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Pignatiello Dissertation FINAL.pdf (898.13 KB)

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The Relationships Among Self-Regulation, Cognitive Load, Decision Support, and Decision Making Readiness in Surrogate Decision Makers for the Critically Ill

Pignatiello, Grant Alan
http://orcid.org/0000-0002-0119-6979
http://rave.ohiolink.edu/etdc/view?acc_num=case1528453527097319

Abstract Details

2018, Doctor of Philosophy, Case Western Reserve University, Nursing.
Chronic critical illness is expected to impact 600,000 Americans annually by 2020. Often, the chronically critically ill (CCI) experience persistent cognitive impairment. Thus, family members serve as surrogate decision makers (SDMs) to make complex healthcare decisions for their loved one. Decision support interventions have been developed to meet the informational needs of SDMs during this distressing period. However, past decision support interventions have not been effective in meeting the informational needs of SDMs. Current decision support interventions have not evaluated unique behavioral and cognitive factors that may influence an SDM’s readiness to engage in decision making. Therefore, this study applied the Strength Model of Self-Control and Cognitive Load Theory to address the following aims: (1) explore how cognitive load differs among SDMs receiving two multimedia decision support interventions; (2) evaluate the association between self-regulation (emotion regulation and cognitive regulation) and cognitive load; and (3) evaluate the relationship between cognitive load and decision making readiness (decision making preparation, self-efficacy, and fatigue).This was a descriptive, correlational, cross-sectional study that captured data from 97 SDMs enrolled in a parent randomized controlled trial. Participants were recruited from the adult ICUs of University Hospitals Cleveland Medical Center, Cleveland, OH. An analysis of covariance (ANCOVA) and a series of multiple regressions were used to test the study’s aims. In this sample, extraneous cognitive load levels were significantly higher (F(2, 78) = 7.6, p = .007) among recipients of INVOLVE (M = 1.40) than recipients of IS (M = 0.46). Furthermore, emotion regulation through use of expressive suppression demonstrated a significant part correlation with extraneous cognitive load (Part r = .24, p = .02). Finally, decision making self-efficacy demonstrated a significant part correlation with intrinsic (Part r = -.32, p = .003) and extraneous (Part r = -.32, p = .006) cognitive load. This study is the first study to compare the cognitive load imposed by multimedia decision support interventions and evaluate how cognitive load relates to regulation of behavior and decision making outcomes among SDMs, which can inform the subsequent design and implementation of electronic decision support interventions among SDMs for the critically ill.
Ronald Hickman, PhD, RN, ACNP-BC, FNAP, FAAN (Committee Chair)
Barbara Daly, PhD, RN, FAAN (Committee Member)
Shirley Moore, PhD, RN, FAAN (Committee Member)
Heath Demaree, PhD (Committee Member)
209 p.
Educational Psychology; Nursing; Philosophy of Science; Psychology
critical illness; decision making; cognitive load; decision support, self-regulation

Recommended Citations

Citations

  • Pignatiello, G. A. (2018). The Relationships Among Self-Regulation, Cognitive Load, Decision Support, and Decision Making Readiness in Surrogate Decision Makers for the Critically Ill [Doctoral dissertation, Case Western Reserve University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=case1528453527097319

    APA Style (7th edition)

  • Pignatiello, Grant. The Relationships Among Self-Regulation, Cognitive Load, Decision Support, and Decision Making Readiness in Surrogate Decision Makers for the Critically Ill. 2018. Case Western Reserve University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=case1528453527097319.

    MLA Style (8th edition)

  • Pignatiello, Grant. "The Relationships Among Self-Regulation, Cognitive Load, Decision Support, and Decision Making Readiness in Surrogate Decision Makers for the Critically Ill." Doctoral dissertation, Case Western Reserve University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=case1528453527097319

    Chicago Manual of Style (17th edition)

case1528453527097319
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This open access ETD is published by Case Western Reserve University School of Graduate Studies and OhioLINK.