Decision Making

Head: Professor Lenard Dalgleish

NEWS: Post-doctoral position in Decision Making filled by Dr Anne Pingenot in October 2006.

For consumers of health and social care

Nurses Midwives and Allied Health Professions are increasingly working as autonomous practitioners making decisions with patients about their care. At the same time, healthcare policy is talking about importance of the concept of choice and control for patients. NMAHPs have a close involvement with patients and families and this can often result in complex decision making processes. These incorporate the patient’s and family’s perspective. This field of study (shared decision making between patients, families and NMAHPs) is largely unexplored and will benefit from the research already done by the team in the decision making programme and the research being planned. For example, one project will investigate how patients and nurses see each other’s assessments of leg ulcers.

For health and social care professionals/practitioners

Nurses Midwives and Allied Health Professions (NMAHPs) are increasingly working in models of care in which they are operating as autonomous practitioners. The judgements and decisions of NMAHPs are central to healthcare provision. The approach will be to work with professionals/practioners to investigate judgment and decision making. One aim is to provide tools to assist NMAHP professionals in their day-to-day activities especially the exercise of professional discretion. In each of the projects being developed an outcome will be tools that assist practice especially in grey area difficult decision making situations. The projects include research (1) in forensic mental health focussing on decisions to move patients from high to medium security, (2) in midwifery focussing on the decision to transfer women in labour from one hospital to another, (3) on decisions by ambulance paramedics to treat a case or refer to hospital, (4) on prison officers making assessments of suicide risk in prisoners, and (5) on shared judgments about wound care by nurses and patients.

For academics and researchers

Nurses Midwives and Allied Health Professions (NMAHPs) are increasingly working in models of care in which they are operating as autonomous practitioners. The judgements and decisions of NMAHPs are central to healthcare provision. Research in NMAHP decision making can both apply the methods from judgment and decision making research and develop and test new theory and methods. The Decision Making programme will build on past research by team members. Examples include analysing judgments made by nursing and medical staff about suicide risk in acute in-patient psychiatric care; analysing judgments and decisions made by community nurses and social workers about financial abuse of older people. The programme for research is being developed collaboratively with discussion about research (1) in forensic mental health focussing on decisions to move patients from high to medium security, (2) in midwifery focussing on the decision to transfer women in labour from one hospital to another, (3) on decisions by ambulance paramedics to treat a case or refer to hospital, (4) on prison officers making assessments of suicide risk in prisoners, and (5) on shared judgments about wound care by nurses and patients.

For Funders and Policy Makers

Nurses Midwives and Allied Health Professions are increasingly working in models of care in which they are operating as autonomous practitioners. The judgements and decisions of NMAHPs are central to healthcare provision. At the same time the concept of choice and control for service users has become central to healthcare policy. Evidence-based health care suggests that decision making should involve an integration of research evidence, practitioner experience, resources available and patient values. The individual or ‘micro’ level decisions, where practitioners are making decisions about the treatment of individual patients, have an impact on the wider policy arena, in terms of the quality of care patients receive.