2.50
Hdl Handle:
http://hdl.handle.net/10755/173777
Type:
Dissertation
Title:
A decision-analytic approach to clinical nursing (DISS)
Abstract:
A decision-analytic approach to clinical nursing (DISS)
This study explored the usefulness of decision analysis for nursing decisions about a complex, emergent patient problem. Two questions were addressed: (a) whether or not nurses differed in their first-ranked intuitive treatment choice and the final treatment choice prescribed by a decision-analytic technique and (b) whether or not nurses differed in their relative ranking of treatment choices using the intuitive and decision-analytic models.



The study consisted of two phases. First, a Delphi technique was used to quantify the intuitive treatment choices of 31 nurses for a hypothetical patient experiencing a pressure ulcer. This process produced five preferred dressing-procedure options. Once the treatment choices were explicated, a multiattribute-utility technique was used to further elucidate the components of the decision process through subjects' assignment of values to seven broad attributes associated with each of the treatments defined by the Delphi technique. The test for a single proportion was used to compare each subject's first-ranked intuitive treatment choice with the treatment choice prescribed by the decision-analytic process. Eleven nurses (35 percent) demonstrated agreement between their first-ranked intuitive choice and their choice prescribed using the multiattribute-utility technique (z=2.42, p<.05). The Hotelling's T2 was used to assess the relationship between nurses' relative rankings of intuitive and quantitative treatment choices. When the relative ranking of the vector of five treatment choices derived intuitively was compared to the relative ranking prescribed by the decision-analytic model, results showed significant disagreement between nurses' intuitive and quantitative choices (F(4,27) = 5.57, p=.002).



A logistic regression suggested an association between nurses' educational preparation and the degree of agreement between their intuitive and analytic choices of most-preferred dressing procedure (Chi squared = 4.26, p<.05). Cost-utility analysis suggested that the value of a dressing procedure shifted depending on the definition of cost. One of the seven attributes studied, that is, opportunity to evaluate the wound, produced a change in nurses' choices when subjected to a sensitivity analysis. The results indicate that further exploration of decision analysis to enhance nursing practice is warranted.
Research Data

Ending Year:1992
Design:Non-Experiment: Longitudinal: Prospective
Study Type:Dissertation
Theoretical Framework:none
Description of Sample:
Sample Size:
Number of Groups:
Sampling Plan:none
Gender:Female
Minimum Age:
Maximum Age:
Data Collection Settings(s):Acute Care

Keywords:
Evaluation research; Cost/cost analysis; Nursing informatics; Design development
Repository Posting Date:
2011-10-27T23:28:33Z
Date of Publication:
1992

Full metadata record

DC FieldValue Language
dc.date.accessioned2011-10-27T23:28:33Z-
dc.date.available2011-10-27T23:28:33Z-
dc.date.issued1992en_GB
dc.identifier.urihttp://hdl.handle.net/10755/173777-
dc.description.abstract<table><tr><td colspan="2" class="item-title">A decision-analytic approach to clinical nursing (DISS)</td></tr><tr><td colspan="2" class="item-abstract">This study explored the usefulness of decision analysis for nursing decisions about a complex, emergent patient problem. Two questions were addressed: (a) whether or not nurses differed in their first-ranked intuitive treatment choice and the final treatment choice prescribed by a decision-analytic technique and (b) whether or not nurses differed in their relative ranking of treatment choices using the intuitive and decision-analytic models.<br/><br/><br/><br/>The study consisted of two phases. First, a Delphi technique was used to quantify the intuitive treatment choices of 31 nurses for a hypothetical patient experiencing a pressure ulcer. This process produced five preferred dressing-procedure options. Once the treatment choices were explicated, a multiattribute-utility technique was used to further elucidate the components of the decision process through subjects' assignment of values to seven broad attributes associated with each of the treatments defined by the Delphi technique. The test for a single proportion was used to compare each subject's first-ranked intuitive treatment choice with the treatment choice prescribed by the decision-analytic process. Eleven nurses (35 percent) demonstrated agreement between their first-ranked intuitive choice and their choice prescribed using the multiattribute-utility technique (z=2.42, p&lt;.05). The Hotelling's T2 was used to assess the relationship between nurses' relative rankings of intuitive and quantitative treatment choices. When the relative ranking of the vector of five treatment choices derived intuitively was compared to the relative ranking prescribed by the decision-analytic model, results showed significant disagreement between nurses' intuitive and quantitative choices (F(4,27) = 5.57, p=.002).<br/><br/><br/><br/>A logistic regression suggested an association between nurses' educational preparation and the degree of agreement between their intuitive and analytic choices of most-preferred dressing procedure (Chi squared = 4.26, p&lt;.05). Cost-utility analysis suggested that the value of a dressing procedure shifted depending on the definition of cost. One of the seven attributes studied, that is, opportunity to evaluate the wound, produced a change in nurses' choices when subjected to a sensitivity analysis. The results indicate that further exploration of decision analysis to enhance nursing practice is warranted.</td></tr><tr><td colspan="2" class="researcher-header">Research Data</td></tr><tr><td colspan="2" class="researcher-data"><hr/></td></tr><tr class="data"><td class="label">Ending Year:</td><td class="value">1992</td></tr><tr class="data"><td class="label">Design:</td><td class="value">Non-Experiment: Longitudinal: Prospective</td></tr><tr class="data"><td class="label">Study Type:</td><td class="value">Dissertation</td></tr><tr class="data"><td class="label">Theoretical Framework:</td><td class="value">none</td></tr><tr class="data"><td class="label">Description of Sample:</td><td class="value"></td></tr><tr class="data"><td class="label">Sample Size:</td><td class="value"></td></tr><tr class="data"><td class="label">Number of Groups:</td><td class="value"></td></tr><tr class="data"><td class="label">Sampling Plan:</td><td class="value">none</td></tr><tr class="data"><td class="label">Gender:</td><td class="value">Female</td></tr><tr class="data"><td class="label">Minimum Age:</td><td class="value"></td></tr><tr class="data"><td class="label">Maximum Age:</td><td class="value"></td></tr><tr class="data"><td class="label">Data Collection Settings(s):</td><td class="value">Acute Care</td></tr><tr><td colspan="2" class="researcher-data"><hr/></td></tr></table>en_GB
dc.subjectEvaluation researchen_GB
dc.subjectCost/cost analysisen_GB
dc.subjectNursing informaticsen_GB
dc.subjectDesign developmenten_GB
dc.titleA decision-analytic approach to clinical nursing (DISS)en_GB
dc.typeDissertationen_GB
dc.contributor.primary-investigatorPanniers, Teresaen_GB
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