Use of a Decision Tree to Improve Accuracy of Diagnosis

Aspinall, Mary Jo

doi:10.1097/00006199-197905000-00014

Cited by 59 publications

(42 citation statements)

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“…Greenwood (1993) observes that the reality of patient care is made up of ‘messy, intermediate situations’ where the best outcomes may be dependent upon opinion, and the ranking of hypotheses may be difficult as well as being meaningless. On the other hand, Grier (1976) and Aspinall (1979) found that nurses using decision trees to assist with their reasoning and to choose the appropriate actions were more often correct in their diagnosis than those nurse practitioners who did not use the technique.…”

Section: Discussionmentioning

confidence: 99%

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

Offredy

1998

Journal of Advanced Nursing

113

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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.

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Section: Discussionmentioning

confidence: 99%

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

Offredy

1998

Journal of Advanced Nursing

113

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“…Research in nursing exploring this theory is sparse due to the need for mutually exclusive alternatives and quantitative probability estimates [5]. An early study [2] demonstrated that data structured in the form of algorithms or decision trees increased the likelihood of finding the correct diagnosis. A recent study [57] of wound treatment options, found that nurses' intuitive decisions agreed with the decision analytic model 35% of the time.…”

Section: Clinical Decision Makingmentioning

confidence: 99%

Development of a hand-held real-time decision support aid for critical care nursing

Fortier

Jagannathan

Michel

et al. 2003

36th Annual Hawaii International Conference on System Sciences, 2003. Proceedings of The

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In the current health care environment, nurse clinicians must work "faster and smarter" making complex decisions on almost a continual basis. Evidencebased knowledge and standardized guides, such as clinical algorithms, can support clinical nursing decisions, however; effective real-time access is limited. This paper outlines research addressing this problem. In this research, current clinical knowledge is delivered to the clinician via an off-the-shelf handheld computer using wireless access to a central server and data repository. Innovative minimal-set database, data mining and knowledge discovery algorithms using a combination of case based and rule based learning with added confidence measures permitting bi-directional (forward and backwards) inferencing based on individual client data are developed and presented for the hand held device. The technology provides real-time decision support for the multiple cases and sequential decisions characterizing present critical care nursing practice. Nurses will be able to consider a full range of alternative explanations, determine additional data needs, find, isolate and examine patient case outliers for additional diagnostic data or verify the appropriateness of a selected strategy. Once fully developed the system will have the capacity to maintain a history of a series of decisions and outcomes thereby over time improving the case base and rule bases used for decision support. Outcomes of the real time decision support aid include more timely health care, less biased decisions, and improved patient outcomes.

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“…The ability of expert nurses to recognize that a significant patient problem existed before any noticeable change in objective vital parameters was used as a basis to study unconscious expert thinking. Although there is research literature on clinical judgment, decision‐making theory ( Hammond, 1955; Hammond et al , 1966a , 1966b; Hammond et al , 1967 ; Aspinall, 1979; Broderick & Ammentorp, 1979; Putzier et al 1985 ; Corcoran, 1986; Tanner et al , 1987 ; Itano, 1989; Fonteyn & Grobe, 1994; Raines, 1996) and intuition in nursing ( Pyles & Stern, 1983; Benner & Tanner, 1987; Young, 1987; Rew, 1988; Crandall & Getchell‐Reiter, 1993; Farrington, 1993; Kenny, 1994; Minick, 1995) little is known about the action‐oriented practice of how nurses think when solving such puzzling and ambiguous problems of practice. A major problem in studying this phenomenon is the unconscious nature of the thought process.…”

Section: Studies On Expert Thinking In Nursing Practicementioning

confidence: 99%

Expert thinking in nursing practice: Implications for supporting expertise

Peden‐McAlpine

1999

Nursing & Health Sciences

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The complexity of the art of expert nursing practice is an elusive phenomenon, which is difficult to articulate in concrete terms that can be translated into achieving quality patient care outcomes. The present study describes the findings of two hermeneutic (interpretive) studies on expert thinking that captured the holistic practice of expert clinicians. The findings from these studies provide insight into how expert practice can be administratively supported. These findings also have strong implications for strategies to facilitate the development of expertise in practice. In order to provide holistic care, nurses must spend time with their patients so that the particularities and meaning inherent in each unique patient situation can be understood. The art of expert thinking is a temporal and ethical activity, which needs to be supported and cultivated in a changing health-care delivery system.

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Use of a Decision Tree to Improve Accuracy of Diagnosis

Cited by 59 publications

References 0 publications

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

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

Development of a hand-held real-time decision support aid for critical care nursing

Expert thinking in nursing practice: Implications for supporting expertise

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