midwifery practice and its application in a midwifery decision-making situation. In conclusion classical decision-making research approaches can be extended to include the naturalistic decision making approach that can capture decision making in dynamic clinical situations and show the underlying knowledge that distinguishes more experienced clinicians.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2005
DOI: 10.1097/00005110-200501000-00010
Abstract: The authors discuss results of a study that found a sense of tension in the nurse and between the supervisor and the team that influenced the decision to come to work when ill. The tension with the supervisor was around reporting and legitimizing illness with the team, around responsibility, staffing concerns, and peer pressure and in the nurse was associated with community perception, work ethic, and financial security. Together, nurse administrators and clinicians should conduct reviews of policies and procedures to build cohesive relationships and promote the self-care practices of nurses.
Publisher: Elsevier BV
Date: 03-1998
DOI: 10.1016/S0266-6138(98)90110-3
Abstract: To present an approach to developing clinical decision-making skills in midwifery students. Use of simulations, 'thinking aloud' technique, reflection and the decision rules of experienced midwives are proposed for developing clinical-reasoning skills and acquiring skilled clinical knowledge. Educators are encouraged to recognise that skill acquisition in clinical decision making requires practise before students engage fully in the clinical setting. The process of decision making is emphasised as essential for students to experience so they develop an understanding of the clinical information attended to, the sequence in which the information is processed and the rules used to combine information to reach clinical judgements. By using clinical simulations developed from 'real cases' the process of decision making is able to be experienced by students. Further, if these simulations are accompanied by the collection of verbal protocols, students have opportunities to retrospectively explore their decision making with reflection. In addition, the presentation and use of decision rules of experienced midwives has the potential to enhance the development of skills in students.
Publisher: Informa UK Limited
Date: 08-2010
DOI: 10.5172/CONU.2010.36.1-2.061
Abstract: In Western societies the community prevalence of chronic conditions is increasing rapidly. Evidence has shown the benefits of care given to these clients by multidisciplinary teams. However, the experience of erse health professionals working in these teams is not well understood. This study presents the experiences of members in multidisciplinary teams caring for clients with chronic conditions in the community. A qualitative descriptive study was used with a purposive s le of 34 multidisciplinary team members who participated in focus groups that were audio-taped, transcribed and analysed. Team members' experiences of working in multidisciplinary teams are described within three categories: shared purpose, working in the team, and tensions within the team. The findings provide direction for addressing team effectiveness, including issues of team leadership and evaluation of team performance.
Publisher: Elsevier BV
Date: 04-2010
DOI: 10.1016/J.MIDW.2008.05.004
Abstract: to present critical cues, related factors, knowledge and experience used by midwives when deciding whether or not to suture perineal and associated trauma after childbirth. an exploratory descriptive study using in-depth interviews to collect data using the Critical Decision Method. birth units in Greater Western Sydney. 19 volunteer midwives experienced in deciding whether or not to suture or in making referrals to suture childbirth trauma. the main findings were the cues of bleeding and trauma with their accompanying specific attributes, and woman- and midwife-centred factors considered when deciding whether or not to suture perineal and associated trauma. Furthermore, the knowledge and experience that supported decision-making, such as detailed knowledge of anatomical structures, workshops and observing highly skilled clinicians, were identified. the cues and related factors can be formed into an inventory and tested for content validity using a panel of expert midwives. such an inventory has the potential to minimise inappropriate intervention and alleviate unnecessary discomfort, thus increasing safety and quality of care for women following childbirth. In addition, midwifery educators and those coaching less-experienced midwives can use the collected clinical information to aid the development of students' and midwives' decision-making skills regarding whether or not to suture childbirth trauma.
Publisher: Wiley
Date: 17-08-2005
Publisher: Wiley
Date: 07-1997
DOI: 10.1046/J.1365-2648.1997.1997026203.X
Abstract: This paper explores intuitive judgements of nurses in clinical decision-making situations. The qualities of intuition are presented from both theoretical and practical perspectives and attitudes towards intuition from both nurses themselves and other health professionals are identified. An heuristic framework from cognitive psychology is applied to intuitive aspects of the clinical judgements that nurses have made. This interpretation is proposed as a partial explanation of intuition, and its use in advancing the understanding of intuition is recommended.
Publisher: Elsevier BV
Date: 2006
DOI: 10.1016/S1322-7696(08)60514-4
Abstract: to describe nurses' experiences of the change associated with redesign of the model of nursing practice in an acute care ward in the preparatory and implementation phases. descriptive case study a surgical ward in an acute care hospital in Greater Western Sydney fourteen registered and six enrolled nurses working on the surgical ward volunteered to be interviewed, eight in the preparatory phase and twelve six months into the implementation phase descriptions of nurses' experiences in the preparatory phase and six months into the implementation phase of the redesigned nursing practice model many nurses felt apprehensive in the preparatory phase, however, six months into implementation phase their willingness to trial the model was evident. Negativity pervaded both phases, as did their concerns for the quality of care being given. In the preparatory phase nurses described the clinical activities coordinator (CAC) role as having potential to be beneficial and this was realised to some degree six months into implementation phase. A preference for registered nurses over enrolled nurses as a dominant component of the staff was evident in both phases the struggle with the change that nurses experienced suggests redesign needs to be a more collaborative process involving strong communication and supportive education so nurses can empower themselves within the change.
Publisher: Wiley
Date: 04-10-2017
DOI: 10.1111/IJN.12593
Abstract: To apply six thinking hats technique for decision making in collaborative care. In collaborative partnerships, effective communications need to occur in patient, family, and health care professional meetings. The effectiveness of these meetings depends on the engagement of participants and the quality of the meeting process. The use of six thinking hats technique to engage all participants in effective dialogue is proposed. Discussion paper. Electronic databases, CINAHL, Pub Med, and Science Direct, were searched for years 1990 to 2017. Using six thinking hats technique in patient family meetings nurses can guide a process of dialogue that focuses decision making to build equal care partnerships inclusive of all participants. Nurses will need to develop the skills for using six thinking hats technique and provide support to all participants during the meeting process. Collaborative decision making can be augmented by six thinking hat technique to provide patients, families, and health professionals with opportunities to make informed decisions about care that considers key issues for all involved. Nurses who are most often advocates for patients and their families are in a unique position to lead this initiative in meetings as they network with all health professionals.
Publisher: Elsevier BV
Date: 02-2013
Publisher: Informa UK Limited
Date: 02-2011
DOI: 10.5172/CONU.2011.37.2.213
Abstract: The concept and definition of pastoral care in aged care remains ambiguous. This paper reports on the defining characteristics and meaning of pastoral care from the perspective of older recipients, their family members and pastoral care workers. Using a qualitative descriptive approach semi-structured in-depth interviews were conducted with 18 pastoral care workers and 11 older people. Transcribed data were analysed using NVivo software and coded for emerging themes. The defining characteristics of pastoral care that emerged from analysis of transcribed interviews were: a trusting relationship, spiritual support, emotional support and practical support. Findings also portray the role of the pastoral care worker as spiritual guide, confidante, and emotional and practical supporter acting within a trusting relationship. Future studies should confirm these results by exploring the perceptions of experts in the field of pastoral care.
Publisher: Elsevier BV
Date: 10-2001
DOI: 10.1016/S0020-7489(00)00096-1
Abstract: Making decisions to call emergency assistance to patients is an important dimension of nursing practice. Most usually these decision making situations are uncertain and it is expected nurses rely on past clinical experiences. This study, approved by the ethics committees of both a university and an area health service, aimed to describe nurses' reliance on past experiences and identify associated judgement strategies (heuristics). Thirty-two registered nurses with five or more years experience were interviewed. Main findings were: nurses did use their past experiences and these experiences were used in the form of the three "classic" heuristics, representativeness, availability and anchoring and adjustment. It can be concluded past experiences are intrinsic to decision making and this has implications for both the clinical components of nursing educational programs and staffing allocations made by administrators. Some nurses, however, did not include referral to past experiences in their decision-making accounts which may be a limitation of the study design.
Publisher: Elsevier BV
Date: 11-2010
DOI: 10.1016/J.AUCC.2010.04.002
Abstract: The criteria used for calling emergency response teams to patients at-risk of clinical deterioration in the acute care adult hospital population include the criterion 'patient of concern'. When calling teams to patients of concern, some 'changes of concern' used by nurses have been identified however the validity of these 'changes of concern' is unknown. This study aimed to determine the content validity of 'changes of concern' used by nurses to call emergency response teams. Ten nurses who had 5 years or more experience with emergency response teams formed an expert group. This expert group examined content validity of the 'changes of concern' nurses used for calling emergency response teams using criterion, 'patient of concern' with a questionnaire based on Bausell's content validity criteria of necessity and sufficiency. Data were summarized using descriptive statistics. The main findings indicate that the 10 'changes of concern' are agreed to be necessary to possibly identify early deterioration in adult patients that may require a call using criterion, 'patient of concern'. The associated factors that relate to these 'changes of concern' are also confirmed to be necessary to assess when these changes are present in patients. Assessment underpinned by these changes of concern (indicators) can provide more complete clinical information for clinicians to recognise possible early deterioration of patients and to coach others so building capacity to appropriately call emergency response teams resulting in increased patient safety. Research is indicated that further explores and identifies the use of 'patient of concern' criterion and that examines the effectiveness of clinical information being used to detect potential early clinical deterioration.
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.COLEGN.2012.11.004
Abstract: The Australian health care system is responsible for delivering health services to an increasingly erse health population. Nurses are in a position to positively influence health-related outcomes by actively addressing the differences in iduals bring to their health care experiences. By focusing ersity on health inequities, nurses can play an important role in identifying those at risk of poorer health. This paper discusses ersity in the health population through health inequities and proposes directions for nursing practice. These suggested directions include application of a definition of ersity that include health determinants targeting specific groups with programmes and services designed to reduce health inequalities engaging in political action to promote effective policy development preparing nurses at an undergraduate and graduate level to build capacity for addressing ersity and health inequities and identifying effective interventions through research studies that address inequities in the health population.
Publisher: SAGE Publications
Date: 05-2007
Abstract: This qualitative study aimed to identify and describe the relatives' and staff's perceptions of environmental change on residents with dementia. Data were collected from audio-taped relative and staff focus group interviews at an aged care facility in Western Sydney. The transcribed data from the focus groups were thematically analysed and categorized. Three major categories emerged from the analysed data: the special care unit as a family home, therapeutic environment and work environment. Relatives and staff identified that the overall design of the unit impacted on the residents' functioning and quality of life, sense of freedom, level of agitation, sleeping patterns and weight. Relatives reported that the environment was conducive to visiting and to children, and staff reported that the working environment was improved because of its layout and equipment. This study has shown that special care units can make a difference to the quality of life of residents and improve conditions for relatives and staff.
Publisher: Hindawi Limited
Date: 04-2008
DOI: 10.1111/J.1365-2834.2007.00774.X
Abstract: This paper reports a case study of nursing practice model redesign in a surgical ward at a large metropolitan acute care hospital in Sydney, Australia. Literature suggests that factors such as financial restraints and shortage of nurses necessitate redesign of nursing care. A descriptive case study design was used. The nursing practice model was changed from a patient allocation model to a team-nursing model and a new role of Clinical Activities Coordinator was introduced. This study has confirmed that people need to be able to empower themselves to ensure an effective change process. It was also apparent in the case study that the staff were resistant to the redesign. Change is a difficult process, which needs to involve all stakeholders. The planning process needs to consider the characteristics of the context such as workload and skill required, and the measures such as patient and staff satisfaction and health outcomes.
Publisher: No publisher found
Date: 2002
DOI: 10.1093/HER/17.1.19
Abstract: Failure of clients to initiate closure and move out of weight management programs after it is considered they should have reached the stage of maintenance in their health behavior change has implications for clients' self-management, provision of health promotion programs and their cost-effectiveness. This study aims to identify factors that enable and inhibit class attendees' transition from a weight management program. Six short-term attendees who had left the program after two terms and six long-term attendees who had attended four or more terms of the program volunteered to participate in in-depth interviews. Enabling factors were identified to be program knowledge and attainment of set goal weight, and inhibiting factors were the perceived need to come to classes, concern about keeping in control, recognition of the potential to lapse and being involved with a group. Recommendations are made for the program to include a component addressing relapse prevention training and to trial some form of follow-up support strategy. Additionally, further research is needed into transition from weight management programs.
Publisher: Elsevier BV
Date: 07-2000
Abstract: The purpose of this study was to explore and describe the patient characteristics and the process of recognition nurses use to recognize patients about whom they are seriously worried. The study design was qualitative, exploratory, and descriptive, and it used in-depth interviews and a purposive s le. The study setting included a teaching hospital and a peripheral hospital in a Sydney area health service. Participants included registered nurses (N = 32) with 5 or more years of experience and a history of calling the medical emergency team (MET). Mean years of experience as a registered nurse was 14 years, and the mean calls to the MET since employed in current hospital was 16 calls. Primary findings showed that nurses relied on 4 patient characteristics to apply the MET criterion, "seriously worried about a patient." These 4 characteristics were (1) feeling "not right," (2) color, (3) agitation, and (4) observations marginally changed or not changed at all. The process used to gather and interpret information to recognize these patients who were deteriorating involved touching, observing, listening, feeling or sensing, and "knowing." In this process of recognition, nurses relied heavily on past experiences and knowledge to detect differences in patient condition. The 4 characteristics need to be included as an explanation for the MET criterion, "seriously worried about a patient." Additional validation and refinement of the 4 characteristics of the nonspecific MET criterion, "seriously worried about a patient," should be carried out. Continuing education programs in health care facilities need to support the use of subjective information in complex situations that result in decisions to call emergency assistance so patients whose conditions are deteriorating can be identified early and responded to rapidly.
Publisher: Elsevier BV
Date: 10-1998
DOI: 10.1016/S0965-2302(98)90077-7
Abstract: Triage assessment of patients on arrival at emergency departments involves complex decision making, resulting in categories being assigned to prioritize patients' needs for attention. The actual process of triage decision making has received limited attention. The aims of this study were to describe aspects of the triage decision-making process used by both more and less experienced nurses (n = 20) and to test the effect of uncertainty in the triage situation on the use of probability judgements (heuristics). Six triage cases based on actual triage situations were simulated to subjects, and their verbal protocols were collected. Protocols were transcribed and analysed. Main findings were: in conditions of higher uncertainty in triage situations all nurses used more probability in their judgements (t-test -2.37, df = 17, P = 0.03) with the heuristic of representativeness being relied on the most. The triage categories finally assigned for each triage situation showed no agreement on a specific triage category for each triage case and past triage experiences were used in decision making. The more experienced group reported higher estimations of correctness regarding the final category assigned, used more single previously experienced cases from memory, collected less data and made more judgements than the less experienced group. Further examination of the decision-making process of triage assessment should occur with attention to the variable use of triage categories, the role of past triage experiences in making judgements and development of triage decision rules for skilling nurses for triage.
Publisher: Wiley
Date: 10-06-2008
DOI: 10.1111/J.1365-2702.2008.02454.X
Abstract: This qualitative study aimed to explore and describes clients' experiences of receiving care from community nurses. Understanding of the experiences of clients with chronic and complex conditions receiving community nursing care can provide insight into their needs. International studies have identified experiences clients have had of receiving care from community nurses. However, no Australian study was found that had specifically explored with clients who had chronic and complex conditions and their experiences of receiving care from community nurses in an area health service. A qualitative descriptive study conducted during 2005 explored and described clients' experiences of the nursing care provided by community nurses. A purposive s le of 13 volunteer participants with chronic and complex conditions was interviewed and the transcripts analysed. Three main categories were identified that clients used to describe their experiences. These were: the client's relationship with the nurse, care process and being able to stay out of hospital. Clients strongly indicated their satisfaction with care provided by experienced community nurses and acknowledged that nurses are playing a key role in fostering their self-management and avoiding their readmission to hospital. Areas that require further attention are the professional development of less-experienced community nurses, services at the weekend, the scope of nursing management of clients with chronic conditions and the education needs of community nurses to meet the goals of these clients. This study highlights the need for nurses who work in strong autonomous clinical roles in the community to have experience in assessment, education, planning and delivery of client care before they can be competent community nurses. The possibility of adverse occurrences during weekends provides the opportunity for managers to review and plan weekday and weekend workloads and staffing.
Publisher: Emerald
Date: 02-2002
DOI: 10.1108/09654280210412367
Abstract: Weight‐management programmes to address obesity are an important strategy for improving community health. Some enrollees in this type of a programme are long term, repeatedly enrolling term after term, while others are short term, enrolling on average for two terms. This paper describes and compares the experiences of long‐ and short‐term enrollees of a community weight‐management programmes. Six long‐term and six short‐term enrollees in the maintenance stage of their behaviour change volunteered to participate in interviews. Both groups found the programme to be beneficial and enjoyable, and said they had learned strategies for weight control that empowered them to manage and sustain their weight loss. Long‐termers identified they had greater need for weight monitoring and ongoing support. The recommendations are to review aspects of such programmes, address ongoing support outside the class and investigate further the greater reliance of long‐term enrollees on external support.
Publisher: Elsevier BV
Date: 05-2006
DOI: 10.1016/S1036-7314(06)80011-1
Abstract: The importance of observing patient vital signs in emergency department (ED) practice has been stressed in the literature. Failure of clinicians to respond to abnormal vital signs (AVS) has been described as a potential reason for delayed management in ED practice, with a likelihood of increased morbidity. This study aimed to explore and describe clinicians' responses to AVS in a busy ED. A qualitative descriptive approach was used with three focus groups being conducted with 18 volunteer registered nurses (RNs) and medical officers (MOs) who worked in the ED of an area health service in Western Sydney. Transcribed focus group interviews were analysed using a process of constant comparison and contrast and a description of clinicians' responses to AVS written. An analysis of text from focus groups revealed three main categories of clinicians' responses to AVS: identification, reporting and implementing action. Clinicians in this study recognised, reported and acted on AVS. However, delays in responding to AVS occurred due to a variety of reasons. The main reasons identified were issues with documentation and the ability to seek advice of appropriate staff, ineffective communication, fear of reprimand, inexperience of working in EDs, workload, distractions and interruptions. In conclusion, environmental and human factors contribute to inappropriate delays regarding AVS in the ED. These factors can be acted on by initiating appropriate education programmes and establishing improved communication networks. Better use of the existing medical emergency team (MET) in the ED can act to alleviate situations associated with delays in managing AVS.
Publisher: Informa UK Limited
Date: 09-2005
DOI: 10.5172/CONU.20.1.78
Abstract: Identification of nurses' experiences of caring for culturally erse patients in acute care settings contributes to transcultural nursing knowledge. This qualitative study aims to describe nurses' experiences of caring for culturally erse adult patients on medical and surgical wards in an acute care setting. These experiences identify current practice and associated issues for nurses caring for culturally erse clients. A purposive s le of ten registered nurses was interviewed and transcripts analysed. Main findings were acquiring cultural knowledge, committing to and engaging with culturally erse patients. Strategies for change developed from these findings focus on increasing cultural competency of nurses by: implementing a formal education program developing partnerships with patients and their families to increase cultural comfort and increasing organisational accommodation of the culturally erse with policy review and extension of resources. Further research to explore issues for bilingual nurses and to describe the experiences of culturally erse patients and their families in general acute care settings is recommended.
Publisher: Elsevier BV
Date: 11-2009
DOI: 10.1016/J.AUCC.2009.07.001
Abstract: Nurses are required to recognise early clinical deterioration in patients and call emergency support. Nurses often use the subjective non-specific criterion, 'concerned about the patient' as the indication for calling. No study has identified cues of relevance to this criterion. The purpose of this study is to identify cues of potential early clinical deterioration used to recognise 'a patient of concern' who is not meeting the current objective physiologic emergency response team calling criteria. An exploratory descriptive approach was used involving interviews with a purposive s le of 17 experienced registered nurses who recalled incidences of calling the team to adult patients based on the criterion, 'concerned about patient'. The transcribed audio tapes of interviews were coding to identify cues. Main findings are ten identified changes of concern (cues): noisy breathing, inability to talk in sentences, increasing supplemental O(2) requirements to maintain SaO(2), agitation, impaired mentation, impaired cutaneous perfusion, not expected trajectory, new or increasing pain, new symptom, and new observation that nurses used to recognise potential early clinical deterioration. Two mediating factors were also identified that influenced the decision-making process. The ten changes of concern (cues) can be considered precursors of potential early deterioration that may assist nurses to detect patients at possible risk. Nurses are also aware that some patient groups are at higher risk as they are not able to communicate potential deterioration as perhaps other patients can. This study has only identified two patient groups and it is possible others should be considered. The availability of identified precursors indicates their validity for recognizing possible early clinical deterioration should be investigated further.
Publisher: Wiley
Date: 25-09-2012
Publisher: Wiley
Date: 03-07-2014
DOI: 10.1111/JOCN.12245
Abstract: To define and validate the role of the community nurse in a multidisciplinary team caring for clients with chronic and complex needs. A key factor in optimising care for clients with chronic and complex conditions in the community is the use of multidisciplinary teams. A team approach is more effective as it enables better integration of services. The role of the community nurse in the multidisciplinary team has as yet not been delineated. A modified Delphi technique was used in this study. A group of 17 volunteer registered nurses who were experienced in the care of clients with chronic conditions and complex care needs in the community formed a panel of experts. Experts were emailed a series of three questionnaires. Main findings show that the role of the community nurse in a multidisciplinary team for clients with chronic conditions has six main domains - advocate, supporter, coordinator, educator, team member and assessor. A consensus on the role of the community nurse in the multidisciplinary team is described. The six key role domains reaffirm the generic role of the nurse and the validation of the role clarifies and reinforces the centrality of the community nurse in the team. Further refinement of the community nurse role is indicated to increase comprehensiveness of role descriptors particularly for the role domain, advocate. Community nurses working in multidisciplinary teams caring for clients with chronic conditions can define their role as a team member. The working relationship of the community nurse with other health professionals in the multidisciplinary team as a key approach to more integrated care for clients and carers enables the use of this approach to be better understood by all team members. With this increased understanding, community nurses are in a position to build stronger and more effective care teams.
Publisher: Elsevier BV
Date: 09-2005
DOI: 10.1016/J.NEPR.2005.03.001
Abstract: As students are expected to apply their knowledge in clinical settings educators need to use learning strategies that provide students with experiences that facilitate knowledge application. The use of simulations has been identified to be such a strategy. However, their use in the classroom has been described as burdensome for educators. Consequently educators may avoid using them. This paper describes the experience of an educator preparing, implementing and evaluating the use of simulations with midwifery students. In conclusion, the educator found the experience to be worthwhile and well received by students.
Publisher: Emerald
Date: 06-2004
DOI: 10.1108/09654280410534540
Abstract: This study aimed to describe men's knowledge of prostate cancer and the factors associated with these knowledge levels at selected regions in Western Sydney. The study was a descriptive, quantitative design using a postal survey of men over 40 years of age. A questionnaire consisting of 19 items that addressed areas of knowledge related to prostate cancer was used. The men in this study needed more information about risk factors for prostate cancer, screening techniques and treatment regimens and their side effects. This study has shown that if men are to make informed decisions about prostate cancer screening, it is important to have some form of decision aid on prostate cancer screening available to them.
Publisher: Wiley
Date: 02-1997
DOI: 10.1046/J.1365-2648.1997.1997025265.X
Abstract: In making clinical judgements, it is argued that midwives use 'shortcuts' or heuristics based on estimated probabilities to simplify the decision-making task. Midwives (n = 30) were given simulated patient assessment situations of high and low complexity and were required to think aloud. Analysis of verbal protocols showed that subjective probability judgements (heuristics) were used more frequently in the high than low complexity case and predominated in the last quarter of the assessment period for the high complexity case. 'Representativeness' was identified more frequently in the high than in the low case, but was the dominant heuristic in both. Reports completed after each simulation suggest that heuristics based on memory for particular conditions affect decisions. It is concluded that midwives use heuristics, derived mainly from their clinical experiences, in an attempt to save cognitive effort and to facilitate reasonably accurate decisions in the decision-making process.
Publisher: SLACK, Inc.
Date: 03-2005
DOI: 10.3928/01484834-20050301-06
Abstract: The actual effect of the use of simulations on clinical decision making is inconclusive. This pilot study used a posttest design to determine the effect of a simulation strategy on the clinical decision-making process of midwifery students. Thirty-six graduate diploma students volunteered and were randomly assigned to two groups, with the experimental group receiving two simulation sessions (normal labor and physiological jaundice), and the control group receiving the two usual lectures. The main findings were that students who received the simulation strategy collected more clinical information, revisited collected clinical information less, made fewer formative inferences, reported higher confidence levels, and for the posttest normal labor simulation, reached a final decision more quickly. Such effects are reasonable for this type of intervention with the existent variability in each group. Further research with a larger s le size and more rigorous data collection strategies is required.
Publisher: Wiley
Date: 07-2000
DOI: 10.1046/J.1365-2648.2000.01414.X
Abstract: Patient survival often depends on decisions by nurses to call emergency assistance. The experiences of nurses calling emergency assistance have not been described. This descriptive study explored the experiences of registered nurses (n=32) using unstructured interviews. The main findings were that nurses questioned whether they were doing the 'right thing' calling the emergency team, sometimes collaborated with others prior to calling and most felt nervous and anxious. They recognized patient deterioration from feelings they had that something was wrong. However, they were not able 'to put their finger on it'. Knowing the patient and past experiences were involved in the recognition of deterioration. This association indicates the importance of experience in the development of clinical decision-making skills. Further, nurses calling emergency assistance need to be provided with the opportunity to debrief after calling. Their heavy reliance on subjective data before searching for objective data as outlined in the emergency calling criteria suggests that it is essential that nurses do not devalue or ignore concerns they may have about patients.
Publisher: Informa UK Limited
Date: 08-2009
DOI: 10.5172/CONU.33.1.2
Abstract: A shift to the practice of team-based models of nursing care has occurred as a response to skill mix changes in acute health care settings. Little is known about nurses' experience of working in team-based models of nursing care delivery. This paper reports the findings of a qualitative study of the experiences of nurses working in teams in acute care settings in an area health service. Main findings are benefits of team nursing, team approach, team effectiveness, increased responsibility, availability of support and engagement with the multidisciplinary team. These findings have implications for understanding the essential elements of team nursing as experienced by team members providing key messages for health services implementing team nursing and giving direction for further research.
Publisher: Elsevier BV
Date: 2007
Publisher: Elsevier BV
Date: 04-2017
Publisher: American Association for Cancer Research (AACR)
Date: 05-2023
DOI: 10.1158/1055-9965.22725303.V1
Abstract: Forest plots for effects of inflammatory biomarkers on breast cancer risk. Forest plots for ( b A /b ) CRP, ( b B /b ) TNFα, and ( b C /b ) IL6.
Publisher: Wiley
Date: 02-01-2009
DOI: 10.1016/J.JMWH.2008.05.010
Abstract: From recalled childbirth cases, a series of cues and related factors were previously identified that were used by midwives when making decisions to suture or not suture perineal and associated trauma incurred during spontaneous vaginal delivery. This study aimed to determine the validity of these cues and related factors. A panel of 18 experienced midwives evaluated their content validity using the criteria of "necessity" and "sufficiency." The two main cue categories-"bleeding" and "birth trauma"-were considered by 18 (100%) of the panel members to be necessary to assess. At least 16 (89%) panel members considered the following specific cues necessary to assess: in the bleeding category-type, flow, amount, and effect of application of pressure or ice in the birth trauma category-trauma sites, trauma types, dimensions of trauma, types of tissue, alignment of tissue, edema, and bruising. Seventeen (94%) panel members considered seven woman-centred related factors that were necessary to assess and 14 (78%) considered the combination of all cues in bleeding, birth trauma, and related factors sufficient for making the decision to suture or not. The availability of these validated cues and related factors has the potential to guide a comprehensive assessment on which the decision to suture or not suture depends. This addition to the domain of midwifery knowledge enables educational preparation of midwives who will have the capacity to more adequately support women in childbirth.
Publisher: Elsevier BV
Date: 04-1999
DOI: 10.1016/S0965-2302(99)80031-9
Abstract: Patient triage in Accident and Emergency departments requires emergency nurses to make rapid decisions based on their knowledge and experiences. The development of triage decision-making skills can be addressed through the use of simulations, 'thinking aloud' technique, reflection and the decision rules of experienced emergency nurses. Clinical educators and experienced emergency nurse mentors are encouraged to recognize that skill acquisition in triage decision making requires practice before registered nurses can engage fully in the process of triaging patients in the emergency department. It is essential to experience the process of triage decision making in order to develop an understanding of the clinical information attended to, the sequence in which the information is processed and the rules used to combine information leading to a decision on the triage category for each patient. By using triage simulations developed from 'real triage cases' the process of decision making can be experienced by nurses. Further, if these simulations are accompanied by the collection of verbal protocols, nurses have opportunities retrospectively to explore their decision making with reflection. In addition, the presentation and use of decision rules used by experienced triage nurses can enhance the development of skills in novice triage nurses.
Publisher: Wiley
Date: 09-2004
Publisher: Elsevier BV
Date: 08-2001
Publisher: Wiley
Date: 10-09-2010
DOI: 10.1016/J.JMWH.2009.12.003
Abstract: Evidence shows that physical activity during and after pregnancy results in health gains for women. There is no clear understanding apparent in the literature of women's experiences with physical activity during their pregnancy. The aim of this study was to describe women's perceptions and participation in physical activity during pregnancy and identify factors influencing participation. In this qualitative descriptive study, face-to-face interviews were conducted with 19 women, all at different stages of pregnancy, who were asked about their experiences with physical activity. Data analysis resulted in four categories describing "meaning of physical activity," "perceived benefits of physical activity in pregnancy," "barriers to and motives for participation in physical activity," and "process of engagement in physical activity." The process of engagement in physical activity by women was shown to have three marked phases: "uncertainty," "engaging," and "compromise." To facilitate women's self-management across these phases, support is needed that focuses on providing strategies to strengthen in idual approaches by women. Such support might promote activities of daily living as a specific entity of physical activity, expose myths about activity during pregnancy, and endorse the benefits of weight management arising from physical activity, not just during pregnancy, but across the lifespan.
No related grants have been discovered for Jane Cioffi.