NURS3002: Decision-Making Theories in Nursing: A Report

This report delves into the application of decision-making theories in nursing, specifically focusing on information processing and intuition theories. The first part of the report provides a detailed overview of these theories, exploring their identifying features, development in nurses, and strengths and limitations, supported by current literature. The second part presents a case study of a 52-year-old patient with multiple myeloma, encountered during a clinical placement. The report analyzes the patient's condition, including mouth ulcers, fatigue, and thrombocytopenia, and discusses the application of the clinical reasoning cycle and decision-making frameworks to address these issues. The student nurse's approach to patient care, including the use of oxygen therapy and prophylactic antimicrobial therapy, is also outlined. The report emphasizes the importance of evidence-based practice and the use of both information processing and intuition in clinical decision-making to enhance patient outcomes and safety.

Running head: EVIDENCE BASED NURSING RESEARCH
EVIDENCE BASED NURSING RESEARCH
Name of the student
Name of the university
Author’s name

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Part 1
Information processing Theory:
Information processing model is a descriptive approach to decision making that directs
the nurse to make decisions and judgments based on their knowledge, expertise, skills and
experience and by using relevant information applied to the situation (Shaban, 2005). Studies
have found that information theory is the most widely used descriptive theory in nursing practice
and it suggests that individuals while making decision goes through many stages guided by the
acquisition of prompts from the environment or situation (Shaban, 2005). The Information theory
underpins some of the essential process for making decision based on clinical reasoning and
analytical thinking including exposure to pre encounter data, conjoining or combining all the
cues and data from the situation, giving a rationale or every explanations, re-examining the
correct hypothesis of the diagnostic data and a proper diagnosis of the same (Shaban, 2005).
Information processing theory in nursing:
The Information theory is used by the nurses as an individual thinker by considering and
recognizing that human have memory stores and information is transferred from one part of the
brain to the other. The theory also recognizes the fact that individual processes information and
knowledge they receive from education and experience rather than just responding to the stimuli
as a behaviourism (Krishnan, 2018). However, researchers have identified some of the
limitations or weakness associated with this theory. One of them is lack of access to the long
term memory and low capacity of the working memory (Krishnan, 2018).

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Strength of the Information processing theory: Nurses gather all the relevant information by
accessing the health condition, backgrounds and all the subjective and objective data and then
use their competencies and skill set required to make decisions by reflecting on their knowledge
and experience with the help of information processing theory (Toney-Butler & Unison-Pace,
2019). For example, if the vitals of a patient shows that BGL is dropped to 3.5 nmol/L, nurses
must use this theory to interpret what the vital implicates and what measures needed to be taken
considering the fact that the patient has low blood glucose level. This theory helps the nurse to
make clinical decisions by using information and knowledge they have gathered through their
experience. A patient with lower blood glucose level is usually recommended to have a diet rich
in carbohydrate, protein and fat that balances the patient’s nutrition requirement and helps to
prevent the condition of low blood glucose level.
Limitation of information theory in nursing: Although, this theory helps the nurses to make
clinical decision by using their expertise and skills, however, the theory limits itself in the area of
knowledge and ability to decipher information stored in human memory and often makes it
challenging for the nurses to remember and use information they have gathered from their past
experiences. For example, if the nurse is not able to interpret the patient’s vitals accurately and
unable to use their knowledge to understand the patient’s area of concern and prioritize the care
process, it can hamper patient’s safety and also lead to mortality of the patient.
Development of information theory in nurses: The nurses use their own perception towards the
problem or issue identified and make decisions by aligning with the professional code of conduct
and use the best available information and evidences on that particular area. The study suggested
and identified the four main steps in decision making as gathering primary information about the

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patient, collecting tentative hypotheses regarding the patient’s health condition, interpreting the
diagnosis or tentative hypotheses through assessments and accessing the alternatives available
before making the actual decision that fits best according to the best available evidences.
Intuition theory:
Intuition is a controversial concept and nurses often finds it difficult to explain their
actions or decision based on intuition. Krishnan, 2018, defines intuition is an attribute
characterised by the ability to understand without rationale. Intuition is a decision making theory
in nursing associated with taking immediate decisions without the consciousness or immediate
possession of knowledge and identified as a process that is independent of linear reasoning
process (Krishnan, 2018).
Strength of the theory: It acknowledges and takes into account the fact that individuals have the
ability to immediate decision making and involves a spontaneous and quick realization and
recognition of the outcome associated with a particular situation (Hassani, Abdi & Jalali, 2016).
Although, this theory was adopted and accepted by many researchers, but the theory has got
many criticisms in the context of a limited information and knowledge possessed by the nurses
(Hassani, Abdi & Jalali, 2016).
For example if a nurse witnesses an elderly person doing any task without support, nurse
intuition tells that they may fall as elderly adults are more susceptible to fall because of their
poor gait and adverse effects of strong medication doses, if any.
Limitation of this theory: The major limitation of the nurse intuition theory is that it is grounded
around a particular context or a specific situation and the nurses cannot apply their skills and

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knowledge outside of that particular situation or context. Melin, Johansson, Palmqvist &
Rönnberg, 2017, believes that incorporation of intuition in the nursing practice includes
application, insistence and experiences and believes that intuition is based on knowledge rather
than evidence based practice. Nurses must integrate both synthesis and analysis of intuition in
addition to the objective data while making decisions. The nurses should practice by relying on
their intuition and use and implement the their knowledge while practicing in clinical settings
that will act as a support for decision making thereby increasing the quality of nursing care and
promote safety of the patients through an enhanced and effective care (Melin, Johansson,
Palmqvist & Rönnberg, 2017).
Development of intuition theory in nursing: Intuition theory is applied in the nursing practice and
develops as a form of knowledge and intuitive skills among the nurses. According to Valenzuela,
2019, intuition is a way of personal knowing occurring as a result of relevant experience and
knowledge, a genuine and authentic nurse patient relationship that contributes to the an enhanced
nursing care.
In order to plan or develop effective intervention strategies to promote health of the
patient, the first step is to identify the health concerns through assessments and recording the
vials that gives information about the patients’ health and help the nurses to deliver care
appropriate for that particular patient. Information theory helps the nurses to access, interpret,
evaluate and finally implement strategies by using their knowledge and expertise to treat the
patient that will improve their health outcome. Information theory directs the nurses to make
clinical decisions based on their knowledge and expertise and helps devise an appropriate care
plan suitable for the patients. Intuitions theory also has implication in nursing practice, however,

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information theory is preferred over intuition theory since intuition only allows the nurses to
make decision based on a particular context or situation rather than developing an immediate and
important care plan for the patient. As stated above, it is more important to monitor the patient’s
vitals by conducting assessments that gives information on the patient’s health thereby helping
the nurse to plan care strategies, than waiting for the an intuitional response of the nurse for a
particular situation. If a patient with a lower BGL is ignored and not given proper treatment, it
may lead to poor health outcome and even mortality of the patient.
Part 2:
Patient consideration:
I had my clinical placement in the haematology ward in a hospital in South Australia
where I was allocated to look after the patients undergoing cancer treatment with a majority of
the patients were having multiple myeloma. I was working under the supervision of my senior
nurse leader who allocated me to look after a patient from the same department having multiple
myeloma. The patient I was assigned to take care of was a 52 year old Australian man named
Max who was transferred from the Emergency Department (ED). The patient has been admitted
to hospital for the chief complaints of the mouth ulcer and extreme weakness and fatigue. Upon
critically analysis the health condition of the patient, he has been diagnosed with multiple
myeloma and admitted to the ED. With newly diagnosed Multiple Myeloma he has past medical
history of diabetes and kidney disease. His social history tells us that he worked in a
petrochemical industry where he was continuously exposed to organic chemicals. He used to live
alone and was separated from his partner long back. For the proper assessment of the patient

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condition two different frameworks has been applied in the assignment which includes, clinical
reasoning cycle and decision making framework.
Clinical reasoning cycle is one of the most effective and common frame work which is
used in the healthcare setting for the proper assessment of the patient’s health condition and for
their treatment accordingly.
Information of the patient:
It is important for me as a nurse to provide appropriate treatment to the patient by
evaluating all the essential information which are required to formulate the care plan of the
patient. Therefore, in order to collect all the necessary information, I used clinical reasoning
cycle that helped me to conduct proper assessment of the patient and record his vitals to plan and
guide Max’s the treatment process.
The objective data of the patient has been collected which includes, haemoglobin of the
patient was found to be significantly low at 10.6g/dl, MCV of 92. He had a normal serum
ferritin, vitamin B12 and folic acid levels. The absolute neutrophil count was 1.3 x 103/ uL and
the platelets 117 x 109/uL. The creatinine value recorded was 0.9 mg/dL and calcium of 9.3
mg/dL and albumin of 3.8g/dL. Through a serum protein electrophoresis, a monoclonal IgA
protein of 1.6 g/dL was recorded that indicates occult lytic lesions in his skull and in the bilateral
humeri and biopsy report shows that 30 percent of the abnormal appearing plasma cells are
involved which is confirmed by CD138+ immunohistochemical stain.
The subjective data of the patient includes nausea, loss of appetite, weakness, increased
thirst and frequent urination, fatigue and mouth ulcer.

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According to the Nursing and Midwifery board of Australia (2019), any decision
regarding the treatment of the patient should be conducted by considering the decision-making
framework for the nurses and the midwives (Nursingmidwiferyboard.gov.au, 2019). The
decision making framework is of three types and is used according to the severity of the
situation. The decision making framework used in this case is Guide to nursing practice
decisions. With the aid of this framework, I will use my clinical knowledge to provide
appropriate care to the patient. By reviewing the health condition of the patient, it can be stated
that the three major issues which needs urgent care of the patient includes, mouth ulcer, fatigue
and thrombocytopenia.
The priority of care for Max were identified as:
Cancer fatigue:
Cancer fatigue is a common side effect associated with cancer. I have witnessed
symptoms in Max by accessing his health condition through assessment and recording his vitals
and implemented clinical reasoning cycle to develop strategies for his treatment (Bower, 2014).
Fatigue is a common symptom associated with cancer patients (Bower, 2014). I have conducted
assessments and used information theory to interpret the patient’s vitals and gave him oxygen
therapy whenever it was necessary. As an oncological nurse, it was necessary for me to possess
all the competencies and an adequate skill set to understand the patient’s situation
comprehensively and implement the intervention strategies that will be applicable in the
scenario. His vitals showed an oxygen saturation of 91 which was low and therefore by using the
Information processing model I gave him oxygen therapy that was important for treating his
condition (Bower, 2014).

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The patient was started on cyclophosphamide, bortezomib, and dexamethasone. He was
also put on prophylactic antimicrobial therapy. The diagnostic results revealed stable hemoglobin
of 9.1 g/dL and serum creatinine at 2.8 mg/dL which indicates he has a much lower haemoglobin
and indicates has his kidney was not working properly.
Clinical reasoning cycle:
Access: I noticed his sleeping patterns, unusual tiredness he was suffering from, and also noticed
that he always looked distressed and tired. I have used 0-to-5 or 0-to-10 response scale that
helped me to determine his severity of fatigue.
Intervene: I encouraged him to perform light activities and motivated him by taking care in a
holistic approach. I have provide him with adequate nutrition that was necessary for his health.
Re-evaluate: I have rechecked with the doctors and evaluated further by accessing his health
concerns.
Mouth ulcer:
On Day 5, Max, was having mouth ulcer as a side effect of chemotherapy which if not
treated on priority basis can even lead to mouth infection and cab also gives rise to mouth cancer.
Hence for that, it is considered as one of the priority complications in case of Max. It can also
create difficulty for the individual while eating and is also associated with pain, due to which the
patient had been admitted.
He was having difficulty in swallowing food and it was very painful for him.
Chemotherapy and radiation impairs the body’s immune system because of which bacteria and

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fungus are more likely to infect the mouth more easily causing mouth sores (Cancer.gov, 2019).
Since he was having difficulty in swallowing food, I gave him fluid based light foods and also
gave ice chips and cold water around his mouth to make him cope up with the pain (Cancer.gov,
2019). I took every measure necessary to manage his mouth ulcer since it can lead to severe
complications and increase the infection and bleeding which must be controlled in a patient with
multiple myeloma (Cancer.gov, 2019).
Clinical reasoning cycle:
Access: I noticed if he was having difficulty in swallowing food.
Intervene: I gave him liquid foods.
Re-evaluate: I have reported the doctor and took effective measures.
Thrombocytopenia:
Thrombocytopenia happens a few days after treatment of chemotherapy and that is why,
on day 5, I was looking for his symptoms of fatigue in Max. Thrombocytopenia is considered as
the primary issue because if thrombocytopenia is not treated on prior basis, it can lead to more
adverse effect such as, Enlarged spleen and jaundice.
Clinical reasoning cycle:
Access: By using clinical reasoning cycle, I have accessed the patient’s condition and monitored
for signs and symptoms of thrombocytopenia like bleeding gums, abdominal pain, spontaneous
bleeding from nostrils, oozing of blood from incisions and by observing neurological changes
like confusion, blurred vision and other related comorbidities.

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Intervene: I have reviewed the medications and reported to the doctor for reducing the intensity
or dose of his chemotherapy and radiation. I have also planned for platelet transfusion depending
on the severity of his condition.
Re-evaluate: I have checked it with the doctor and reported him about every symptoms and vitals
I have recorded and collected by monitoring the patient.
By associating my clinical knowledge with the patient condition, I concluded that
Patients undergoing chemotherapy are susceptible to thrombocytopenia and therefore they must
be assisted with their daily activities to prevent fall or occurrence of any injury that can cause
bleeding. I helped him with daily activities and monitored every vitals of the patient especially,
platelet count, white blood count, haemoglobin, coagulation tests, renal functions like urinalysis,
serum creatinine and also creatinine clearance since he has a medical history of kidney disease
(Donovan, Tran & Kanaan, 2010). I have assisted him with hygiene, shaving and mobility
assistance to prevent falls though he is independent. I have also assessed bowel movements/urine
color.intake and output for evaluating the hydration status and checking the stools for occult
blood. I have used clinical reasoning cycle to access and intervene the patient’s condition. By
recording his vitals, I found that he has lower blood pressure and an increased heart rate that can
be both because of his medical history of kidney disease and also effects of drug and medications
he was given. Therefore, I monitored and reviewed his medication order and reported to the
doctor regarding the same. In order to reduce the bleeding risk, I have restricted the use of razors,
venepuncture, toothbrushes, tampons and also intramuscular or subcutaneous injections
(Donovan, Tran & Kanaan, 2010).

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He was facing both physical as well as psychological issues. Since he was in the regimen
of chemotherapy, he was having thrombocytopenia, that is, a low platelet count Khorana, A. A.,
(Dalal, Lin & Connolly, 2013). To address this issue and effectively manage his condition, I
have used Information theory by applying all my knowledge and important information I have
regarding management of his condition. This is because the theory helps the nurses be more
active, attentive towards the patient and their needs as well as helps the nurses develop their
problem solving skills (Johansen & O' Brien, 2016). This enables the nurses to analyse each
situation and accurately prioritize the different medical processes that are required before and
after the treatment procedure. There are three main stages of information processing which is
incorporated in this theory- receiving information, analysing it and reacting or responding
according to it (Johansen & O' Brien, 2016).
Cancer patients besides physical treatments also seeks for psychological treatment and
support. I worked by aligning with the nursing standards which clearly states to follow a patient
centred approach to care. I took care of him from every aspects and provided him support so that
he can cope up with his condition. I have developed a nurse patient relationship by aligning with
the nursing standards and made him educated of his condition and gave him information about
the treatment approaches available.