Neil Smith on his research into decision making in the ICU [Interview]


Alfred Long, ICS Communications Officer

Neil Smith, the recipient of the 2014 Nurse and AHP Foundation Fellowship Award, speaks about his research on decision making in ICUs. He is currently working at Hull Royal Infirmary whilst pursuing a PhD at the University of Hull.

Neil’s study looks into individual decision making in the use of Continuous Renal Replacement Therapy (CRRT).

What initially drew you to this area of research?

“Whilst guidelines exist, people tend to make decisions without always taking them into account. As everyone is an individual; they all have different experiences, I’m interested in determining what actually ends up helping a person make a decision.

There is a lot of autonomy expected in the ICU, clinical experience suggests that people don’t necessarily make consistent clinical decisions despite being presented with the same clinical scenario on separate occasions, understanding why this behaviour happens is important to me.”

What research have you done in preparation?

“I looked at studies on ICU based decision making, for example, how to wean patients from mechanical ventilation. One of the papers looked at practitioner fatigue, and a concept called decision regret, people had to rate how tired they were and then whether they regret any decisions they made on that particular shift. One thing that struck me was that people particularly regretted decisions made when tired. The influence of those personal day to day things might have an impact on the clinical decision you make. Almost like a butterfly effect, as they escalate, they could affect a patient’s outcome. It’s those consequences that that surprised me and got me thinking.”

What effect would you like your research to have?

“I’m hoping that it will increase understanding about how people make decisions, the practical aspect of it will be to improve training. If you can understand why people are making decisions because of their experiences then training could be better focused in addressing those issues. And as a grand plan I’d love to see that improve patient outcomes, but my research is a long way off being able to prove that a bespoke training package improves patient outcomes.”

How has the Foundation Fellowship helped you?

“Other than the fact I was shocked to get it, it certainly helped take the pressure off the issues about funding. Whilst I’ve got NHS funding to finish my degree, the actual time and effort to do the logistics would be much more difficult without the fellowship funding. Without it there would have been so many more barriers in the way. In our region there’s not a lot of emphasis put on this sort of training for people like myself, but the foundation fellowship has given that kudos enabling my organisation to support me doing the project.”