Nurses

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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

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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 (n82)
• Observation data (270 hours)
• Q methodological statistical modelling (n120)
• Local information resource audit (circa 1000
  sources)
• Rigour explicit purposive sampling frame
  between method subject triangulation
  multi-rater Kappa for descriptive coding tasks

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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

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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
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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
  inducing ways of thinking and different kinds of
  knowledge use

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Stage 1 assessment
pure scientific experiment
Time, Visibility Of process -
good Task Structure poor
System aided judgement
Peer aided judgement
intuition
intuition
Analysis
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Stage 2 conflict
pure scientific experiment
Time, Visibility Of process -
good Task Structure poor
System aided judgement
Peer aided judgement
intuition
intuition
Analysis
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Stage 3 resolution
pure scientific experiment
Time, Visibility Of process -
good Task Structure poor
System aided judgement
Peer aided judgement
intuition
intuition
Analysis
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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