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Testing and refinement of an integrated,   Testing and refinement of an integrated,... - Document (955 K)
Author Wolf, Lisa Adams
Title Testing and refinement of an integrated, ethically-driven environmental model of clinical decision-making in emergency settings
Date created 2011
Abstract The purpose of the study was to explore the relationship between multiple variables within a model of critical thinking and moral reasoning that support and refine the elements that significantly correlate with accuracy and clinical decision-making. <bold>Background:</bold> Research to date has identified multiple factors that are integral to clinical decision-making. The interplay among suggested elements within the decision making process particular to the nurse, the patient, and the environment remain unknown. Determining the clinical usefulness and predictive capacity of an integrated ethically driven environmental model of decision making (IEDEM-CD) in emergency settings in facilitating accuracy in problem identification is critical to initial interventions and safe, cost effective, quality patient care outcomes. Extending the literature of accuracy and clinical decision making can inform utilization, determination of staffing ratios, and the development of evidence driven care models. <bold>Methodology:</bold> The study used a quantitative descriptive correlational design to examine the relationships between multiple variables within the IEDEM-CD model. A purposive sample of emergency nurses was recruited to participate in the study resulting in a sample size of 200, calculated to yield a power of 0.80, significance of .05, and a moderate effect size. The dependent variable, accuracy in clinical decision-making, was measured by scores on clinical vignettes. The independent variables of moral reasoning, perceived environment of care, age, gender, certification in emergency nursing, educational level, and years of experience in emergency nursing, were measures by the Defining Issues Test, version 2, the Revised Professional Practice Environment scale, and a demographic survey. These instruments were identified to test and refine the elements within the IEDEM-CD model. Data collection occurred via internet survey over a one month period. Rest's Defining Issues Test, version 2 (DIT-2), the Revised Professional Practice Environment tool (RPPE), clinical vignettes as well as a demographic survey were made available as an internet survey package using Qualtrics TM. Data from each participant was scored and entered into a PASW database. The analysis plan included bivariate correlation analysis using Pearson's product-moment correlation coefficients followed by chi square and multiple linear regression analysis. <bold>Findings: </bold>The elements as identified in the IEDEM-CD model supported moral reasoning and environment of care as factors significantly affecting accuracy in decision-making. Findings reported that in complex clinical situations, higher levels of moral reasoning significantly affected accuracy in problem identification. Attributes of the environment of care including teamwork, communication about patients, and control over practice also significantly affected nurses' critical cue recognition and selection of appropriate interventions. Study results supported the conceptualization of the IEDEM-CD model and its usefulness as a framework for predicting clinical decision making accuracy for emergency nurses in practice, with further implications in education, research and policy
Use Restrictions I hereby allow Boston College to include and preserve my dissertation/thesis in electronic form in the Boston College Institutional Repository, which shall include the right to publicly post my dissertation/thesis on the World Wide Web. I will retain copyright ownership, but I grant to Boston College the non-exclusive right to copy, distribute, and publicly display my dissertation/thesis in any form as may be necessary or convenient in the future as file formats, storage media, and distribution mechanisms evolve.
Subject accuracy
clinical decision-making
emergency nursing
moral reasoning
professional practice environment
Genre Heading Electronic Thesis or Dissertation
Publisher Boston College
Link to Item 2345/2224
Thesis Advisor Jones, Dorothy A.
Grace, Pamela J.
Degree Name PhD
Degree Grantor Boston College. Connell School of Nursing.
Sys. No. 000011884
Related collections
Graduate Theses and Dissertations > Connell School of Nursing > 2011

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