DECISION-ANALYTIC APPROACH TO CLINICAL NURSING (NURSING).
Contributors: University of Rochester.
Published: 1991
Number of pages: 167
Subjects: Health Sciences, Nursing.
Description: This study explored the usefulness of decision analysis for nursing decisions about a complex, emergent patient problem. Two questions were addressed: (a) whether or not nurses differed in their first-ranked intuitive treatment choice and the final treatment choice prescribed by a decision-analytic technique and (b) whether or not nurses differed in their relative ranking of treatment choices using the intuitive and decision-analytic models.

The study consisted of two phases. First, a Delphi technique was used to quantify the intuitive treatment choices of 31 nurses for a hypothetical patient experiencing a pressure ulcer. This process produced five preferred dressing-procedure options. Once the treatment choices were explicated, a multiattribute-utility technique was used to further elucidate the components of the decision process through subjects' assignment of values to seven broad attributes associated with each of the treatments defined by the Delphi technique. The test for a single proportion was used to compare each subject's first-ranked intuitive treatment choice with the treatment choice prescribed by the decision-analytic process. Eleven nurses (35%) demonstrated agreement between their first-ranked intuitive choice and their choice prescribed using the multiattribute-utility technique (z = 2.42, p $<$.05). The Hotelling's T$\sp2$ was used to assess the relationship between nurses' relative rankings of intuitive and quantitative treatment choices. When the relative ranking of the vector of five treatment choices derived intuitively was compared to the relative ranking prescribed by the decision-analytic model, results showed significant disagreement between nurses' intuitive and quantitative choices (F(4,27) = 5.57, p =.002).

A logistic regression suggested an association between nurses' educational preparation and the degree of agreement between their intuitive and analytic choices of most-preferred dressing procedure ($\chi\sp2$ = 4.26, p $<$.05). Cost-utility analysis suggested that the value of a dressing procedure shifted depending on whether the costs of materials, nursing intensity, or total resource intensity were considered. One of the seven attributes studied, that is, "opportunity to evaluate the wound", produced a change in nurses' choices when subjected to a sensitivity analysis. The results indicate that further exploration of decision analysis to enhance nursing practice is warranted.
Notes: Source: Dissertation Abstracts International, Volume: 52-05, Section: B, page: 2503.

Thesis (PH.D.)--THE UNIVERSITY OF ROCHESTER, 1991.

School code: 0188.