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Clinical decision making involves a consideration of multiple factors; clinical options are constructed based on the objective clinical data and evidence-based standards. Technologic advances have led not only to life saving interventions, but also to the use of these technologies when benefit to the patient was unclear or unexamined. The cases of Karen Quinlan, Nancy Cruzan, and Terri Schiavo provide a framework for examining the evolution of clinical decision making, including when to use or not to use technologies such as ventilators and artificial nutrition and hydration, and the role of specific questions in the process. Advance directives are a means to convey patient preferences, however, in the absence of advance directives, skilled questioning can elicit patient preferences. Nurses' roles in clinical decision making are often nebulous but can be enhanced by understanding these interrelated processes, as well as by knowing the policies and procedures of their institutions.
Palliative Care and Ethics, School of Nursing, George Mason University, 4400 University Drive, Mail Stop 3C4, Fairfax, VA 22030, USA.
This article was published in the following journal.
Name: The Nursing clinics of North America
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Deciding about prolonged life support for critically ill patients can be very difficult. Therefore, the investigators are doing a study to see if an internet-based decision aid can improve...
This study will look at a cohort of parents whose children are confronting life-threatening illnesses in intensive care, palliative care, and complex care settings, to test whether parents...
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Computer-based information systems used to integrate clinical and patient information and provide support for decision-making in patient care.
The purpose of this 1990 federal act is to assure that individuals receiving health care services will be given an opportunity to participate in and direct health care decisions affecting themselves. Under this act, hospitals, health care agencies, and health maintenance organizations are responsible for developing patient information for distribution. The information must include patients' rights, advance directives, living wills, ethics committees' consultation and education functions, limited medical treatment (support/comfort care only), mental health treatment, resuscitation, restraints, surrogate decision making and transfer of care. (from JCAHO, Lexicon, 1994)
Organization of medical and nursing care according to the degree of illness and care requirements in the hospital. The elements are intensive care, intermediate care, self-care, long-term care, and organized home care.
Mathematical or statistical procedures used as aids in making a decision. They are frequently used in medical decision-making.
Care alleviating symptoms without curing the underlying disease. (Stedman, 25th ed)
Palliative care is the active holistic care of patients with advanced progressive illness. Management of pain and other symptoms and provision of psychological, social and spiritual support is paramount. The goal of palliative care is achievement of the ...
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