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.

Investigating the influence of African American and African Caribbean race on primary care doctors' decision making about depression

This paper explores differences in how primary care doctors process the clinical presentation of depression by African American and African-Caribbean patients compared with white patients in the US and the UK. The aim is to gain a better understanding of possible pathways by which racial disparities arise in depression care. One hundred and eight doctors described their thought processes after viewing video recorded simulated patients presenting with identical symptoms strongly suggestive of depression. These descriptions were analysed using the CliniClass system, which captures information about micro-components of clinical decision making and permits a systematic, structured and detailed analysis of how doctors arrive at diagnostic, intervention and management decisions. Video recordings of actors portraying black (both African American and African-Caribbean) and white (both White American and White British) male and female patients (aged 55 years and 75 years) were presented to doctors randomly selected from the Massachusetts Medical Society list and from Surrey/South West London and West Midlands National Health Service lists, stratified by country (US v.UK), gender, and years of clinical experience (less v. very experienced). Findings demonstrated little evidence of bias affecting doctors' decision making processes, with the exception of less attention being paid to the potential outcomes associated with different treatment options for African American compared with White American patients in the US. Instead, findings suggest greater clinical uncertainty in diagnosing depression amongst black compared with white patients, particularly in the UK. This was evident in more potential diagnoses. There was also a tendency for doctors in both countries to focus more on black patients' physical rather than psychological symptoms and to identify endocrine problems, most often diabetes, as a presenting complaint for them. This suggests that doctors in both countries have a less well developed mental model of depression for black compared with white patients. © 2014 The Authors.

Interactive data and retail investor decision-making:an experimental study

The results of an experimental study of retail investors' use of eXtensible Business Reporting Language tagged (interactive) data and PDF format for making investment decisions are reported. The main finding is that data format made no difference to participants' ability to locate and integrate information from statement footnotes to improve investment decisions. Interactive data were perceived by participants as quick and 'accurate', but it failed to facilitate the identification of the adjustment needed to make the ratios accurate for comparison. An important implication is that regulators and software designers should work to reduce user reliance on the comparability of ratios generated automatically using interactive data.

The Problems of Forming the Inner Personal Conflict as a Factor which Influences Decision-making

the article views examine the problems concerning with the sources of origin of unconscious the inner personal conflicts and the way the presence of this factor is reflected on the decision-making process by a person.

Expert System for Decision-Making Problem in Economics

An expert system (ES) is a class of computer programs developed by researchers in artificial intelligence. In essence, they are programs made up of a set of rules that analyze information about a specific class of problems, as well as provide analysis of the problems, and, depending upon their design, recommend a course of user action in order to implement corrections. ES are computerized tools designed to enhance the quality and availability of knowledge required by decision makers in a wide range of industries. Decision-making is important for the financial institutions involved due to the high level of risk associated with wrong decisions. The process of making decision is complex and unstructured. The existing models for decision-making do not capture the learned knowledge well enough. In this study, we analyze the beneficial aspects of using ES for decision- making process.

A Multi-agent Framework for Distributed Decision-making Systems

An approach of building distributed decision support systems is proposed. There is defined a framework of a distributed DSS and examined questions of problem formulation and solving using artificial intellectual agents in system core.

Synergetic Methods of Complexation in Decision Making Problems

Synergetic methods of data complexation are proposed that make it possible to obtain a maximal amount of available information using a limited number of channels. Along with freedom degrees reducers, a mechanism of freedom degrees discriminators is proposed that enables all the channels to take part in the development of a cooperative decision in accordance with their informativeness in a current situation.

Operating Model of Knowledge Quantum Engineering for Decision-Making in Conditions of Indeterminacy

The operating model of knowledge quantum engineering for identification and prognostic decision- making in conditions of α-indeterminacy is suggested in the article. The synthesized operating model solves three basic tasks: Аt-task to formalize tk-knowledge; Вt-task to recognize (identify) objects according to observed results; Сt-task to extrapolate (prognosticate) the observed results. Operating derivation of identification and prognostic decisions using authentic different-level algorithmic knowledge quantum (using tRAKZ-method) assumes synthesis of authentic knowledge quantum database (BtkZ) using induction operator as a system of implicative laws, and then using deduction operator according to the observed tk-knowledge and BtkZ a derivation of identification or prognostic decisions in a form of new tk-knowledge.

Understanding dynamics of strategic decision-making in venture creation:a process study of effectuation and causation

This study draws upon effectuation and causation as examples of planning-based and flexible decision-making logics, and investigates dynamics in the use of both logics. The study applies a longitudinal process research approach to investigate strategic decision-making in new venture creation over time. Combining qualitative and quantitative methods, we analyze 385 decision events across nine technology-based ventures. Our observations suggest a hybrid perspective on strategic decision-making, demonstrating how effectuation and causation logics are combined, and how entrepreneurs’ emphasis on these logics shifts and re-shifts over time. We induce a dynamic model which extends the literature on strategic decision-making in venture creation.

About Problems of Decision Making in Social and Economic Systems

The reasons of a restricted applicability of the models of decision making in social and economic systems. 3 basic principles of growth of their adequacy are proposed: "localization" of solutions, direct account of influencing of the individual on process of decision making ("subjectivity of objectivity") and reduction of influencing of the individual psychosomatic characteristics of the subject (" objectivity of subjectivity ") are offered. The principles are illustrated on mathematical models of decision making in ecologically- economic and social systems.

Active Monitoring and Decision Making Problem

Active monitoring and problem of non-stable of sound signal parameters in the regime of piling up response signal of environment is under consideration. Math model of testing object by set of weak stationary dynamic actions is offered. The response of structures to the set of signals is under processing for getting important information about object condition in high frequency band. Making decision procedure by using researcher’s heuristic and aprioristic knowledge is discussed as well. As an example the result of numerical solution is given.

Model of Active Structural Monitoring and Decision-making for Dynamic Identification of Buildings, Monuments and Engineering Facilities

Structural monitoring and dynamic identification of the manmade and natural hazard objects is under consideration. Math model of testing object by set of weak stationary dynamic actions is offered. The response of structures to the set of signals is under processing for getting important information about object condition in high frequency band. Making decision procedure into active monitoring system is discussed as well. As an example the monitoring outcome of pillar-type monument is given.

The role of shared decision-making in audiologic rehabilitation

Shared decision-making (SDM), a component of patient-centered care, is the process in which the clinician and patient both participate in decision-making about treatment; information is shared between the parties and both agree with the decision. Shared decision-making is appropriate for health care conditions in which there is more than one evidence-based treatment or management option that have different benefits and risks. The patient's involvement ensures that the decisions regarding treatment are sensitive to the patient's values and preferences. Audiologic rehabilitation requires substantial behavior changes on the part of patients and includes benefits to their communication as well as compromises and potential risks. This article identifies the importance of shared decision-making in audiologic rehabilitation and the changes required to implement it effectively.

How organizational cognitive neuroscience can deepen understanding of managerial decision-making:a review of the recent literature and future directions

There is growing interest in exploring the potential links between human biology and management and organization studies, which is bringing greater attention to bear on the place of mental processes in explaining human behaviour and effectiveness. The authors define this new field as organizational cognitive neuroscience (OCN), which is in the exploratory phase of its emergence and diffusion. It is clear that there are methodological debates and issues associated with OCN research, and the aim of this paper is to illuminate these concerns, and provide a roadmap for rigorous and relevant future work in the area. To this end, the current reach of OCN is investigated by the systematic review methodology, revealing three clusters of activity, covering the fields of economics, marketing and organizational behaviour. Among these clusters, organizational behaviour seems to be an outlier, owing to its far greater variety of empirical work, which the authors argue is largely a result of the plurality of research methods that have taken root within this field. Nevertheless, all three clusters contribute to a greater understanding of the biological mechanisms that mediate choice and decision-making. The paper concludes that OCN research has already provided important insights regarding the boundaries surrounding human freedom to act in various domains and, in turn, self-determination to influence the workplace. However, there is much to be done, and emerging research of significant interest is highlighted.