63. Difficult decisions: Exploring heart failure specialist nurses’ decision making in clinical practice (348)
Dawn Dowding, Senior Lecturer in Clinical Decision Making, Health Sciences (Research), University of York, York, United Kingdom
Co authors: Karen Spilsbury, Carl Thompson, Jill Pattendon & Ros McNama
dawn.dowding@hyms.ac.uk
Abstract:
Background:
Heart failure specialist nurses (HFSN) are key to the management of patients with heart failure in the community. HFSNs report that they have difficulty developing decision making skills for their role. This study uses cognitive continuum theory (CCT) to explore in-depth the types of decisions HFSN face and the strategies they deploy to make decisions in clinical practice.
Methods:
A qualitative study using non-participant observation and semi-structured interviews. We observed 6 HFSN carrying out 3 consultations with patients (n = 18) and interviewed 12 HFSN about their decision making in practice. The HFSN participants represented both experienced and newly appointed HFSNs.
Results:
Observations revealed that medication titration was a common decision faced by HFSNs. During interviews, HFSNs identified decisions surrounding the timing of palliative care as particularly challenging. Medication titrations were characterised by a number of features that suggest a ‘quasi-rational’ approach to thinking would assist in making accurate judgements. Palliative care decisions were characterised by features that would make a more intuitive approach to reasoning appropriate. HFSNs tended to use a mixture of an experimental approach, together with internal guidelines and discussion with others to inform decisions about medication. Palliative care decisions were frequently passed on to other health care professionals.
Discussion:
CCT suggests that for optimum decision making to occur the features of the task and the thought processes used by an individual should correspond. HFSN decision making may benefit from interventions which assist them to use thought processes which match the decision task for medication titration decisions. Further research is required into the nature of palliative care decisions, and how to ensure HFSN feel better equipped with skills in this area of their clinical practice.
Source of Funding: UK - Health Service (Local)
Hull York Medical School pump priming
Amount in Funding: 10,001 - 50,000
Biography:
I am currently senior lecturer in clinical decision making at the Hull York Medical School and the Department of Health Sciences, University of York. I am a registered nurse, with a background in psychology, and have been researching the decision making of health care professionals for 15 years. My current interests include examining how we can use technology effectively to help support clinicians decision making.