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Nurses’ use of research information in clinical decision making in primary care

Nurses’ use of research information in clinical decision making in primary care. Carl Thompson; Dorothy McCaughan; Pauline Raynor; Nicky Cullum; Trevor Sheldon. Funder: Medical Research Council. methods. Subjects: health visitors, practice nurses, district nurses, nurse practitioners

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Nurses’ use of research information in clinical decision making in primary care

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  1. Nurses’ use of research information in clinical decision making in primary care Carl Thompson; Dorothy McCaughan; Pauline Raynor; Nicky Cullum; Trevor Sheldon. Funder: Medical Research Council

  2. methods • Subjects: health visitors, practice nurses, district nurses, nurse practitioners • Mixed method, multi-site case study design, 3 geographical areas over one year (2001-2) • In depth interviews (n=82) • Observation data (270 hours) • Q methodological statistical modelling (n=120) • Local information resource audit (circa 1000 sources) • Rigour: explicit purposive sampling frame; between method & subject triangulation; multi-rater Kappa for descriptive coding tasks

  3. Why information use in decision making context? • Finite range of uncertainties (coming next…) • Decision making is often ‘missing link’ in models of research utilisation • Adding value to what we know • Decisions affect the ways we think and the knowledge required • Expertise is not enough WE NEED TO KNOW MORE ABOUT DECISION TASKS AND RESPONSES OF NURSES

  4. Cognitive continuum (cf. Hammond, Hamm, Dowie 1963-2002) ‘pure’ scientific experiment + Time, Visibility Of process - good Task Structure poor System aided judgement Peer aided judgement intuition intuition Analysis

  5. Decision space in the real world? • Assume limited time • Increasing need for visibility in decision making • Task structure is vital to understanding the mechanism for inducing cognition • Understand task structure – possibility of inducingways of thinking and different kinds of knowledge use

  6. Other health information: smoker? Mobility? Medication?…etc General medical condition: diabetic? RA; anaemic?… etc ARTICLES DAILY VISITS Doppler ABPI Compliance? History: how and when ulcer started; current treatment; pain… etc PHYSIOLOGY Ulcer: size, odour, slough, exudates? Background information Investigations: urine, FBC, ESR, urea and electrolytes, blood glucose, swab (if appropriate) Leg exam: oedema, temperature; ankle and calf circumference… PATIENT INFORMATION COLLEAGUE’S ‘EXPERIMENTS’ general condition: well? Pulse, BP, weight COST PATIENT REJECTION OF EXPERTISE ROLE CONFLICT, GP WISHES REJECTION OF EXPERTISE CNS NEED FOR VISIBILITY IN DECISION SHARED DECISION MAKING VALUES SEEING IS BELIEVING AND EXPERIMENTATION WOUND FORMULARY COST DOWN TO WHAT I’VE USED OVER THE YEARS

  7. Stage 1: assessment ‘pure’ scientific experiment + Time, Visibility Of process - good Task Structure poor System aided judgement Peer aided judgement intuition intuition Analysis

  8. Stage 2: conflict ‘pure’ scientific experiment + Time, Visibility Of process - good Task Structure poor System aided judgement Peer aided judgement intuition intuition Analysis

  9. Stage 3: resolution ‘pure’ scientific experiment + Time, Visibility Of process - good Task Structure poor System aided judgement Peer aided judgement intuition intuition Analysis

  10. So what does all this mean? • One size does not fit all and EB decision elements present in many decisions • Structuring decisions moves people along the continuum • (All things being equal), expertise AND decision knowledge a powerful combination • Implications for future research • Looking inside the ‘black box’ for given (and common) tasks • Interventions

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