Understanding nurses’ decision-making when managing weaning from mechanical ventilation: a study of novice and experienced critical care nurses in Scotland and Greece.

Aim and objectives To examine how nurses collect and use cues from respiratory assessment to inform their decisions as they wean patients from ventilatory support. Background Prompt and accurate identification of the patient's ability to sustain reduction of ventilatory support has the potential to increase the likelihood of successful weaning. Nurses' information processing during the weaning from mechanical ventilation has not been well-described. Design A descriptive ethnographic study exploring critical care nurses' decision-making processes when weaning mechanically ventilated patients from ventilatory support in the real setting. Methods Novice and expert Scottish and Greek nurses from two tertiary intensive care units were observed in real practice of weaning mechanical ventilation and were invited to participate in reflective interviews near the end of their shift. Data were analysed thematically using concept maps based on information processing theory. Ethics approval and informed consent were obtained. Results Scottish and Greek critical care nurses acquired patient-centred objective physiological and subjective information from respiratory assessment and previous knowledge of the patient, which they clustered around seven concepts descriptive of the patient's ability to wean. Less experienced nurses required more encounters of cues to attain the concepts with certainty. Subjective criteria were intuitively derived from previous knowledge of patients' responses to changes of ventilatory support. All nurses used focusing decision-making strategies to select and group cues in order to categorise information with certainty and reduce the mental strain of the decision task. Conclusions Nurses used patient-centred information to make a judgment about the patients' ability to wean. Decision-making strategies that involve categorisation of patient-centred information can be taught in bespoke educational programmes for mechanical ventilation and weaning. Relevance to clinical practice Advanced clinical reasoning skills and accurate detection of cues in respiratory assessment by critical care nurses will ensure optimum patient management in weaning mechanical ventilation

Exploring the relationship between impulsivity and decision-making on mobile devices.

Mobile devices offer a common platform for both leisure and work-related tasks but this has resulted in a blurred boundary between home and work. In this paper we explore the security implications of this blurred boundary, both for the worker and the employer. Mobile workers may not always make optimum security-related choices when ‘on the go’ and more impulsive individuals may be particularly affected as they are considered more vulnerable to distraction. In this study we used a task scenario, in which 104 users were asked to choose a wireless network when responding to work demands while out of the office. Eye-tracking data was obtained from a subsample of 40 of these participants in order to explore the effects of impulsivity on attention. Our results suggest that impulsive people are more frequent users of public devices and networks in their day-to-day interactions and are more likely to access their social networks on a regular basis. However they are also likely to make risky decisions when working on-the-go, processing fewer features before making those decisions. These results suggest that those with high impulsivity may make more use of the mobile Internet options for both work and private purposes but they also show attentional behavior patterns that suggest they make less considered security-sensitive decisions. The findings are discussed in terms of designs that might support enhanced deliberation, both in the moment and also in relation to longer term behaviors that would contribute to a better work-life balance.