BackgroundTraditionally, clinical decision making has been perceived as a purely rational and cognitive process. Recently, a number of authors have linked emotional intelligence (EI) to clinical decision making (CDM) and calls have been made for an increased focus on EI skills for clinicians. The objective of this integrative literature review was to identify and synthesise the empirical evidence for a role of emotion in CDM.MethodsA systematic search of the bibliographic databases PubMed, PsychINFO, and CINAHL (EBSCO) was conducted to identify empirical studies of clinician populations. Search terms were focused to identify studies reporting clinician emotion OR clinician emotional intelligence OR emotional competence AND clinical decision making OR clinical reasoning.ResultsTwenty three papers were retained for synthesis. These represented empirical work from qualitative, quantitative, and mixed-methods approaches and comprised work with a focus on experienced emotion and on skills associated with emotional intelligence. The studies examined nurses (10), physicians (7), occupational therapists (1), physiotherapists (1), mixed clinician samples (3), and unspecified infectious disease experts (1). We identified two main themes in the context of clinical decision making: the subjective experience of emotion; and, the application of emotion and cognition in CDM. Sub-themes under the subjective experience of emotion were: emotional response to contextual pressures; emotional responses to others; and, intentional exclusion of emotion from CDM. Under the application of emotion and cognition in CDM, sub-themes were: compassionate emotional labour – responsiveness to patient emotion within CDM; interdisciplinary tension regarding the significance and meaning of emotion in CDM; and, emotion and moral judgement.ConclusionsClinicians’ experienced emotions can and do affect clinical decision making, although acknowledgement of that is far from universal. Importantly, this occurs in the in the absence of a clear theoretical framework and educational preparation may not reflect the importance of emotional competence to effective CDM.Electronic supplementary materialThe online version of this article (10.1186/s12909-017-1089-7) contains supplementary material, which is available to authorized users.
Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.
ObjectiveClinicians are challenged to decide when and how to conduct decision‐making capacity assessment and guardianship applications for confused hospitalised older patients. This study aimed to understand the characteristics of confused hospitalised older patients who require decision‐making capacity assessment and guardianship applications and to determine the impact of a locally introduced capacity testing procedure on the conduct of decision‐making capacity assessment and guardianship application in a regional hospital setting.DesignBefore and after study.SettingRegional New South Wales hospital.ParticipantsTwenty‐four confused hospitalised older patients who had decision‐making capacity assessment during November 2014‐April 2015 and November 2015‐April 2016.Main outcome measureThe impact of a standardised capacity testing procedure on the conduct of decision‐making capacity assessment.ResultsAfter capacity testing procedure implementation, there were significant improvements in the number of multidisciplinary team meetings, documentation of decision‐making capacity assessment process and length of stay. The majority of patients who required guardianship application was aged over 70 years, had a medical history of dementia, >20 days of acute hospital admission and had no evidence of future care‐planning.ConclusionImplementation of capacity testing procedure is likely to have contributed to the positive changes in the conduct of decision‐making capacity assessment and guardianship application process for confused hospitalised older patients. This study provides some evidence of decision‐making capacity assessment process gaps; and indicates clinical and demographic characteristics of confused hospitalised older patients who might require decision‐making capacity assessment and guardianship applications. The evidence of lack of appropriate future care‐planning for ageing patients and increasing hospital admissions of confused hospitalised older patients presents future challenges in rural health.
This article describes an action research project that highlighted reflective processes, so hospital nurses could work systematically through problem solving processes to uncover constraints against effective nursing care; and to improve the quality of their care in light of the identified constraints and possibilities. Four Registered Nurses (RNs) co-researched their practice with the facilitator and over the research period identified the thematic concern of the need for assertiveness in their work. The RNs planned, implemented and evaluated an action plan and, as a direct result of their reflections and collaborative action, they improved their nursing practice in relation to becoming more effective in assertiveness in work situations.
ObjectiveDecision‐making capacity assessments for hospital settings are challenging as it is dominated by the ethical and legal principles of maintaining autonomy and protection. Health clinicians, especially in rural areas, are challenged with a lack of a standardised processes and pathways for decision‐making capacity assessment. A literature review was conducted to determine what measurement tools clinicians are utilising in the hospital setting for decision‐making capacity assessment and how decisions relating to consent to treatment, independent living and finances are made.DesignLiterature review.MethodA search of MEDLINE, EMBASE and PsycINFO databases from January 2006 to April 2019 was conducted for peer‐reviewed articles to determine how decision‐making capacity assessments are conducted and the tools clinicians are utilising in the hospital setting.ResultsFive main themes were identified from this review: (a) domains of capacity; (b) capacity assessment; (c) capacity assessment instruments; (d) who performs capacity assessment; and (e) challenges and limitations to capacity assessment in the hospital setting. Currently, there is no gold standard for capacity assessment.ConclusionThis review shows that there is currently a lack of a uniform approach or a singular test to determine capacity. It is proposed that a multidisciplinary approach to decision‐making capacity assessment could be an effective model in the hospital setting, especially in rural health due to limited access to aged care specialists. It is important that clinicians receive ongoing training in decision‐making capacity assessment and further research is recommended in this specialised area of practice.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.