6.2.1 What do we mean by ‘supported’ decision making? (351)

Dawn Dowding, Senior Lecturer in Clinical Decision Making, Health Sciences (Research), University of York, York, United Kingdom Co authors: Rebecca Randell, Natasha Mitchell, Rebecca Foster & Val Lattimer, Carl Thompson, Nicky Cullum, Rebecca Owens dawn.dowding@hyms.ac.uk

Abstract:

Background:

Nurses are increasingly working more autonomously in extended roles with a number of Computerised Decision Support Systems (CDSS) being introduced to support the process. However, little is known about how nurses actually use such systems to support their clinical practice. This paper will draw on results from a Department of Health (England) funded study which examined how nurses use technology to support their decision making, to explore this in more detail.

Methods:

Data was drawn from two sources; a secondary analysis of existing data sets and a case site study of nurses’ use of CDSS from 4 NHS Trusts in England. Data sets for the secondary analysis were taken from a study examining primary care nurses’ use of evidence to inform their decision making (410 observations and 76 interviews) (Thompson et al., 2005), and an evaluation of The Exemplar Programme for out-of-hours care (55 interviews) (Lattimer et al., 2004). The case site data consisted of non-participant observation of nurses use of CDSS (n=124), patient interviews (n=38), nurse interviews (n=55) and interviews with clinical unit and Trust level managers (n=17). Secondary data was analysed using framework analysis and case site data analysed using content analysis.

Results:

Nurses were observed and reported using technology in a variety of different ways, all of which were perceived to support their decision making. This included using technology to provide guidance for clinical decisions, as well as to assist with the assessment and monitoring of patients’ conditions, to confirm a decision they had already made, for record keeping and for research/audit.

Discussion:

Nurses often use technology in ways that are not envisaged by the original developer, and ‘adapt’ their use according to the local context in which they work and their own experience with the patient(s) or the technology. All of these uses could be considered as ‘supporting’ the decision process.

Recommended reading list:

  • Lattimer, v., Gerard, K., George, S., Smith, H., Lathlean, J., Burgess, A., Turnbull, J. & Surridge, H. (2004) The Examplar Programme for Integrated Out-of-Hours Care: Evaluation Report. University of Southampton
  • Thompson, C., McCaughan, D., Cullum, N., Sheldon, T. & Raynor, P. (2005) Barriers to evidence-based practice in primary care nursing - why viewing decsion making as context is helpful. Journal of Advanced Nursing, 52, 432-444

Source of Funding: UK - Health Service (National)

Amount in Funding: 100,001 - 500,000

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.