Mutual Intacting Keeping the patient-practitioner relationship and patient treatment intact
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Abstract
The aim of this grounded theory study was to discover the main concerns of clinical practitioners when making clinical judgments in the community care context and to explain the processes they used to resolve practice problems. Interview data from twenty-one advanced practitioners working in various mental healthcare and accident and emergency settings in Ireland was collected. In this paper, the process of clinical judgment is conceptualised as ‘Mutual Intacting’. It proposes that clinical judgment comprises three stages: situated patterning, intacting therapeutic relationship, and intacting therapy. ‘Mutual Intacting’ explains how clinical practitioners make clinical judgments through a process of adapting treatment so that the patient-practitioner relationship is maintained and treatment is delivered in a way that takes account of the patient’s circumstances.
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References
Ayton, P. (2005) Judgment and decision making. In Cognitive Psychology (Eds, Braisby, N. and Gellatly, A.) OxfordUniversity Press, Oxford, pp. 382- 417.
Benner, P. (1984) From Novice to Expert: Excellence and Power in Clinical Nursing Practice, Addison-Wesley Publishing Company, Menlo Park CA.
Brown, S. J. (2005) Direct Clinical Practice. In Advanced Practice Nursing (Eds, Hamric, A. B., Spross, J. A. and Hanson, C. M.) Elsevier Saunders, St Louis, Missouri, pp. 143-187.
Buckingham, C. D. and Adams, A. (2000a) Classifying clinical decision making: a unifying approach. Journal of Advanced Nursing, 32(4), 981-989.
Buckingham, C. D. and Adams, A. (2000b) Classifying clinical decision making: interpreting nursing intuition, heuristics and medical diagnosis. Journal of Advanced Nursing, 32(4), 990-998.
Cader, R., Campbell, S. and Watson, D. (2005) Cognitive Continuum Theory in nursing decision-making. Journal of Advanced Nursing, 49(5), 397- 405.
Cioffi, J. (1997) Heuristics, servants to intuition, in clinical decision-making. Journal of Advanced Nursing, 26(1), 203- 208.
Cioffi, J. (2000) Nurses’ experiences of making decisions to call emergency assistance to their patients. Journal of Advanced Nursing, 32(1), 108-114.
Clark, E. (2004) Quality of life: a basis for clinical decisionmaking in community psychiatric care. Journal of Psychiatric and Mental Health Nursing, 11(6), 725-730.
Corcoran, S. A. (1986) Task Complexity and Nursing Expertise as Factors in Decision Making. Nursing Research, 35(2), 107- 112.
Corcoran-Perry, S., Narayan, S. M. and Cochrane, S. (1999) Coronary care nurses’ clinical decision making. Nursing and Health Sciences, 1, 49- 61.
Easen, P. and Wilcockson, J. (1996) Intuition and rational decision-making in professional thinking: a false dichotomy? Journal of Advanced Nursing, 24(4), 667-673.
Elstein, A. (1978) Medical problem solving: an analysis of clinical reasoning, Harvard University Press, Cambridge, Mass.
Fowler, L. P. (1997) Clinical Reasoning Strategies Used During Care Planning. Clinical Nursing Research, 6(4), 349-361.
Glaser, B. G. (1978) Theoretical Sensitivity, Sociology Press, Mill Valley CA.
Glaser, B. G. (1998) Doing Grounded Theory: Issues and Discussions, Sociology Press, Mill Valley, CA.
Glaser, B. G. and Holton, J. (2004) Remodeling Grounded Theory. In Forum: Qualitative Social Research, Vol. 2004, pp. 80 paragraphs.
Glaser, B. G. and Strauss, A. L. (1967) The Discovery of Grounded Theory: strategies for qualitative research, Aldine de Gruyter, New York.
Greenwood, J. and King, M. (1995) Some surprising similarities in the clinical reasoning of ‘expert’ and ‘novice’ orthopaedic nurses. Report of study using verbal protocols and protocol analyses. Journal of Advanced Nursing, 22(5), 907- 913.
Grobe, S. J., Drew, J. A. and Fonteyn, M. E. (1991) A Descriptive Analysis of Experienced Nurses’ Clinical Reasoning During a Planning task. Research in Nursing and Health, 14(4), 305- 314.
Hallett, C. E., Austin, L., Caress, A. and Luker, K. A. (2000) Wound care in the community setting: clinical decision making in context. Journal of Advanced Nursing, 31(4), 783-793.
Hammond, K. R. (2000) Judgments Under Stress, Oxford University Press, Oxford.
Haworth, S. K. and Dluhy, N. M. (2001) Holistic symptom management: modelling the interaction phase. Journal of Advanced Nursing, 36(2), 302-310.
International Council of Nurses (2001) International Survey of Nurse Practitioner/Advanced Practice Nursing Roles. Vol. 2002.
Lajoie, S. P., Azevedo, R. and Fleiszer, D. (1998) Cognitive Tools for Assessment and Learning in a High Information Flow Environment. Journal of Educational Computing Research, 18(3), 205- 235.
Levy, V. (1999) Protective steering: a grounded theory study of the processes by which midwives facilitate informed choices during pregnancy. Journal of Advanced Nursing, 29(1), 104- 112.
Maimbolwa, M. C. (2006) 30th anniversary commentary on Levy V. (1999) Protective steering: a grounded theory study of the processes by which midwives facilitate informed choices during pregnancy. Journal of Advanced Nursing 29(1), 104-112. Journal of Advanced Nursing, 53(1), 123-124.
Mander, R. (2006) 30th anniversary commentary on Levy V. (1999) Protective steering: a grounded theory study of the processes by which midwives facilitate informed choices during pregnancy. Journal of Advanced Nursing 29(1), 104-112. Journal of Advanced Nursing, 53(1), 122-123.
McCutcheon, H. and Pincombe, J. (2001) Intuition: an important tool in the practice of nursing. Journal of Advanced Nursing, 35(3), 342- 348.
McGuire, R., McCabe, R. and Priebe, S. (2001) Theoretical frameworks for understanding and investigating the therapeutic relationship in psychiatry. Social Psychiatry and Psychiatric Epidemiology, 36(11), 557-564.
Morse, J. M. (1991) Negotiating commitment and involvement in the nurse-patient relationship. Journal of Advanced Nursing, 16(4), 455- 468.
Narayan, S. M. and Corcoran-Perry, S. (1997) Line of Reasoning as a Representation of Nurses’ Clinical Decision Making. Research in Nursing and Health, 20(4), 353- 364.
National Council for the Professional Development of Nursing and Midwifery (2004) Framework for the Establishment of Advanced Nurse Practitioner and Advanced Midwife Practitioner Posts, National Council for the Professional Development of Nursing and Midwifery, Dublin.
Newell, A. and Simon, H. (1972) Human Problem Solving, Prentice-Hall, Englewood Cliffs, NJ.
Offredy, M. (1998) The application of decision making concepts by nurse practitioners in general practice. Journal of Advanced Nursing, 28(5), 988- 1000.
Paterson, B., Russell, C. and Thorne, S. (2001) Critical analysis of everyday self-care decision making in chronic illness. Journal of Advanced Nursing, 35(3), 335- 341.
Royal College of Nursing (undated) Nurse Practitioners- an RCN guide to the nurse practitioner role, competencies and programme accreditation. Vol. 2004 Royal College of Nursing, UK.
Rydon, S. E. (2005) The attitudes, knowledge and skills needed in mental health nurses: The perspective of users of mental health services. International Journal of Mental Health Nursing, 14(2), 78-87.
Simon, H. (1978) Information-Processing Theory of Human Problem Solving. In Handbook of Learning and Cognitive Processes, Vol. 5 (Ed, Estes, W. K.) Lawrence Erlbaum Associates, Hillsdale, New Jersey, pp. 271-297.
Taylor, F. (2006) A comparative study examining the decisionmaking processes of medical and nursing staff in weaning patients from mechanical ventilation. Intensive and Critical Care Nursing, 22(5), 253-263.
Thompson, C. (2002) Human error, bias, decision making and judgement in nursing- the need for a systematic approach. In Clinical Decision Making and Judgement in Nursing(Eds, Thompson, C. and Dowding, D.) Churchill Livingstone, Edinburgh, pp. 21-47.
Tversky, A. and Kahneman, D. (1982) Introduction. Judgment under uncertainty: Heuristics and biases. In Judgment under uncertainty: Heuristics and biases(Eds, Kahneman, D., Slovic, P. and Tversky, A.) Cambridge University Press, Cambridge, UK, pp. 3-23.
Winefield, H. R., Murrell, T. G. and Clifford, J. (1995) Process and Outcomes in General Practice Consultations: Problems in Defining High Quality Care. Social Science & Medicine, 41(7), 969- 975.