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Theories of clinical judgment and decision-making: A review of the theoretical literature

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    ABSTRACT: This is the third paper in a series that heralds a study that examines paramedic accounts and constructs of judgment and decision-making (JDM) of mental health and mental illness. This paper will overview an innovative theoretical framework for conducting a discourse-historical case study of paramedic judgment and decision-making of mental health and mental illness using ethnographic and ethnomethodological research methods. The review of the existing research and literature suggests an insufficiency of current theoretical and methodological frameworks to address the research problem and questions of this study. Little examination of judgment in mental illness and health has occurred, which is discussed in an earlier paper. 1 Those studies, and the theoretical frameworks used, are insufficient in addressing key aspects of inquiry in judgment and decision-making, particularly in the paramedic ecology. The theoretical framework described here seeks to begin addressing this insufficiency in a new and innovative way.
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    ABSTRACT: Sound clinical decision making (CDM) is one critical factor in the delivery of quality health care. The purpose of this cross-sectional study was to examine therapists' autonomy in CDM, to describe therapists' clinical reasons influencing CDM, and to describe the influence of autonomy on actual clinical practice. A survey was distributed to 754 hand therapists and descriptive statistics was performed. Of the 754 surveys, 191 were returned (response rate 25.3%). Autonomy in CDM was perceived to be low by most therapists. Greatest autonomy was seen in setting the frequency of rehabilitation sessions, and the least autonomy in choosing the protocol and the timing of initiation of rehabilitation. Shared decision making between therapist and surgeon occurred frequently, however, CDM was rarely fully collaborative. Clinical reasoning strategies were consistent with a novice-type approach. The perceived lack of autonomy in CDM negatively impacted therapists' compliance with surgeons' preferences.
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May 29, 2014