Clinical Decision Making at the Bedside

Marino, Marie Ann; Andrews, Katherine; Ward, Julia

doi:10.1016/j.cnur.2019.10.003

Cited by 10 publications

(5 citation statements)

References 22 publications

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“…The last aligns with the observation of a lower mortality rate in patients with a blushed skin and may suggest an adequate response to, e.g., infectious disease. The patient's face re ects the severity of illness, and the healthcare provider's "gut feeling" may be of crucial additive value [7][8][9].…”

Section: Discussionmentioning

confidence: 99%

Facial expression associates with longitudinal multi-organ failure: an ICU cohort study

Cox,

Bussel,

Llamazares

et al. 2024

Preprint

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Background Facial expression, at least unconsciously, may affect clinical decisions and treatments in the ICU. However, the association between objective clinical measurement of facial expression and multi-organ failure remains unknown. The aim of this study was to examine whether facial expression at admission is associated with longitudinal measurement of multi-organ failure. Methods This was a sub-study of the Simple Intensive Care Studies-II, a prospective observational cohort study. All adult patients acutely admitted to the ICU between March 26, 2019, and July 10, 2019, were included. Facial expression was assessed within three hours of ICU admission using predefined pictograms. The SOFA score was serially measured each day for the first seven days after ICU admission. The association between eye opening and facial color with longitudinal Sequential Organ Failure Assessment (SOFA) scores were investigated using generalized estimation equations. Results SOFA scores were measured in 228 patients. Clinical gestalt scored by the degree of eye opening was associated with a higher SOFA score at admission and follow-up (unadjusted 0.7 points per step (95%CI 0.5 to 0.9)). Facial color was not associated with worse SOFA score over time. However, patients with slinked or closed eyes combined with blushed skin had a lower SOFA score than patients with a pale or normal skin color (P-interaction < 0.1). Conclusions The patient's face revealed integrated cues regarding the disease state of critically ill patients, as scored by the degree of eye opening and facial color. Incorporating clinical gestalt using more advanced facial recognition techniques is promising to support future intensive care.

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Section: Discussionmentioning

confidence: 99%

Facial expression associates with longitudinal multi-organ failure: an ICU cohort study

Cox,

Bussel,

Llamazares

et al. 2024

Preprint

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“…This result is similar to that reported by Eline M.’s study 13 . Nurses with less seniority attends to the patient at his bedside every day and is required to perform various treatments 18 . They have little time to assess the patient's condition.…”

Section: Discussionmentioning

confidence: 99%

“…The nurse did not actively check the patient's laboratory test results and did not understand how to analyze the image. This may be the reason why prognoses made by physicians are superior to objective models 6 – 9 , 18 . This may explain why physicians were more accurate than nurses.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of physician and nurse predictions for 28-day prognosis in ICU: a single center prospective study

Huang,

Zhang,

Deng

et al. 2023

Sci Rep

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The proportion of correctly predicted prognoses and factors associated with prediction accuracy are unknown. The objective of this study was to explore the accuracy of physician and nurse predictions of 28-day mortality in the ICU. This was a prospective observational single-center study. All medical staff in the ICU have access to patient data, can communicate with patients or clients, and can independently predict the prognosis of patients within 24 h of patient admission. The only question of the questionnaire survey was: What is the patient’s outcome on day 28 (alive or death)? There were 2155 questionnaires completed by 18 physicians and 1916 submitted by 15 nurses. In the 312 patients included, the 28-day mortality rates were predicted by physicians and nurses. The overall proportion of correct prognosis prediction was 90.1% for physicians and 64.4% for nurses (P = 0.000). There was no significant difference in the overall correct proportion and average correct proportion among physicians with different seniority levels. The overall correct proportion and average correct proportion increased among nurses with seniority. Physicians in the ICU can moderately predict 28-day mortality in critically ill patients. Nurses with a seniority of less than 10 years in ICU cannot accurately predict 28-day mortality in critically ill patients. However, the accuracy of nurses’ prediction of patients’ 28-day prognosis increased with their seniority in the ICU.

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“…The majority of the sample were women (87.4%), aged from 25 clinical decisions, while the nurses in ERs and ICUs made good and very good clinical decisions.…”

Section: Sample Demographic Infromationmentioning

confidence: 99%

Clinical Decision Making of Greek Nurses Working in Health Centers, Emergency Rooms, Medical-Surgical Clinics and ICUs

Michael¹,

Nikolaos²,

Michalopoulos³

et al. 2021

ACMCR

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Clinical decision making is an integral part of nursing science and daily clinical nursing practice. Aims:To investigate and compare clinical decisions made by nurses working in Health Centers, Emergency Departments (ERs), Medical and Surgical Clinics and Intensive Care Units (ICU). Methods:Clinical decision-making cards (Q methodology) and a questionnaire were developed to investigate factors that influence clinical decision-making. Results:Nurses working in Health Centers made moderate clinical decisions for dyspnea and incomplete clinical decisions for CPR, while nurses working in ERs made good clinical decisions for MI and moderate for dyspnea. Also, nurses working in Medical Clinics made moderate clinical decisions for all scenarios (CPR, MI, dyspnea, vomiting). Finally, nurses working in Surgical Clinics made good clinical decisions for dyspnea and moderate for CPR, while nurses working in ICU made good clinical decisions for all scenarios. Conclusions:Nurses working in ICU make better clinical decisions than nurses working in Health Centers, ERs, Medical and Surgical Clinics. This is possible due to the better staffing of the ICUs, the implementation of nursing protocols, the high degree of autonomy they have and the severity of the patietns illness they face on a daily basis.

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Clinical Decision Making at the Bedside

Cited by 10 publications

References 22 publications

Facial expression associates with longitudinal multi-organ failure: an ICU cohort study

Facial expression associates with longitudinal multi-organ failure: an ICU cohort study

Accuracy of physician and nurse predictions for 28-day prognosis in ICU: a single center prospective study

Clinical Decision Making of Greek Nurses Working in Health Centers, Emergency Rooms, Medical-Surgical Clinics and ICUs

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