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.
    Journal of Hand Therapy 01/2008; 21(3):254-9; quiz 260. · 1.17 Impact Factor
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    ABSTRACT: There has been a rapid increase in members of the Australian population using opioids in recent years. The flow-on effect has been an increase in demand for treatments, particularly opioid replacement therapy (ORT), but the availability of treatments has not increased. This has frequently resulted in delays before treatment can be commenced. Outcomes could improve if health-care professionals had clearer guidelines on how to prioritize access to ORT. This review investigates the triage of consumers in ORT within Australia. Information on triage in ORT was not available, and an understanding of how consumer needs are managed when they present for ORT triage was not identified. In the absence of research to guide this practice, the body of evidence regarding ORT treatment access is weighted on government policies. Triage, as applied in general health and mental health-care service delivery, was reviewed to consider the components of triage and how these might pertain to triage in ORT. Failure to facilitate the needs of consumers accessing ORT can result in further harm to consumers and increased social and financial costs for society. Research is required to investigate how this issue is currently being managed and to lead the way for needed improvements in service delivery.
    International journal of mental health nursing 05/2011; 20(6):418-27. · 1.29 Impact Factor

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May 29, 2014