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: Provision of web-based resources is a valuable addition to face-to-face teaching in a blended learning environment. To understand how both order of presentation and number of online resources impacts on the frequency of access by learners in postgraduate vocational training in general practice. Information was collected on how many times individual online resources were accessed. Data regarding access rates for 15 separate topics used in postgraduate general practice vocational training were aggregated. Analysis was on the basis of order of presentation where the mean of percentages of hits by order of presentation with standard deviations was calculated. The first four listed resources were accessed at a higher rate than the remainder of the resources. All resources after the first four were accessed at a relatively uniform low rate. It would appear that providing more than four resources per topic is associated with learner overload. The number of online resources to support face-to-face teaching should be limited to four. Resource material needs to be carefully considered in terms of how it adds educational value. The ability of resource material to present a different perspective on a topic and adherence to both curriculum and assessment objectives are important considerations.
    Journal of primary health care 01/2012; 4(3):213-6.
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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.
    Journal of Hand Therapy 07/2008; 21(3):254-9; quiz 260. DOI:10.1197/j.jht.2007.10.022 · 1.81 Impact Factor

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May 29, 2014