Abstract：
BACKGROUND:Nurses caring for the large numbers of people with leg ulceration play a key role in promoting quality in health via their diagnostic and treatment clinical judgements. In the UK, audit evidence suggests that the quality of these judgements is often sub optimal. Misdiagnosis and incorrect treatment choices are likely to affect healing rates, patients' quality of life, patient safety and healthcare costs. OBJECTIVES:To explore the diagnostic judgements and treatment choices of UK community nurses managing venous leg ulceration. DESIGN:A judgement analysis based on Brunswik's psychological Lens Model theory. SETTING:UK community and primary care nursing services. PARTICIPANTS:18 community generalist nurses working in district (home) nursing teams and general practitioner services and 18 community tissue viability specialist nurses. METHODS:During 2011 and 2012, 36 nurses made diagnostic judgements and treatment choices in response to 110 clinical scenarios. Scenarios were generated from real patient cases and presented online using text and wound photographs. The consensus judgements of a panel of nurses with advanced knowledge of leg ulceration judged the same scenarios and provided a standard against which to compare the participants. Correlations and logistic regression models were constructed to generate various indices of judgement and decision "performance": accuracy (R(a)), consistency (R(s)) and information use (G) and uncertainty (R(e)). RESULTS:Taking uncertainty into account, nurses could theoretically have achieved a diagnostic level of accuracy of 0.63 but the nurses only achieved an accuracy of 0.48. For the treatment judgement (whether applying high compression was warranted) nurses could have achieved an accuracy of 0.88 but achieved only an accuracy of 0.49. This may have been due to the nurses giving insufficient weight to the diagnostic cues of medical history and appearance of the leg and ulcer and insufficient weight to the treatment cues of type of leg ulcer and pain. CONCLUSION:Clinical judgements and decisions made by nurses managing leg ulceration are complex and uncertain and some of the variability in judgements and choices can be explained by the ways in which nurses process the information and handle the uncertainties, present in clinical encounters.
journal_name
Int J Nurs Studjournal_title
International journal of nursing studiesauthors
Adderley UJ,Thompson Cdoi
10.1016/j.ijnurstu.2014.09.004subject
Has Abstractpub_date
2015-01-01 00:00:00pages
345-54issue
1eissn
0020-7489issn
1873-491Xpii
S0020-7489(14)00236-3journal_volume
52pub_type
杂志文章abstract：:This paper reports on the first phase of an action research practice development project to explore, develop and evaluate the role of the generic healthcare support worker in a high dependency rehabilitation service. The project is being jointly conducted by staff from the University of Southampton, the University of ...
journal_title：International journal of nursing studies
pub_type： 杂志文章
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abstract：BACKGROUND:Post-traumatic stress disorder is one of the most prevalent mental health sequelae of intimate partner violence, and as a result, it has been extensively documented in Western literature. However, whether abused women from non-Western cultures experience similar post-traumatic responses to intimate partner v...
journal_title：International journal of nursing studies
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journal_title：International journal of nursing studies
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journal_title：International journal of nursing studies
pub_type： 杂志文章
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journal_title：International journal of nursing studies
pub_type： 杂志文章
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journal_title：International journal of nursing studies
pub_type： 临床试验,杂志文章
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更新日期：1989-01-01 00:00:00
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journal_title：International journal of nursing studies
pub_type： 杂志文章
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journal_title：International journal of nursing studies
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journal_title：International journal of nursing studies
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journal_title：International journal of nursing studies
pub_type： 杂志文章
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journal_title：International journal of nursing studies
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journal_title：International journal of nursing studies
pub_type： 杂志文章,多中心研究
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更新日期：2015-09-01 00:00:00
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journal_title：International journal of nursing studies
pub_type： 杂志文章
doi：10.1016/j.ijnurstu.2007.10.013
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journal_title：International journal of nursing studies
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pub_type： 杂志文章,随机对照试验
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pub_type： 杂志文章
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