Critical care nurses' decision-making activities in the natural clinical setting

• This article reports on observation of 18 nurses in urban and rural based critical care settings.

• The purpose of the study was to observe and describe the decision-making activities of critical care nurses within natural clinical settings.

• During the 2-hour observation, the researcher dictated a detailed commentary on to audio-tape of each nurse's actions. Tapes were transcribed and subjected to content analysis.

• Findings indicated three main categories of decisions. Decision frequencies were linked to nurses' critical care experience, appointment level, and location, as well as nursing shifts.

• The findings are discussed in relation to previous empirical evidence and the implications for practice.

• The author concludes that future research should be directed towards measuring the contextual influences on nurses' decision-making on the outcome of patient care.

Informing decision-making in libraries: informetric research as input to LIS education and practice.(Library and Information Science).

Findings from informetric research represent an important background resource to add to the mix of information useful for resolving difficult and ongoing problems in specific library environments or information service settings. This paper provides examples of informetric research that can be useful input to decision-making in the field of library management and information service provision. This overview takes four of the challenges that Michael Buckland outlined for library research as a way of guiding the discussion of ways that informetric work can be used to inform library decision-making. (1) References are made to relevant informetric work undertaken or conducted in Australia, by Australian researchers, or with Australian data.

Informetrics includes both quantitative and qualitative methods, which when used in combination can provide a rounded set of findings that has great validity for management, policy and service applications. Quantitative methodologies are generally based on bibliometric techniques, such as mining and analysis of data from various bibliographic and textual databases. Qualitative methods include survey, case study and historical approaches. Used in combination, each set of findings adds richness and other perspectives to an analysis.

Use of a decision aid for prenatal testing of fetal abnormalities to improve women's informed decision making: a cluster randomised controlled trial [ISRCTN22532458]

Objective To evaluate the effectiveness of a decision aid for prenatal testing of fetal abnormalities compared with a pamphlet in supporting women's decision making.
Design A cluster randomised controlled trial.
Setting Primary health care.
Population Women in early pregnancy consulting a GP.
Methods GPs were randomised to provide women with either a decision aid or a pamphlet. The decision aid was a 24-page booklet designed using the Ottowa Decision Framework. The pamphlet was an existing resource available in the trial setting.
Main outcome measures Validated scales were used to measure the primary outcomes, informed choice and decisional conflict, and the secondary outcomes, anxiety, depression, attitudes to the pregnancy/fetus and acceptability of the resource. Outcomes were measured at 14 weeks of gestation from questionnaires that women completed and returned by post.
Findings Women in the intervention group were more likely to make an informed decision 76% (126/165) than those in the control group 65% (107/165) (adjusted OR 2.08; 95% CI 1.14–3.81). A greater proportion of women in the intervention group 88% (147/167) had a 'good' level of knowledge than those in the control group 72% (123/171) (adjusted OR 3.43; 95% CI 1.79–6.58). Mean (SD) decisional conflict scores were low in both groups, decision aid 1.71 (0.49), pamphlet 1.65 (0.55) (adjusted mean difference 0.10; 95% CI −0.02 to 0.22). There was no strong evidence of differences between the trial arms in the measures of psychological or acceptability outcomes.
Conclusion A tailored prenatal testing decision aid plays an important role in improving women's knowledge of first and second trimester screening tests and assisting them to make decisions about screening and diagnostic tests that are consistent with their values.

Utility of real-time decision-making in commercial data stream mining domains

The objective is to measure utility of real-time commercial decision making. It is important due to a higher possibility of mistakes in real-time decisions, problems with recording actual occurrences, and significant costs associated with predictions produced by algorithms. The first contribution is to use overall utility and represent individual utility with a monetary value instead of a prediction. The second is to calculate the benefit from predictions using the utility-based decision threshold. The third is to incorporate cost of predictions. For experiments, overall utility is used to evaluate communal and spike detection, and their adaptive versions. The overall utility results show that with fewer alerts, communal detection is better than spike detection. With more alerts, adaptive communal and spike detection are better than their static versions. To maximise overall utility with all algorithms, only 1% to 4% in the highest predictions should be alerts.

The decision-making journey of a family carer : information and social needs in a cultural context

While the important role of family as carer has been increasingly recognised in healthcare service provision, particularly for patients with acute or chronic illnesses, the carer's information and social needs have not been well understood and adequately supported. In order to provide continuous and home-based care for the patient, and to make informed decisions about the care, a family carer needs sufficient access to medical information in general, the patient's health information specifically, and supportive care services. Two key challenges are the carer's lack of medical knowledge and the many carers with non-English speaking and different cultural backgrounds. The informational and social needs of family carers are not yet well understood. This paper analyses the web-log of a husband-carer who provided support for his wife, who at the time of care was a lung cancer patient. It examines the decision-making journey of the carer and identifies the key issues faced in terms of informational and social practices surrounding care provision.

Ethics in nursing practice: a guide to ethical decision making

Every day nurses are required to make ethical decisions in the course of caring for their patients. Ethics in Nursing Practice provides the background necessary to understand ethical decision making and its implications for patient care. The authors focus on the individual nurse’s responsibilities, as well as considering the wider issues affecting patients, colleagues and society as a whole. This third edition is fully updated, and takes into account recent changes in ICN position statements, WHO documents, as well as addressing current issues in healthcare, such as providing for the health and care needs of refugees and asylum seekers, bioethics and the enforcement of nursing codes.

Practitioner perspectives on the family risk evaluation tool : an aide to decision making or 'just another form to fill in'?

The findings of research that explored how child protection practitioners in Queensland used the Structured Decision Making (SDM) tools are presented, focusing on how the Family Risk Evaluation tool (FRET) was used in decision making. The main finding was that the FRET was not used to assist the decision making of practitioners and consequently was ineffective in targeting the children most in need of a service. For practitioners, it was 'just another form to fill in'. As suggested by the participants in this research, a better strategy than the implementation of the SDM tools to improve decision making is the development of practitioner expertise through higher education.

Living with amyotrophic lateral sclerosis/motor neurone disease (ALS/MND) : decision-making about 'ongoing change and adaptation

Aims and objectives. To present a model that explicates the dimensions of change and adaptation as revealed by people who are diagnosed and live with amyotrophic lateral sclerosis/motor neurone disease.

Background. Most research about amyotrophic lateral sclerosis/motor neurone disease is medically focused on cause and cure for the illness. Although psychological studies have sought to understand the illness experience through questionnaires, little is known about the experience of living with amyotrophic lateral sclerosis/motor neurone disease as described by people with the disease.

Design. A grounded theory method of simultaneous data collection and constant comparative analysis was chosen for the conduct of this study.

Methods. Data collection involved in-depth interviews, electronic correspondence, field notes, as well as stories, prose, songs and photographs important to participants. QSR NVivo 2® software was used to manage the data and modelling used to illustrate concepts.

Findings. Participants used a cyclic, decision-making pattern about 'ongoing change and adaptation' as they lived with the disease. This pattern formed the basis of the model that is presented in this paper.

Conclusion. The lives of people living with amyotrophic lateral sclerosis/motor neurone disease revolve around the need to make decisions about how to live with the disease progression and their deteriorating abilities. Life decisions were negotiated by participants to maintain a sense of self and well-being in the face of change.

Relevance to clinical practice. The 'ongoing change and adaptation' model is a framework that can guide practitioners to understand the decision-making processes of people living with amyotrophic lateral sclerosis/motor neurone disease. Such understanding will enhance caring and promote models of care that are person-centred. The model may also have relevance for people with other life limiting diseases and their care.

Decision-making in a social welfare context

This paper presents analysis of the decision-making strategies adopted by respondents when confronted with potential policy options that include changes in both aggregate levels of welfare and equity in distribution. The analysis is based on the results of a choice experiment designed to estimate intergenerational distributional preferences. Non-linear welfare functions are employed within a conventional conditional logit framework. The heuristics employed by respondents in the stated preference context provide valuable insights into the application of welfare principles by respondents in determining trade-offs between the potential changes in the well-being of different generations.

Ethics and self-knowledge in corruption related decision making

The nature of corruption in international business is briefly considered and several types of bribes are distinguished. Two managerial decision-models are then proposed, in order to assist international managers faced with corruption-related situations. The first model is based upon an ethical analysis and it conditionally endorses some types of facilitating-payment. The second is based upon a psychological analysis and it involves identification and classification of the generic consequences of bribe payments. The two models are intended to form part of a wider and multifaceted approach to reducing corruption.