Person‐centred shared decision making

While multiple versions of shared decision making (SDM) have been advanced, most share two seemingly essential elements: (a) SDM is primarily focused on treatment choices and (b) the clinician is primarily responsible for providing options while the patient contributes values and preferences. We argue that these two elements render SDM suboptimal for clinical practice. We suggest that SDM is better viewed as collaboration in all aspects of clinical care, with clinicians needing to fully engage with the patient's experience of illness and participation in treatment. SDM can only take place within an ongoing partnership between clinician and patient, both respecting the other as a person, not as part of an isolated encounter. Respect for the patient as a person goes beyond respect for their choice. Non‐interference is not the only way, or even the most important way, to respect patient autonomy. Knowing the patient as a person and providing an autonomy‐supportive context for care are crucial. That is, the clinician must know the patient well enough to be able to answer the patient's question “What would you do, if you were me?” This approach acknowledges clinicians as persons, requiring them to understand patients as persons. We provide examples of such a model of SDM and assert that this pragmatic method does not require excessive time or effort on the part of clinicians or patients but does require direct and particular knowledge of the patient that is often omitted from clinical decisions.     

Therapist self‐disclosure and the problem of shared‐decision making

Therapist self‐disclosure is one of the most controversial topics in the history of psychotherapy. The controversies reflect some basic discussions regarding the nature of psychotherapy practice. In psychotherapy practice, a particular concern is the interaction between the psychotherapist and the patient. The expert‐patient interaction has been addressed in a novel framework for clinical practice called shared‐decision making. In this paper, we discuss the relationship between self‐disclosure and shared‐decision making. The chief aim is to illustrate some of the principles and practical problems with shared‐decision making by using therapist self‐disclosure as an example.     

护理本科生临床实习环境与职业决策自我效能感的相关研究

目的了解护理本科生临床实习环境、职业决策自我效能的现状,探讨二者之间的相关性。方法选取306名护理本科生进行问卷调查,采用护理本科生一般资料调查表、临床实习环境评价量表、职业决策自我效能问卷进行调查。结果护理本科生临床实习环境评价总分为(119.33±20.80)分,职业决策自我效能总均分为(3.72±0.46)分,临床实习环境评价与职业决策自我效能呈正相关(P0.05);教学方法、工作氛围、组织支持维度可影响护理本科生的职业决策自我效能。结论创建一个良好的、支持性的临床学习环境,可提升护理本科生的职业决策自我效能。     

The decision making of heart failure specialist nurses in clinical practice

Aims and objectives. To explore decision processes and types of decisions made by heart failure specialist nurses. Background. Heart failure specialist nurses are key to the management of patients with heart failure in the community. In previous studies heart failure specialist nurses have reported difficulty in developing decision making skills. Cognitive continuum theory can be used to examine the relationship between decision tasks and the processes used by heart failure specialist nurses to make decisions. Design. A qualitative study using non‐participant observation and semi‐structured interviews. Methods.  Six heart failure specialist nurses were observed while they carried out consultations with three patients each (n = 18). Twelve heart failure specialist nurses were interviewed about their decision making in practice. Data were analysed using thematic content analysis. Results. Two areas of decision making were identified by heart failure specialist nurses as key; pharmacological management and managing patients in the palliative phase of their condition. Pharmacological management decisions involved the trading off of risks and benefits of titrating medication, with nurses using internalised guidelines to inform their practice. In contrast, nurses relied on support from other health care professionals when making decisions about a patient’s need for palliative care. Conclusions. Medication titration decisions have a mixture of intuition and analysis inducing features making them amenable to the use of decision tools. The timing of the need for palliative care is less predictable, suggesting an intuitive approach to decision making may be more appropriate. Relevance to clinical practice. There are several strategies that could be used to improve the match between the decisions that heart failure specialist nurses take and the decision processes they use. These include the development of more tailored decision support tools for medication titration decisions and the provision of structured decision aids for assessing patients’ need for palliative care.     

Synthesis and characterization of poly(glycerol‐co‐sebacate‐co‐ε‐caprolactone) elastomers

In this study, poly(glycerol‐co‐sebacate‐co‐ε‐caprolactone) (PGSCL) elastomers were synthesized for the first time from the respective monomers. The structural analysis of PGSCL elastomers by nuclear magnetic resonance (¹H‐NMR) and Fourier transform infrared spectroscopy (FTIR) revealed that the elastomers have a high number of hydrogen bonds and crosslinks. X‐ray diffraction (XRD) and thermal analysis indicated an amorphous state. Differential scanning calorimetry (DSC) analysis showed that the elastomers has a glass transition temperature (T_g) of –36.96°C. The Young's modulus and compression strength values were calculated as 46.08 MPa and 3.192 MPa, respectively. Calculations based on acid number and end groups analysis revealed a number average molecular weight of 148.15 kDa. Even though the foaming studies conducted by using supercritical CO₂ resulted in a porous structure; the obtained morphology tended to disappear after 48 h, leaving small cracks on the surface. This phenomenon was interpreted as an indication of self‐healing due to the high number of hydrogen bonds. The PGSCL elastomers synthesized in this study are flexible, robust to compression forces and have self‐healing capacity. Thanks to good biocompatibility and poor cell‐adhesion properties, the elastomers may find diverse applications where a postoperative adhesion barrier is required. Copyright © 2013 John Wiley & Sons, Ltd.     

Do Knowledge and Experience Have Specific Roles in Triage Decision‐making?

Accuracy of triage decisions is a major influence on patient outcomes. Triage nurses' knowledge and experience have been cited as influential factors in triage decision-making. The aim of this article is to examine the independent roles of factual knowledge and experience in triage decisions. All of the articles cited in this review were research papers that examined the relationship between triage decisions and knowledge and/or experience of triage nurses. Numerous studies have shown that factual knowledge is an important factor in improving triage decisions. Although a number of studies have examined the role of experience as an independent influence on triage decisions, none have found a significant relationship between experience and triage decision-making. Factual knowledge appears to be more important than years of emergency nursing or triage experience in triage decision accuracy. Many triage education programs are underpinned by the assumption that knowledge acquisition will result in improved triage decisions. A better understanding of the relationships between clinical decisions, knowledge, and experience is pivotal for the rigorous evaluation of education programs.     

Globalization, decision making and taboo in nursing

This paper is a reflection on the representation of nurses and their practice at a global level. In considering the International Council of Nurses (ICN) conference in Malta (2011), it is clear that certain assumptions have been made about nurses and their practice which assume that globalization is under way for the whole of the profession and that the assumptions can be applied equally around the world. These assumptions appear in many ways to be implicit rather than explicit. The implicitness of the assumptions is examined against the particular decision-making processes adopted by the ICN. An attempt is then made to identify another base for the ongoing global work of the ICN. This involves the exploration of taboo (that which is forbidden because it is either holy or unclean) as a way of examining why nursing is not properly valued, despite years of international representation. The paper concludes with some thoughts on how such a new approach interfaces with the possibilities held out by new information technologies.     

The application of decision making concepts by nurse practitioners in general practice

The application of decision making concepts by nurse practitioners in general practice ¶This paper is concerned with the conceptual frameworks which could be applied to nurse practitioners in general practice in reaching decisions during patient consultations. Four strategies of decision making are explained within a practice context: hypothetico-deductive method, decision analysis, pattern recognition and intuition. The study uses retrospective verbalization and observation of 20 nurse practitioners working alongside general practitioners to explore decision making issues. The results of the study show that important factors relating to decision making include: the ability to recognize patterns in clinical situations to fit with patterns previously seen; an appreciation of the consequences of inappropriate action; and the ability to concentrate simultaneously on complex and sometimes masked patient cues as well as multiple treatment options.