Classifying clinical decision making:interpreting nursing intuition, heuristics and medical diagnosis

This is the second of two linked papers exploring decision making in nursing. The first paper, 'Classifying clinical decision making: a unifying approach' investigated difficulties with applying a range of decision-making theories to nursing practice. This is due to the diversity of terminology and theoretical concepts used, which militate against nurses being able to compare the outcomes of decisions analysed within different frameworks. It is therefore problematic for nurses to assess how good their decisions are, and where improvements can be made. However, despite the range of nomenclature, it was argued that there are underlying similarities between all theories of decision processes and that these should be exposed through integration within a single explanatory framework. A proposed solution was to use a general model of psychological classification to clarify and compare terms, concepts and processes identified across the different theories. The unifying framework of classification was described and this paper operationalizes it to demonstrate how different approaches to clinical decision making can be re-interpreted as classification behaviour. Particular attention is focused on classification in nursing, and on re-evaluating heuristic reasoning, which has been particularly prone to theoretical and terminological confusion. Demonstrating similarities in how different disciplines make decisions should promote improved multidisciplinary collaboration and a weakening of clinical elitism, thereby enhancing organizational effectiveness in health care and nurses' professional status. This is particularly important as nurses' roles continue to expand to embrace elements of managerial, medical and therapeutic work. Analysing nurses' decisions as classification behaviour will also enhance clinical effectiveness, and assist in making nurses' expertise more visible. In addition, the classification framework explodes the myth that intuition, traditionally associated with nurses' decision making, is less rational and scientific than other approaches.

Minority dissent and team innovation:the importance of participation in decision making

This study integrates research on minority dissent and individual creativity, as well as team diversity and the quality of group decision making, with research on team participation in decision making. From these lines of research, it was proposed that minority dissent would predict innovation in teams but only when teams have high levels of participation in decision making. This hypothesis was tested in 2 studies, 1 involving a homogeneous sample of self-managed teams and 1 involving a heterogeneous sample of cross-functional teams. Study 1 suggested that a newly developed scale to measure minority dissent has discriminant validity. Both Study 1 and Study 2 showed more innovations under high rather than low levels of minority dissent but only when there was a high degree of participation in team decision making. It is concluded that minority dissent stimulates creativity and divergent thought, which, through participation, manifest as innovation.

The effects of the menstrual cycle on social decision making

The cyclic change in hormonal profiles between the two main phases of the menstrual cycle mediate shifts in mate preference. Males who advertise social dominance are preferred over other men by females in the follicular phase of the cycle. The present study explored assignment of high or low status resources to dominant looking men by females in either phase of the menstrual cycle. Thirteen females who reported that they were free from any kind of hormonal intervention and experienced a 28 day cycle, were invited to participate in a mock job negotiation scenario. Participants were asked to assign either a minimum, low, high or maximum social status job package to a series of male 'employees' that were previously rated to look either dominant or non-dominant. The results showed that during the follicular phase of the cycle participants assigned dominant looking men more high status job resources than the non-dominant looking men. However, during the luteal phase the participants assigned low status resources to the non-dominant looking men. Females are not merely passive observers of male status cues but actively manipulate the environment to assign status. © 2006 Elsevier B.V. All rights reserved.

Greening operations: an investigation of environmental decision making

This PhD thesis belongs to three main knowledge domains: operations management, environmental management, and decision making. Having the automotive industry as the key sector, the investigation was undertaken aiming at deepening the understanding of environmental decision making processes in the operations function. The central research question for this thesis is ?Why and how do manufacturing companies take environmental decisions? This PhD research project used a case study research strategy supplemented by secondary data analysis and the testing and evaluation of a proposed systems thinking model for environmental decision making. Interviews and focus groups were the main methods for data collection. The findings of the thesis show that companies that want to be in the environmental leadership will need to take environmental decisions beyond manufacturing processes. Because the benefits (including financial gain) of non-manufacturing activities are not clear yet the decisions related to product design, supply chain and facilities are fully embedded with complexity, subjectivism, and intrinsic risk. Nevertheless, this is the challenge environmental leaders will face - they may enter in a paradoxical state of their decisions – where although the risk of going greener is high, the risk of not doing it is even higher.

A concept-based framework for retrieving evidence to support emergency physician decision making at the point of care

The goal of evidence-based medicine is to uniformly apply evidence gained from scientific research to aspects of clinical practice. In order to achieve this goal, new applications that integrate increasingly disparate health care information resources are required. Access to and provision of evidence must be seamlessly integrated with existing clinical workflow and evidence should be made available where it is most often required - at the point of care. In this paper we address these requirements and outline a concept-based framework that captures the context of a current patient-physician encounter by combining disease and patient-specific information into a logical query mechanism for retrieving relevant evidence from the Cochrane Library. Returned documents are organized by automatically extracting concepts from the evidence-based query to create meaningful clusters of documents which are presented in a manner appropriate for point of care support. The framework is currently being implemented as a prototype software agent that operates within the larger context of a multi-agent application for supporting workflow management of emergency pediatric asthma exacerbations. © 2008 Springer-Verlag Berlin Heidelberg.

Measuring and modelling the influence of investor behaviour on investment decision making

Guest editorial

Decision making in nuclear waste management:the use of the synoptic approach

This thesis is concerned with the use of the synoptic approach within decision making concerning nuclear waste management. The synoptic approach to decision making refers to an approach to rational decision making that assumes as an ideal, comprehensiveness of information and analysis. Two case studies are examined in which a high degree of synoptic analysis has been used within the decision making process. The case studies examined are the Windscale Inquiry into the decision to build the THORP reprocessing plant and the Nirex safety assessment of nuclear waste disposal. The case studies are used to test Lindblom's hypothesis that a synoptic approach to decision making is not achievable. In the first case study Lindblom's hypothesis is tested through the evaluation of the decision to build the THORP plant, taken following the Windscale Inquiry. It is concluded that the incongruity of this decision supports Lindblom's hypothesis. However, it has been argued that the Inquiry should be seen as a legitimisation exercise for a decision that was effectively predetermined, rather than a rigorous synoptic analysis. Therefore, the Windscale Inquiry does not provide a robust test of the synoptic method. It was concluded that a methodology was required, that allowed robust conclusions to be drawn, despite the ambiguity of the role of the synoptic method in decision making. Thus, the methodology adopted for the second case study was modified. In this case study the synoptic method was evaluated directly. This was achieved through the analysis of the cogency of the Nirex safety assessment. It was concluded that the failure of Nirex to provide a cogent synoptic analysis supported Lindblom's criticism of the synoptic method. Moreover, it was found that the synoptic method failed in the way that Lindblom predicted that it would.

Teacher logs and interactive decision-making:a case study of contingencies in an EFL organizational culture and the implications for teacher development for part-time teachers

This is a case study of a program of native speaker part-time EFL (English as a Foreign Language) teachers in a junior college in Japan. It has grown out of a curiosity to ascertain how the teachers have formed and continue to maintain a coordinated program in what would seem to be a disadvantageous national context where as part-time foreign teachers they are expected to do little more than just teach a few classes of mainly oral English. This study investigates the organizational culture the teachers have formed for themselves within their staffroom, and looks at the implications of this for part-time teachers in such an environment. More specifically, the study highlights that central to the program is an interactive decision-making function engaged in by all the teachers which has not only created but also continually enables an identifiable staffroom culture. This organizational culture is contingent on college and staffroom conditions, program affordances such as shared class logs and curriculum sharing, and on the interactive decision-making itself. It is postulated that the contingencies formed in this created and continually creating shared world not only offer the teachers a proficient way to work in their severely time-constricted environment, but also provide them with fertile ground for the self-regulation of a thus created zone of covert staffroom ‘on-the-job’ teacher development.

Public sector investment appraisal:the place of flexibility in the decision making process

This thesis reviews the main methodological developments in public sector investment appraisal and finds growing evidence that appraisal techniques are not fulfilling their earlier promise. It is suggested that an important reason for this failure lies in the inability of these techniques to handle uncertainty except in a highly circumscribed fashion. It is argued that a more fruitful approach is to strive for flexibility. Investment projects should be formulated with a view to making them responsive to a wide range of possible future events, rather than embodying a solution which is optimal for one configuration of circumstances only. The distinction drawn in economics between the short and the long run is used to examine the nature of flexibility. The concept of long run flexibility is applied to the pre-investment range of choice open to the decisionmaker. It is demonstrated that flexibility is reduced at a very early stage of decisionmaking by the conventional system of appraisal which evaluates only a small number of options. The pre-appraisal filtering process is considered further in relation to decisionmaking models. It is argued that for public sector projects the narrowing down of options is best understood in relation to an amended mixed scanning model which places importance on the process by which the 'national interest ' is determined. Short run flexibility deals with operational characteristics, the degree to which particular projects may respond to changing demands when the basic investment is already in place. The tension between flexibility and cost is noted. A short case study on the choice of electricity generating plant is presented. The thesis concludes with a brief examination of the approaches used by successive British governments to public sector investment, particularly in relation to the nationalised industries

A reevaluation of achromatic spatio-temporal vision: nonoriented filters are monocular, they adapt, and can be used for decision making at high flicker speeds

Masking, adaptation, and summation paradigms have been used to investigate the characteristics of early spatio-temporal vision. Each has been taken to provide evidence for (i) oriented and (ii) nonoriented spatial-filtering mechanisms. However, subsequent findings suggest that the evidence for nonoriented mechanisms has been misinterpreted: those experiments might have revealed the characteristics of suppression (eg, gain control), not excitation, or merely the isotropic subunits of the oriented detecting mechanisms. To shed light on this, we used all three paradigms to focus on the ‘high-speed’ corner of spatio-temporal vision (low spatial frequency, high temporal frequency), where cross-oriented achromatic effects are greatest. We used flickering Gabor patches as targets and a 2IFC procedure for monocular, binocular, and dichoptic stimulus presentations. To account for our results, we devised a simple model involving an isotropic monocular filter-stage feeding orientation-tuned binocular filters. Both filter stages are adaptable, and their outputs are available to the decision stage following nonlinear contrast transduction. However, the monocular isotropic filters (i) adapt only to high-speed stimuli—consistent with a magnocellular subcortical substrate—and (ii) benefit decision making only for high-speed stimuli (ie, isotropic monocular outputs are available only for high-speed stimuli). According to this model, the visual processes revealed by masking, adaptation, and summation are related but not identical.

Design of a novel solar thermal collector using a multi-criteria decision-making methodology

Three novel solar thermal collector concepts derived from the Linear Fresnel Reflector (LFR) are developed and evaluated through a multi-criteria decision-making methodology, comprising the following techniques: Quality Function Deployment (QFD), the Analytical Hierarchy Process (AHP) and the Pugh selection matrix. Criteria are specified by technical and customer requirements gathered from Gujarat, India. The concepts are compared to a standard LFR for reference, and as a result, a novel 'Elevation Linear Fresnel Reflector' (ELFR) concept using elevating mirrors is selected. A detailed version of this concept is proposed and compared against two standard LFR configurations, one using constant and the other using variable horizontal mirror spacing. Annual performance is analysed for a typical meteorological year. Financial assessment is made through the construction of a prototype. The novel LFR has an annual optical efficiency of 49% and increases exergy by 13-23%. Operational hours above a target temperature of 300 C are increased by 9-24%. A 17% reduction in land usage is also achievable. However, the ELFR suffers from additional complexity and a 16-28% increase in capital cost. It is concluded that this novel design is particularly promising for industrial applications and locations with restricted land availability or high land costs. The decision analysis methodology adopted is considered to have a wider potential for applications in the fields of renewable energy and sustainable design. © 2013 Elsevier Ltd. All rights reserved.