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Towards a Framework for Telenurses' Decision Making: the Decision Ladder by Danica S. Tuden RN, Langara College, 1988 BSN

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Towards a Framework for Telenurses' Decision Making: the Decision Ladder by Danica S. Tuden RN, Langara College, 1988 BSN Towards a Framework for Telenurses’ Decision Making: The Decision Ladder by Danica S. Tuden RN, Langara College, 1988 BSN, University of Victoria, 2009 A Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of MASTER OF SCIENCE in the School of Health Information Science Danica S. Tuden, 2016 University of Victoria All rights reserved. This thesis may not be reproduced in whole or in part, by photocopy or other means, without the permission of the author. ii Supervisory Committee Towards a Framework for Telenurses’ Decision Making: The Decision Ladder by Danica S. Tuden RN, Langara College, 1988 BSN, University of Victoria, 2009 Supervisory Committee Dr. Elizabeth Borycki, School of Health Information Science Supervisor Dr. Andre Kushniruk, School of Health Information Science Departmental Member Mary Alyse Capron, MN, School of Health Information Science Departmental Member iii Abstract Supervisory Committee Dr. Elizabeth Borycki, School of Health Information Science Supervisor Dr. Andre Kushniruk, School of Health Information Science Departmental Member Mary Alyse Capron, MN, School of Health Information Science Departmental Member Telenursing is a highly specialized area of nursing practice that has evolved in response to the advent of new technologies within the delivery of health care. Telenursing has been defined as “the use of communications and information technology [ICT’s] to deliver health and health care services and information over large and small distances (CRNBC, 2016). Telenurses use health information systems (HIS) in the form of a Clinical Decision Support System (CDSS) to assist callers with their health related concerns on a 24/7 basis. As decision making is an integral part of telenurse practice, particularly because they are using a CDSS while assessing the caller over the phone, it was important to understand the factors that influence the decision making process so as to better support telenurse practice in terms of education as well as other supports. This thesis identified those factors and used Rasmussen’s Decision Ladder as a model in order to provide a framework for telenursing. It was found that there were several factors identified that influenced how telenurses made decisions while using a CDSS. Additionally, the decision ladder was validated as a framework to describe telenurse practice. iv Table of Contents Supervisory Committee ...................................................................................................... ii Abstract .............................................................................................................................. iii Table of Contents ............................................................................................................... iv List of Tables .................................................................................................................... vii List of Figures .................................................................................................................. viii Acknowledgments.............................................................................................................. ix Dedication ........................................................................................................................... x CHAPTER 1: INTRODUCTION ....................................................................................... 1 1.1 Telehealth Nursing .................................................................................................... 2 1.2 Decision Making ....................................................................................................... 3 1.3 Clinical Decision Support Systems (CDSS) ............................................................. 5 1.4 Decision Ladder ........................................................................................................ 6 1.5 Statement of the Problem .......................................................................................... 7 1.6 Significance and Purpose of the Study ..................................................................... 9 1.7 Research Objectives ................................................................................................ 10 1.8 Research Questions ................................................................................................. 10 1.9 Summary ................................................................................................................. 10 CHAPTER 2: LITERATATURE REVIEW ..................................................................... 12 2.1 Introduction ............................................................................................................. 12 2.2 Telehealth Nursing (Telenursing) ........................................................................... 12 2.3 Telenursing and the Cognitive Process of Decision Making .................................. 13 2.4 Telenursing and Decision Making: Influences of Stress and Fatigue..................... 15 2.6 Telenurses and Decision Making: Novice to Expert .............................................. 18 2.7 Rasmussen’s Decision Ladder ................................................................................ 21 2.8 Conclusion .............................................................................................................. 24 CHAPTER 3: RESEARCH APPROACH ....................................................................... 27 3.1 Research Methodologies ......................................................................................... 27 3.2 Participants .............................................................................................................. 28 3.3 Inclusion Criteria .................................................................................................... 28 3.4 Recruitment ............................................................................................................. 29 3.5 Research Setting...................................................................................................... 30 3.6 Procedure ................................................................................................................ 31 3.7 Data Analysis .......................................................................................................... 33 3.8 Ethics Approval ...................................................................................................... 36 v 3.9 Conclusion .............................................................................................................. 36 CHAPTER 4: STUDY FINDINGS .................................................................................. 38 4.1 Introduction ............................................................................................................. 38 4.2 Demographic Characteristic of Participants ........................................................... 38 4.2.1 Basic Demographic Characteristics of the Participants ................................... 39 4.2.2 Computer Competency Questionnaire Results ................................................ 39 4.3 Post Simulation Interview Observations ................................................................. 40 4.3.1 Explanation of Simulations .............................................................................. 41 4.3.2 Decision Making Processes and Strategies ...................................................... 42 4.3.5 Incidence of Problems and Utility of CDSS .................................................... 52 4.3.6 Level of Ease/Difficulty with System: ............................................................. 56 4.3.7 Suggestions for System Improvement ............................................................. 58 4.3.8 How the System Affected Decision Making Skills ......................................... 62 4.3.9 System Effects on Level of Ease/Difficulty in Terms of Decision .................. 64 Making ...................................................................................................................... 64 4.3.10 Factors Influencing Decision Making Skills.................................................. 65 4.3.11 Factors Influencing the Utility of Shortcuts ................................................... 70 4.4 Data Elements Potentially Relevant to Shortcuts ................................................... 75 4.4.1 Call Handle Time ............................................................................................. 76 4.4.2 Accessing the CDSS During Call Encounter ................................................... 78 4.4.3 Completion of Health History Section ............................................................. 79 4.5 The Relevance of the Decision Ladder as a Framework to Telenurse ................... 82 Practice .......................................................................................................................... 82 4.5.1 Defining the Decision Making Processes in the Decision Ladder as .............. 82 Mapped to Telenurse Practice ................................................................................... 82 4.5.2 Decision Ladder Steps ..................................................................................... 86 4.6 Conclusion of Findings ......................................................................................... 105 CHAPTER 5: DISCUSSION AND CONCLUSIONS ..................................................
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