Decision Making Theories for Nursing Professionals

This article discusses different types of decision-making theories that can be used by nurses in different scenarios to make effective decisions and help patients to get proper treatment and expect better quality life. The theories discussed include information processing theory, intuition decision making, and expected utility theory.

Running head: DECSION MAKING THEORIES
DECSION MAKING THEORIES
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Introduction:
Clinical decision-making can be defined as the contextual, continuous act and an ever
evolving procedure. In the procedure, data is gathered and is there by interpreted and then
evaluated to select an evidence-base of a particular action for a task (Johansen and O’brien
2016). During the time of making clinical judgments, nursing professionals are seen to draw
different types of information from many different sources that would also include their formal
nursing education as well as from their experience that is usually gained over a period in their
practice. The clinical decision-making can be therefore defined as the effective choosing
between different alternative and can be considered as a skill, which helps in improvement of the
nurses gain of experiences both as a nurse and in a specific specialty (Standing 2017).
Researchers are of the opinion that clinical decision making mainly needs good quality judgment
that should include critical thinking. The definition of critical thinking in nursing is therefore
described as “Critical thinkers in nursing practice the cognitive skills of analyzing, applying
standards, discriminating, information seeking, logical reasoning, predicting and transforming
knowledge” (Yeates et al. 2016). Many of the researchers have also define decision making as
the procedure where professionals use to gather information about the patients and thereby
evaluate them and make judgments which result in the provision of the nursing care. Qualified
nurses should be able to use effective decision-making skills to provide safe and effective
nursing care. Over the course of time, researchers have put different types of decision-making
theories forward. This assignment would mainly be discussing about the different types of
decision-making theories that can be used by nurses in different scenarios to make effective
decision and thereby help patients to get proper treatment and expect better quality life.

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Information processing theory:
The basic concept of the information processing theory is that individual human beings
have minds that are like computers or information processors. They can simply not be considered
to provide responses to stimulus that are present in the environmental surrounding. The human
brain is seen to receive information just like a computer. Information that is gathered from the
senses as input can then be processed and then stored by the brain (Decoux et al. 2016). This
information then helps in delivering output that mainly comes out with the process of behavioral
response. The information-processing model is also called the psychological theory and is much
used in the research of the medical decision-making. It is also referred to as the scientific
approach to for effective decision-making and is also termed as the hypothetic-deductive
approach. In the nursing profession, there are four main stages of this process. The first one is the
gathering of preliminary clinical information about the patient and then generating tentative
hypothesis about the condition of the patient (Garner, Boyard and Gray 2015). Then the
professionals interpret the initially registered cues in the light of the tentative hypothesis and then
weight the decision alternatives. This is then followed by the choosing of the one that seems to
fit best in the light of the evidence collected. One of the drawbacks of this hypothesis deductive
approach is that it may result in inaccurate structures sometimes that may have wrong
probabilities that may remain attached with the with the results in the invalidation of the
outcomes. Sometimes the hypothesis may be wrong and this may lead to a rise of a proposition,
which may be fundamentally incorrect.
A model of working memory or short-term memory was introduced that mainly
comprises of three important components. These are the selection of the information, effective
method of processing, meaning and then ultimately deciding the components of the information

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that had to be transferred to the long-term memory or to forget it. Two of the counterparts of this
system is the auditory loop where the auditory information is saved and the visual-spatial
checkpad where the visual information is proceeded. The information that is obtained is
maintained in the short-term memory mainly by two procedures. The first is the maintenance
process that occurs through repetition of the information and the other is elaboration that refers
to the organization of the information through chunking (Sliakbari et al. 2015). This mode of
information processing theory cannot be depended by the nursing professionals for decision-
making. Different nurses have different varying levels of cognitive load. Therefore, those nurses
who cannot take enough cognitive loads in the rehabilitation department, it may lead to negative
outcomes (Cocks et al. 2016). Again, one of the features is that when the information is repeated
many times, the information becomes automatic. At that time, it does not require cognitive
resources. Moreover, this system helps in focusing on particular information and that is really
important and relevant. Often nurses in the rehabilitation ward have to conduct many activities
that are physically and mentally strenuous. Starting from manual handling to making of beds,
medication, conducting activities of daily lives of the patient and many others are also the duties
of nurses in rehabilitation wards (Tiffen et al. 2014). Therefore, in such times of cognitive load
where different information is poured from different members of the multidisciplinary team in
the wards, the nurse may become filled with cognitive load and hence the information may slip
resulting in issue in decision-making (Krishnan 2018). However, one of the good features is that
information, which is often repeated in the ward like importance of effective documentation
about the progression of health of the patient is often declared by nurse managers. Hence, this
information may remain stored and thus not require cognitive resources. With the help of this

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short-term memory model, nurses can specifically focus on particular information that is highly
relevant and necessary.
Long-term memory is different from the short-term memory with the fact that it has
unlimited space. It include proper encoding which is the elaboration process to the long term
memory and the other is the retrieval process which is the scanning of the information and the
transferring to short term memory or the working memory so that it can be used. Often a nurse is
seen to conduct excessive literature review and learn different evidence based information to
develop their skills in the rehabilitation ward (Toplak et al. 2014). This is then stored in the long-
term memory. As per requirement of the situation, information from here is transferred to short-
term memory for effective application. Therefore, in way this model is highly beneficial in
decision making for the nurses. However, this model is yet under arguments about how parallel
information can be collected and processed and recollected dieting the times of need.
Researchers argue that nurses need to be highly skilled to achieve this (Chen et al. 2014).
Therefore this model can then never be applied to all nurses especially who are novices as they
may fail to undertake parallel processing of information. Therefore, it cannot be considered as an
effective source.
The intuition decision making:
Approaches of decision-making can be quite diverse and many range from classical, rationalistic
and even decision making procedures to a less structured, intuitive as well as decision making
style. Rational decision-making procedures are seen to consist of sequence of step that are
designed rationally for development of desired solution (Melin et al. 2017). However, intuitive
decision-making is entirely different which is being more instinctive subjective as well as

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subconscious in nature. Often it is seen that the decisions of the nursing professionals are made
on judgments that are affected by a range of factors. These may include experiences, values,
emotions as well as attitudes. Many of the researchers also name it as the judgment heuristic
decision-making. This system is mainly seen to use simple rules as well as approximate short
cuts that help the professionals in arriving at decisions. Many of the researchers are of the
opinion that by adapting to this form of decision-making, they mainly rely on experiences and
attitudes and they mainly do so by helping to cut through excessive information that can
overload as well as result in delay of decisions (Payne 2015). Although this procedure helps the
professionals in simplifying complex situations, the nature of this form of decision-making can
also result in the introduction of the bias. Different types of judgment heuristic can be
representative heuristic. Here, the judgments are based on things with which the professionals
are familiar with or are inferred from representative characteristics. Another is the anchor
heuristics where the professionals are seen to take decisions that are based on the anchor like a
typical value and then different adjustments are made from that starting point. Another one is the
availability heuristics where judgments are mainly built on the information that is readily
available or on the easily called memory experience. Another study had given an explanation s
the main foundation of the decision-making procedures. It is mainly seen that in many cases
making a decision becomes difficult because it’s not poplar but mainly due to the reason as it
come from the “gut” and defines a clinical or the technical rationale. It is seen that professionals
are sometimes observer of things so many times that they become s capable to understand what
is going on this time. In this scenario, the facts may be incomplete and the data may be also
limited but the professionals can very well feel aligned or can recognize the outcome seven
before the situation reaches to completion (Hassani et al. 2016). Therefore, in simple terms it can

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be stated in case of intuition theory of decision making, the professional is mainly believing on
something that had been already known and is also perceived, understood as well as believed by
instinct, feelings of the nature without undertaking the help of actual evidence but by the
utilisation of thought, rational processes or reasons. Researchers are of the opinion that brain
researches point to different regions of the brain that are seen to work simultaneously with the
conscious though processes of the human beings and act as parallel intelligent systems . These
systems are mainly seen to create responses that are seen to compete with each other in
determination of the response of the person. However on the other hand, when human beings are
guided by the experience with a previous pattern, then the responses are said o be a result of the
intuition.
However, in many cases, it is seen to have a number of drawbacks, as this form of
decision-making can often be a source of the significant errors. Sometime sot may result in
flawed information. Intuition making is mainly seen to respond quickly to inaccurate, unreliable,
insufficient as well as incomplete information on patterns on previous experiences that might not
always yield similar results as previous time and may contribute to flawed information. short
term emotional basis may also take place as any researchers state that decisions of professionals
are influenced by the unrelated emotions during the time of making a decision. Moreover, it also
results in insufficient considerations of alternatives. Researchers are of the opinion that as mainly
this intuition generally bases on pattern recognition, it mainly points to solutions that have
already worked with current perceived patterns (Cork 2014). This in turn limits considerations of
other options although the alternative may give more fruitful it better results. Prejudices may also
creep in as emotions help in formation of intuitions and thereby it can allow flawed experiences
for overruling sound facts and evidences.

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The intuition of the nurses is an important component in relation to patient care and
intuition decision making guides the nurses in various types of nursing procedures. Knowledge,
experiences, skill levels, personal characteristics as well as relationships with the patients all play
an important role in the nursing ability for development and application of the intuitive abilities.
However when the nurses are not well experienced, this process of decision-making may have
negative impacts on the patients. Nurses are therefore seen to integrate intuition as well as
analysis or synthesis alongside objective data when decision-making. They need to be alert of
their sense of intuition that may in turn expand their knowledge and experience and therefore
develop the quality of patient care.
In the rehabilitation ward, a patient was seen to be suffering from abdominal pain and
was feeling confused and did not want to lie down. He continued to stay so even after pain
medication was given. Diagnostic tests like ECG showed that he had normal heart rhythms and
other members could not understand how to ease the patient. The senior nurse called for the
cardiac arrest team and within very hours, the patient had a cardiac arrest. After the patient was
saved , the team asked her what made her understand so. She exclaimed that it was her intuition
that advised her to do so. This can be considered a judgment on over analysis because no cues
from the situation indicated that such a situation could have taken place.
Expected utility theory:
Expected utility theory is of the opinion that every decision maker should choose between the
risky or uncertain prospects of a task with the help of comparison of the expected utility values
that is the weighted sum obtained by addition of the utility values of outcomes multiplied by
their respective probability (Guistinelli 2016). Researchers are of the opinion that expected

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utility theory is mainly helpful as a tool for analysis of situations where individuals must make a
decision without knowing which of the outcomes of the task will result from the decision and
that are decision-making takes place under uncertainty. The professional would choose that
particular option which will result in the highest expected utility that is which is the sum of the
products of the probability and utility over all possible outcomes. One of the important thing is
that the decision which will be made also depends on the risk aversion of the agent as well as the
utility of the other reasons (Gerard et al. 2015). To make it simpler, it can be stated as a Theory
that helps in estimating the likely validity of an action when the professional faces uncertainty
about the outcome. Which theory suggests that the rational choice is to choose an answer that
will have the highest expected utility in the situation. A number of disadvantages are associated
with this theory. Researchers have conducted surveys that have show that people are very risk
averse towards any form of gambles especially in cases that involves their health related
outcomes (Fischer, Pelka and Riedl 2015). The survey also indicated that there is significant
variability in the risk attitudes across different professional pertaining any given gamble and that
there is significant variability in the risk attitude of a given individual across gambles. It has been
also found from the survey that the variability of this risk attitude of a given individual suggests
that the risk attitudes are not absolute but are in the functions of the parameters that are present in
the gamble.
Patient of 75 years was admitted in the rehabilitation ward after facing a fall in the garden
following a stroke. He was a patient for about stage 5 chronic kidney diseases and was taking
dialysis for above ten years. After the emergency treatment that cured his stroke chances and
helped in dressing the wounds, the patient and family requested to conduct a kidney transplant so
that the patient can get over having a proper quality life. In such a situation, the senior nurses and

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the physicians were seen to conduct an analysis of the risks that are associated with it so that the
utility of the intervention that would be taken can be judged. They came to discussion where it
was revealed that the patient is already having dialysis to more than 10 years and evidences show
that such patients do not have extra benefits and higher mortality after transplantation in
comparison to those who have started dialysis recently or taking them for little number of years.
Again it was seen that the donor was supposed to be his wife who was also old and this also
increases the risk of failure of transplantation success. Age also plays an important factor in
ensuring success of this process. Hence, the nursing professionals and physicians decided not to
undertake transplantation surgery as better utility and success remains associated with dialysis
for the patient.
Comparison of the three theories:
The information processing theory is a systematic procedure of decision-making process that can
be used by both new nurses and experienced nurses. They are able to find solutions of the of the
problems by creating hypothesis of the decision maker based on knowledge that had been
already gathered (Reyna et al. 2015). On the other hand, intuition theory is very different because
of the fact that it is not based on any form of rationale. It is entirely based on the intuition that the
nurses develop at that particular moment from her previous experiences that might not have any
steady logic to defend the decisions. Expected utility theory is again based on another rationale
and is mainly help in situations when there is uncertainty like when there are number of risks
associated with the different ways of performing a task (shabn 2015). This theory helps to
decides which of the intervention along with the risk would help in providing more benefit in

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comparison to the other modes of interventions with the risks that would result in more harm and
less benefits. Therefore, in a way those theories are helpful in different situations and help to
decide with different angles that may help professionals to come to a decision that brings out
success.
Application to that of the nursing field:
This theory is one of the best theories of decision-making as it follows a systematic procedure
that provides very little scope of resulting in conducting mistakes. This theory addresses the
basic psychological concepts of memory, cognitive processing and problems solving. The theory
has also been successful in acting as framework for many of the studies based on clinical
decision-making (Nestel and beardman 2015). It is one of the best theories that help in describing
the processes of problem solving behavior based on the interaction of the between the task and
that of the problem solver. Clinical decision making mainly give rise to situations that require
considering huge amount of data to be gathered properly followed by their documentation and
then acting upon them. Here, the potential for cognitive strain is very high. Here the
professionals can develop their capacity of working memory or the short-term memory by the
clustering of the data into the familiar chunks for information processing (Lin et al. 2016). The
four steps that the professionals should undertake to complete it successfully are quite easier.
Firstly, the professionals need to gather and attend to the initially available cues and symptoms.
Then the professionals with the help of the cues activate some of the hypotheses that may satisfy
the initial cues that had been selected. Then the professional need to gather additional data that is
usually that are hypotheses directed (Brinol et al. 2015) . Then the professionals need to evaluate

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the hypothesis by weighing the likelihood of each in the light of the new cue until the diagnosis
is accepted. Therefore, this systematic procedure helps the professionals to link their theoretical
knowledge taught in their classes and training to relate with the real life situations that give very
little scope of errors and mistakes. Therefore, it results in fewer changes of the patient harm and
better patient safety than the other decision-making skills (Niedtfeldt et al. 2017).
From the above discussion, it becomes clear that the nurses can utilize different types of
decision-making theory in different situations in order to reach a conclusion. The decisions
making theory help the nurses take the correct decisions in order to provide the care that is not
only safe but also ensures better quality life for the patients. Different types of decision-making
theories have been put forward by different researchers out of which the information processing
theory is one of the most important and helps nurses to develop a hypothesis against the cues
obtained from the initial assessment of the patient. This hypothesis is then tested with the cues
with the help of already learnt information and knowledge prior to the occurrence of the task and
this knowledge helps the nurses to decide up number of particular interventions according to the
authorities of the patients. In addition, other important decision making theory is the intuition
decision-making theory. Here the nurses do not follow particular knowledge but take decisions
from the intuition, which does not remain, based on prior knowledge but usually remains based
on prior experiences. However, one negative point about this is that it may result the nurse to
conduct mistake even when the same decision had resulted in success in the previous cases.
Another decision-making theory is the utility theory where the nurse mainly takes judgment
about the utility of the different interventions that are associated with the task. Then the nurses
take sides of that particular intervention which has less risks and most number of benefits to the
patients in comparison to the other interventions. This type of theory is mainly helpful in the

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cases of uncertainty. Therefore, the nurses might use the different types of decision-making
theories in different cases and develop decisions that bring them success in their careers.

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References:
Aliakbari, F., Parvin, N., Heidari, M. and Haghani, F., 2015. Learning theories application in
nursing education. Journal of education and health promotion, 4.
Briñol, P., Rucker, D.D. and Petty, R.E., 2015. Naïve theories about persuasion: Implications for
information processing and consumer attitude change. International Journal of
Advertising, 34(1), pp.85-106.
Chen, R., Dore, K., Grierson, L.E., Hatala, R. and Norman, G., 2014. Cognitive load theory:
Implications for nursing education and research. CJNR (Canadian Journal of Nursing
Research), 46(2), pp.28-41.
Cocks, A.J., Jackson, R.C., Bishop, D.T. and Williams, A.M., 2016. Anxiety, anticipation and
contextual information: A test of attentional control theory. Cognition and Emotion, 30(6),
pp.1037-1048.
Cork, L.L., 2014. Nursing intuition as an assessment tool in predicting severity of injury in
trauma patients. Journal of Trauma Nursing, 21(5), pp.244-252.
DeCoux, V. M. 2016. Kolb's learning style inventory: A review of its applications in nursing
research. Journal of Nursing Education, 29(5), 202-207.
Fischer, S., Pelka, S. and Riedl, R., 2015. Understanding patients’ decision-making strategies in
hospital choice: Literature review and a call for experimental research. Cogent Psychology, 2(1),
p.1116758.

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Gardner, J. W., Boyer, K. K and Gray, J. V. 2015. Operational and strategic information
processing: Complementing healthcare IT infrastructure. Journal of Operations
Management, 33, 123-139.
Gerard, K., Tinelli, M., Latter, S., Smith, A. and Blenkinsopp, A., 2015. Patients' valuation of the
prescribing nurse in primary care: A discrete choice experiment. Health Expectations, 18(6),
pp.2223-2235.
Giustinelli, P., 2016. Group decision making with uncertain outcomes: Unpacking child–parent
choice of the high school track. International Economic Review, 57(2), pp.573-602.
Hassani, P., Abdi, A. and Jalali, R., 2016. State of science,“intuition in nursing practice”: A
systematic review study. Journal of clinical and diagnostic research: JCDR, 10(2), p.JE07.
Johansen, M.L. and O'brien, J.L., 2016, January. Decision making in nursing practice: a concept
analysis. In Nursing forum (Vol. 51, No. 1, pp. 40-48).
Krishnan, P., 2018. A Philosophical Analysis of Clinical Decision Making in Nursing. Journal of
Nursing Education, 57(2), pp.73-78.
Lin, H.C., Chiou, J.Y., Chen, C.C. and Yang, C.W., 2016. Understanding the impact of nurses'
perception and technological capability on nurses' satisfaction with nursing information system
usage: A holistic perspective of alignment. Computers in Human Behavior, 57, pp.143-152.
Melin‐Johansson, C., Palmqvist, R. and Rönnberg, L., 2017. Clinical intuition in the nursing
process and decision‐making–A mixed studies review. Journal of clinical nursing.

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DECSION MAKING THEORIES
Nestel, D. and Bearman, M., 2015. Theory and simulation-based education: Definitions,
worldviews and applications. Clinical Simulation in Nursing, 11(8), pp.349-354.
Niedtfeld, I., Defiebre, N., Regenbogen, C., Mier, D., Fenske, S., Kirsch, P., Lis, S. and
Schmahl, C., 2017. Facing the problem: impaired emotion recognition during multimodal social
information processing in borderline personality disorder. Journal of personality
disorders, 31(2), pp.273-288.
Payne, L.K., 2015. Toward a Theory of Intuitive Decision–Making in Nursing. Nursing science
quarterly, 28(3), pp.223-228.
Reyna, V.F., Wilhelms, E.A., McCormick, M.J. and Weldon, R.B., 2015. Development of risky
decision making: Fuzzy‐trace theory and neurobiological perspectives. Child Development
Perspectives, 9(2), pp.122-127.
Shaban, R., 2015. Theories of clinical judgment and decision-making: a review of the theoretical
literature. Australasian Journal of Paramedicine, 3(1).
Standing, M., 2017. Clinical Judgement and Decision Making in Nursing. Learning Matters.
Tiffen, J., Corbridge, S.J. and Slimmer, L., 2014. Enhancing clinical decision making:
development of a contiguous definition and conceptual framework. Journal of Professional
Nursing, 30(5), pp.399-405.
Toplak, M.E., West, R.F. and Stanovich, K.E., 2014. Assessing miserly information processing:
An expansion of the Cognitive Reflection Test. Thinking & Reasoning, 20(2), pp.147-168.

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Yeatts, D.E., Shen, Y., Yeatts, P.E., Solakoglu, O. and Seckin, G., 2016. Shared decision-making
in nursing homes: factors associated with the empowerment of direct care workers. Journal of
aging and health, 28(4), pp.621-643.