Decision-making in clinical practice: how do expert nurses, midwives and health visitors make decisions?

Orme, Laila; Maggs, Christopher

doi:10.1016/0260-6917(93)90052-4

Cited by 72 publications

(44 citation statements)

References 13 publications

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“…The research reported here was also guided hy the work of Patncia Benner, who in tum drew on the Dreyfus model of skill acquisition (Benner 1984, Dreyfus 1979, Dreyfus etal 1986 The importance Benner attaches to the knowledge which IS 'embedded' m nursmg practice has influenced much subsequent nursing research (Bondy 1983, Gately 1992, Morle & Maggs 1993, Orme & Maggs 1993 and certainly colours the mterpretation of the data presented here…”

Section: Background To the Workmentioning

confidence: 93%

The learning career in the community setting: a phenomenological study of a Project 2000 placement*

Hallett

Williams²,

Butterworth

1996

Journal of Advanced Nursing

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The findings of one element of an English National Board-funded research study conducted in two phases between 1989 and 1992 are discussed. The study examined one aspect of the new Project 2000 courses introduced in 13 'demonstration districts' in England in the autumn of 1989. During Phase 2 of the study (1991-1992). 14 district nursing sisters and 12 of the students they supervised were interviewed. Data were re-transcribed and interpreted in 1993; the interpretation was based on a phenomenological paradigm which focused on the subjective perceptions of students and supervisors. Participants identified 'learning', as it took place in the community setting, as a sequential process, which is referred to here as the 'learning career'. Using terminology adopted by participants themselves; the authors identify the stages of the 'learning career' as:'encountering reality'; 'having a go' 'gaining confidence'; 'thinking through and understanding'; 'developing ideas'; 'being independent'; and 'being assessed'. Supervisors could ease their students' passage through this complex and anxiety-provoking sequence of events in a number of ways. They could demonstrate their practice and provide opportunities for students to gain experience for themselves; they could teach their students about nursing, and enable them to reflect on their own practice; and they could also monitor and assess their students' work.

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Section: Background To the Workmentioning

confidence: 93%

The learning career in the community setting: a phenomenological study of a Project 2000 placement*

Hallett

Williams²,

Butterworth

1996

Journal of Advanced Nursing

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“…Pyles andStern (1983, cited in Higgs andJones 2000), in a study of nursesÕ reasoning processes, described intuition or Ônursing gestaltÕ as being as important to decision-making as knowledge. As a cognitive skill it is seen by some to be an essential component of the decision making process (Benner et al, 1996) and by others to have little value (Orme and Maggs, 1993;Sjostrom et al, 2000). Intuitive feelings on a stand-alone basis should not bare relevance in a clinical judgement or form the basis of a decision; such practice would be unsafe and unjustified.…”

Section: Intuitionmentioning

confidence: 97%

Strategies used by nurses for decision-making in the paediatric orthopaedic setting

Judd

2005

Journal of Orthopaedic Nursing

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“…The emotional component that inter-links with the cognitive element of the clinical examination is generated by the clinicians' empathy and the ability to interpret and appreciate the patient experience enhancing the patients' sense of being listened to and understood (Mattingly 1991;Orme and Maggs 1993). This clinician and patient relationship has been described as intuitive practice (English 1993;Gore & Sadler-Smith 2011;Smith et al 2004) and is well documented in nursing literature.…”

Section: Cognition and Emotional Markersmentioning

confidence: 99%

“…This synthesising process involves considering many facets of patient data, clinician experience, clinician knowledge, and the literature (Higgs and Jones 2008;Simmons 2010). This interactive process then further evidences the clinical decision (Childs et al 2003;Curran et al 2006;Doody & McAteer 2002;Noll et al 2001;Orme & Maggs 1993). Musculoskeletal physiotherapy research has seen common reference to models such as hypothetico-deductive, pattern-recognition, narrative reasoning and clinical prediction (Childs et al 2004;Jensen et al 2000;Jones et al 2008;Mattingly and Fleming 1994).…”

Section: Introductionmentioning

confidence: 99%

The role of clinician emotion in clinical reasoning: Balancing the analytical process

2016

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TitleThe role of clinician emotion in clinical reasoning: balancing the analytical process.Key words: Physiotherapy; reasoning; emotion. Authors DiscussionIt is proposed that clinicians should consider the emotions associated with decision-making, especially when there is concern surrounding a presentation. Reflecting on practice in the clinical environment and subsequently applying this to a patient presentation should involve some acknowledgement of clinicians' physical responses, emotions and how they may play a part in any decision made. Presenting intuition and gut-feeling as separate reasoning methods and how these processes co-exist with other more accepted reasoning such as hypotheticodeductive is also discussed. ConclusionMusculoskeletal physiotherapy should consider the elements of feelings, emotions and physical responses when applying reflective practice principles. Furthermore, clinicians dealing with difficult and challenging presentations should look at the emotional as well as the analytical experience when justifying decisions and learning from practice.

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Decision-making in clinical practice: how do expert nurses, midwives and health visitors make decisions?

Cited by 72 publications

References 13 publications

The learning career in the community setting: a phenomenological study of a Project 2000 placement*

The learning career in the community setting: a phenomenological study of a Project 2000 placement*

Strategies used by nurses for decision-making in the paediatric orthopaedic setting

The role of clinician emotion in clinical reasoning: Balancing the analytical process

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