When physicians and nurses are looking at the same patient, they may not see the same picture. If assuming that the clinical reasoning of both professions is alike and ignoring possible differences, aspects essential for care can be overlooked. Understanding the multifaceted concept of clinical reasoning of both professions may provide insight into the nature and purpose of their practices and benefit patient care, education and research. We aimed to identify, compare and contrast the documented features of clinical reasoning of physicians and nurses through the lens of layered analysis and to conduct a simultaneous concept analysis. The protocol of this systematic integrative review was published doi: 10.1136/bmjopen-2021-049862. A comprehensive search was performed in four databases (PubMed, CINAHL, Psychinfo, and Web of Science) from 30th March 2020 to 27th May 2020. A total of 69 Empirical and theoretical journal articles about clinical reasoning of practitioners were included: 27 nursing, 37 medical, and five combining both perspectives. Two reviewers screened the identified papers for eligibility and assessed the quality of the methodologically diverse articles. We used an onion model, based on three layers: Philosophy, Principles, and Techniques to extract and organize the data. Commonalities and differences were identified on professional paradigms, theories, intentions, content, antecedents, attributes, outcomes, and contextual factors. The detected philosophical differences were located on a care-cure and subjective-objective continuum. We observed four principle contrasts: a broad or narrow focus, consideration of the patient as such or of the patient and his relatives, hypotheses to explain or to understand, and argumentation based on causality or association. In the technical layer a difference in the professional concepts of diagnosis and the degree of patient involvement in the reasoning process were perceived. Clinical reasoning can be analysed by breaking it down into layers, and the onion model resulted in detailed features. Subsequently insight was obtained in the differences between nursing and medical reasoning. The origin of these differences is in the philosophical layer (professional paradigms, intentions). This review can be used as a first step toward gaining a better understanding and collaboration in patient care, education and research across the nursing and medical professions.
MULTIFILE
The capacity to deal with digital transformation is a valuable asset for established organizations, and employees play a crucial role in this process. This study contributes to the understanding of employees’ sensemaking of digital transformation in the tour operating industry. Using prior digital transformation research, construal-level theory (CLT), and dynamic change perspectives, our scholarly work focuses on the complexities of organizational change in a digital transformation context. Although employees generally support digital transformation, our findings show that their perceptions change over time across a range of specific challenges experienced during the employee change journey. Our findings stress the importance of adopting a social exchange lens in digital transformation knowledge as this represents deep structure change that might cause well-designed transformation processes to fail. Implications for hospitality and tourism management are discussed.
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One of the main aims of game AI research is the building of challenging and believable artificial opponents that act as if capable of strategic thinking. In this paper we describe a novel mechanism that successfully endows NPCs in real-time games with strategic planning capabilities. Our approach creates adaptive behaviours that take into account long-term and short term consequences. Our approach is unique in that: (i) it is sufficiently fast to be used for hundreds of agents in real time; (ii) it is flexible in that it requires no previous knowledge of the playing field; and (iii) it allows customization of the agents in order to generate differentiated behaviours that derive from virtual personalities.
