Decision making in the treatment of acute illness in nursing homes: framing the decision problem, treatment plan, and outcome.
This article investigates the social-cultural factors and other circumstances that influence decision making in the treatment of acute illness in three West Coast nursing homes. Participant observation, in-depth interviews with physicians, nursing staff, nursing home residents, and family members, and event analysis were used to gather data. Using decision-making theory as the theoretical framework, analysis focuses on how internal and external factors influence the decision-making process. Two case studies are used to illustrate how in real-life acute clinical situations, physicians frame decision problems, treatment plans, and expected outcomes in order to persuade residents and their families to comply with their preferred treatment plans.
Kayser-Jones
J
J
Department of Physiological Nursing, University of California, San Francisco, USA.
D000208:Acute Disease / Q000191:economics; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003662:Decision Theory; D003704:Dementia / Q000191:economics; D030881:Disclosure; D034462:Dissent and Disputes; D005260:Female; D006126:Group Processes; D006707:Homes for the Aged / Q000191:economics; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000191:economics; D010043:Outcome and Process Assessment, Health Care; D026706:Paternalism; D010347:Patient Care Planning / Q000191:economics*; D010348:Patient Care Team / Q000191:economics; D010817:Physician-Patient Relations; D011379:Prognosis; D012017:Referral and Consultation / Q000191:economics; D028761:Withholding Treatment