In the decision-making environment of evidence-based practice, the following three sources of information must be integrated: research evidence of the intervention, clinical expertise, and the patient’s values. In reality, evidence-based practice usually focuses on research evidence (which may be translated into clinical practice guidelines) and clinical expertise without considering the individual patient’s values. The shared decision-making model seems to be helpful in the integration of the individual patient’s values in evidence-based practice. We aim to discuss the relevance of shared decision making in chronic care and to suggest how it can be integrated with evidence-based practice in nursing. We start by describing the following three possible approaches to guide the decision-making process: the paternalistic approach, the informed approach, and the shared decision-making approach. Implementation of shared decision making has gained considerable interest in cases lacking a strong best-treatment recommendation, and when the available treatment options are equivalent to some extent. We discuss that in chronic care it is important to always invite the patient to participate in the decision-making process. We delineate the following six attributes of health care interventions in chronic care that influence the degree of shared decision making: the level of research evidence, the number of available intervention options, the burden of side effects, the impact on lifestyle, the patient group values, and the impact on resources. Furthermore, the patient’s willingness to participate in shared decision making, the clinical expertise of the nurse, and the context in which the decision making takes place affect the shared decision-making process. A knowledgeable and skilled nurse with a positive attitude towards shared decision making – integrated with evidence-based practice – can facilitate the shared decision-making process. We conclude that nurses as well as other health care professionals in chronic care should integrate shared decision making with evidence- based practice to deliver patient-centred care.
AIM: To understand the steps in the decision-making process regarding pain assessment and management for people living with dementia from the perspectives and experiences of people with dementia, formal and informal carers.METHODS: A systematic review was conducted. Seven English databases were searched, including PubMed, Psychological Information Database, Cochrane Library, Scopus, Cumulative Index of Nursing and Allied Health Literature, Web of Science, and ProQuest, using synonyms and derivatives for "dementia", "cognitive impairment", "pain", "pain assessment", "pain management", "decision", "decision support", and "decision-making".RESULTS: Twenty-eight studies fulfilled the eligibility criteria. Pain assessment and management in dementia are complex, successive, and collaborative processes carried out by different individuals over a period based on one's understanding of the person with dementia but with high uncertainty. Pain assessment involves a certain degree of guesswork, while pain management is a trial-and-error process.CONCLUSION: More pragmatic approaches are needed to overcome challenges, including uncertainty and decisional conflicts.
Proper decision-making is one of the most important capabilities of an organization. Therefore, it is important to have a clear understanding and overview of the decisions an organization makes. A means to understanding and modeling decisions is the Decision Model and Notation (DMN) standard published by the Object Management Group in 2015. In this standard, it is possible to design and specify how a decision should be taken. However, DMN lacks elements to specify the actors that fulfil different roles in the decision-making process as well as not taking into account the autonomy of machines. In this paper, we re-address and-present our earlier work [1] that focuses on the construction of a framework that takes into account different roles in the decision-making process, and also includes the extent of the autonomy when machines are involved in the decision-making processes. Yet, we extended our previous research with more detailed discussion of the related literature, running cases, and results, which provides a grounded basis from which further research on the governance of (semi) automated decision-making can be conducted. The contributions of this paper are twofold; 1) a framework that combines both autonomy and separation of concerns aspects for decision-making in practice while 2) the proposed theory forms a grounded argument to enrich the current DMN standard.
The IMPULS-2020 project DIGIREAL (BUas, 2021) aims to significantly strengthen BUAS’ Research and Development (R&D) on Digital Realities for the benefit of innovation in our sectoral industries. The project will furthermore help BUas to position itself in the emerging innovation ecosystems on Human Interaction, AI and Interactive Technologies. The pandemic has had a tremendous negative impact on BUas industrial sectors of research: Tourism, Leisure and Events, Hospitality and Facility, Built Environment and Logistics. Our partner industries are in great need of innovative responses to the crises. Data, AI combined with Interactive and Immersive Technologies (Games, VR/AR) can provide a partial solution, in line with the key-enabling technologies of the Smart Industry agenda. DIGIREAL builds upon our well-established expertise and capacity in entertainment and serious games and digital media (VR/AR). It furthermore strengthens our initial plans to venture into Data and Applied AI. Digital Realities offer great opportunities for sectoral industry research and innovation, such as experience measurement in Leisure and Hospitality, data-driven decision-making for (sustainable) tourism, geo-data simulations for Logistics and Digital Twins for Spatial Planning. Although BUas already has successful R&D projects in these areas, the synergy can and should significantly be improved. We propose a coherent one-year Impuls funded package to develop (in 2021): 1. A multi-year R&D program on Digital Realities, that leads to, 2. Strategic R&D proposals, in particular a SPRONG/sleuteltechnologie proposal; 3. Partnerships in the regional and national innovation ecosystem, in particular Mind Labs and Data Development Lab (DDL); 4. A shared Digital Realities Lab infrastructure, in particular hardware/software/peopleware for Augmented and Mixed Reality; 5. Leadership, support and operational capacity to achieve and support the above. The proposal presents a work program and management structure, with external partners in an advisory role.
The purpose of this project was to create a roadmap with selected mechanisms to assist destination management organisations to optimize the benefits generated by tourism for their destination communities and ensure that it is shared equitably. By providing tools to identify and address inequality in terms of access to the benefits and value tourism generates, it is envisaged that a more equitable tourism model can be implemented leading to the fair distribution of benefits in destination communities, potentially increasing the value for previously excluded or underserved groups. To produce the roadmap, the study team will explore the range of challenges that hinder the equitable distribution of tourism-induced benefits in destinations as well as the enabling factors that influence the extent to which this is achieved. The central question the research team has set out to answer is the following: What does an equitable tourism model look like for destination communities?Societal issueHowever, while those directly involved in tourism will gain the most, the burden of hosting visitors is widely felt by local communities. This imbalance has, unsurprisingly, sparked civil mobilisations and protests in destinations around the world. It’s clear that placemaking and benefit-sharing must be part of the future of destination management to maintain public support. This project addressed issues around equity (environmental, economic, spatial, cultural and tourism experience). In line with the intentions set out in the CELTH Agenda Conscious Destinations.Benefit to societyBased on 25 case studies around 40 mechanisms were identified that can grow or better distribute the value from tourism, so that more people in destination communities benefit. These mechanisms are real-world practices already in use. DMOs and NTOs can consider introducing the mechanisms that best fit their destination context, pulling levers such as: taxes and revenue sharing, business incubation and training, licencing and zoning, community enterprises and volunteering, and product development..This report also outlines a pathway to an Equity-Driven Management (EDM) approach, which is grounded in participatory decision-making principles and aims to create a more equitable tourism system by strengthening the hand of destination governance and retaining control of local resources.Collaborative partnersNBTC, the Travel Foundation, Destination Think, CELTH, ETFI, HZ.
Nature areas in North-West Europe (NWE) face an increasing number of visitors (intensified by COVID-19) resulting in an increased pressure on nature, negative environmental impacts, higher management costs, and nuisance for local residents and visitors. The high share of car use exaggerates these impacts, including peak pressures. Furthermore, the almost exclusive access by car excludes disadvantaged people, specifically those without access to a car. At the same time, the urbanised character of NWE, its dense public transport network, well-developed tourism & recreation sector, and presence of shared mobility providers offers ample opportunities for more sustainable tourism. Thus, MONA will stimulate sustainable tourism in and around nature areas in NWE which benefits nature, the environment, visitors, and the local economy. MONA will do so by encouraging a modal shift through facilitating sustainableThe pan-European Innovation Action, funded under the Horizon Europe Framework Programme, aims to promote innovative governance processes ,and help public authorities in shaping their climate mitigation and adaptation policies. To achieve this aim, the GREENGAGE project will leverage citizens’ participation and equip them with innovative digital solutions that will transform citizen’s engagement and cities’ effectiveness in delivering the European Green Deal objectives for carbon neutral cities.Focusing on mobility, air quality and healthy living, citizens will be inspired to observe and co-create their cities by sensing their urban environments. The aim to complement, validate, and enrich information in authoritative data held by the public administrations and public agencies. This will be facilitated by engaging with citizens to co-create green initiatives and to develop Citizen Observatories. In GREENGAGE, Citizen Observatories will be a place where pilot cities will co-examine environmental issues integrating novel bottom-up process with top-down perspectives. This will provide the basis to co-create and co-design innovative solutions to monitor environmental problems at ground level with the help of citizens.With two interrelated project dimensions, the project aims to enhance intelligence applied to city decision-making processes and governance by engaging with citizen observations integrated with Copernicus, GEOSS, in-situ, and socio-economic intelligence, and by delivering innovative governance models based on novel toolboxes of decision-making methodologies and technologies. The envisioned citizens observatory campaigns will be deployed and fully demonstrated in 5 pilot engagements in selected European cities and regions including: Bristol (the United Kingdom), Copenhagen (Denmark), Turano / Gerace (Italy) and the region of Noord Brabant (the Netherlands). These innovation pilots aim to highlight the need for smart city governance by promoting citizen engagement, co-creation, gathering new data which will complement existing datasets and evidence-based decision and policymaking.
