Women's approaches to decision making about mammography.

Health professionals have an obligation to understand women's decision making about mammography and to advocate for their active participation in health care decision making. Although mammography is a major screening measure for the second largest cancer killer of women, only approximately half of women older than age 50 years, and fewer older than age 70 years, undergo mammography in accordance with American Cancer Society (ACS) guidelines. Therefore, the purpose of this study was to identify women's overall decision-making approaches when considering mammography. Subjects were a purposive, convenience sample of 50 women in the community who had made a decision about mammography; they included those who chose to have mammograms and those who decided not to have mammograms according to the pre-1997 ACS guidelines. Subjects participated in audiotaped interviews. Results indicated that women approached the mammography decision differently, regardless of the decision they made. Three overall decision-making approaches to addressing risk factors, issues about mammography, or other factors before their decision were evident. The approaches were (1) thoughtful consideration; (2) cursory consideration; and (3) little or no consideration. Each approach has implications for nurses who assist women in making decisions about mammography.

Coronary care nurses' clinical decision making.

Increasing acuity of hospitalized persons with cardiac disease places great demands on nurses' decision-making abilities. Yet nursing lags in knowledge-based system development because of limited understanding about how nurses use knowledge to make decisions. The two research questions for this study were: how do the lines of reasoning used by experienced coronary care nurses compare with those used by new coronary care nurses in a representative sample of hypothetical patient cases, and are the predominant lines of reasoning used by coronary care nurses in hypothetical situations similar to those used for comparable situations in clinical practice? Line of reasoning was defined as a set of arguments in which knowledge is embedded within decision-making processes that lead to a conclusion. Sixteen subjects (eight experienced and eight new nurses) from coronary care and coronary step-down units in a large, private, teaching hospital in Minnesota, USA, were asked to think aloud while making clinical decisions about six hypothetical cases and comparable actual case. One finding was that most subjects in both groups used multiple lines of reasoning per case; but they used only one predominantly. This finding highlighted the non-linear nature of clinical decision making. Subjects used 25 predominant lines of reasoning, with intergroup differences on six of them. Where there were differences, experienced nurses used lines of reasoning of lower quality than did new subjects. The type variability in lines of reasoning suggested that multiple pathways should be incorporated into knowledge-system design. One implication of the variability in subjects' line of reasoning quality is that nurses at all levels of expertise are fallible and could benefit from decision support. The finding that subjects tended to use similar lines of reasoning for comparable hypothetical and actual cases was modest validation of subjects' performance on hypothetical cases as representing their decision making in practice. Consequently, there was support for using simulations and case studies in teaching and studying clinical decision making.

Enhancing orthopaedic nurses' clinical decision making.

Clinical decision making ability is necessary for safe and effective orthopaedic nursing practice. By clinical decision making, we mean the rendering of a judgment about patient care using analytical and intuitive processes and incorporating professional knowledge. Although recent research findings indicate that there is no single approach that clinicians use to make all decisions, there are several general aspects of decision making processes. Among these are the development of mental representations, decision-making procedures, and pattern recognition. Five selected strategies for enhancing these general processes are described and illustrated with patient situations relevant to orthopaedic nursing.

The focus of the discipline of nursing.

The focus of nursing as a discipline has not been clearly defined but is emergent in the centrality of the concepts of caring and health. The authors propose a focus for nursing as a professional discipline in the form of a statement that identifies a domain of inquiry that reflects the social relevance and nature of its service. Several perspectives from which the focus can be studied are described. The authors assert that a unitary-transformative perspective is essential for the full explication of nursing knowledge.