Decision Making in Nursing Practice: Theories, Models, and Analysis

This report delves into the critical aspects of decision-making within the nursing field, focusing on how different theories and models can enhance the quality of patient care. The report explores decision-making theories such as the cognitive continuum, social judgement, and expected utility theories, analyzing their application in nursing practice. It examines the strengths and limitations of each theory, providing insights into how nurses can utilize these frameworks to make informed clinical judgements. The report highlights the importance of understanding these theories to improve patient outcomes and satisfaction, discussing how factors like task structure, cognitive mode, and information processing influence the decision-making process. Furthermore, the report provides an analysis of the application of these theories in specific nursing practices such as post-exposure prophylaxis (PEP), emphasizing the importance of selecting the appropriate decision-making approach based on the context of the clinical scenario. The report also discusses the limitations of each theory, and their potential applications in real-world situations, making it a useful resource for nursing students and professionals seeking to improve their decision-making skills.

DECISION MAKING IN
PRACTICE

Table of Contents
INTRODUCTION...........................................................................................................................1
MAIN BODY...................................................................................................................................1
CONCLUSION................................................................................................................................8
REFERENCES ...............................................................................................................................9

INTRODUCTION
Decision making refers to the process regarding making selection of one option out of
several alternatives available. Clinical judgement and decision making is the main aspect of
professional nursing. In the context of health and social care sector, clinical decision making
plays a vital role in enhancing the quality of care that nurses provide to the patients. Moreover,
poor judgements lead adverse situations and thereby results into negative consequences for the
patients. Hence, satisfaction level of the patients is highly influenced from the quality of care
and decisions taken by the nurses. In this, the present report will provide deeper insight about the
theories and models that can be employed in nursing practices. Hence, report will shed light on
the manner in which cognitive continuum, social judgement and expected utility theories aid in
the decision making aspect under nursing field. Report also depicts how one theoretical model is
considered as better over others.
MAIN BODY
Critically analysing decision making theories or models that can be used in nursing practice
According to the views of Tomlin and et.al., (2017), considering the limitations of
systematic-positivist and intuitive humanist model, cognitive continuum theory was developed
by Hammond. From assessment, it has been found that Hammond believed that cognition was
not solely a function of analysis or intuition. Hence, author stated that cognitive process operates
on a continuum basis where analysis falls at one pole and intuition on another side. Hence, gap
which takes place between such two poles recognised or considered as quasi-rational decision
making. This in turn may also be served as combination of analytical and intuitive processes.
Kam, Chismar and Thomas (2014) presented in their study that cognitive continuum has
mainly three dimensions such as task structure, cognitive mode and process time. Such
theoretical framework lays emphasis on reconciling the stark differences that take place between
systematic-analytical and intuitive approaches. Moreover, it assumes that both the approaches
are highly needed for making optimal decisions. In accordance with such theory, decision based
on the extent to which task is well or ill structured. This theory presents that when decision task
is well structured, then systematic reasoning provides assistance in taking the best decisions. On
the other side, ill-structured tasks are highly suited for intuition. Hence, it can be stated that
decision making aspect varies across a continuum.
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Offredy, Kendall and Goodman (2008) entailed in the study that cognitive continuum has
mainly four components. On the basis of this aspect, cognitive continuum of decision making is
analytical at one hand and intuitive on the other area. Along with this, it focuses on combining or
fulfilling variations that takes place between analytical and intuitive decision making. Further,
third aspect entails that, theory of task structure presents, capacity by taking into account
analytical, intuitive or quasirational cognition. Fourth aspect on which cognitive continuum
theory is based imply for dynamic cognition. However, Dhami and Thomson (2012) criticized
cognitive continuum theory on the basis of its slowness. In other words, such analytical process
is slow and includes conscious processing of data set as per complex principles. Such analytical
process ensures high degree of consistency as well as accuracy but also contain a potential
pertaining to big errors. Further, intuition aspect of such theoretical base includes rapid and
unconscious processing of the data set. This in turn combines averaging principle with low
consistency, moderate level of accuracy and limited errors.
Bjork and Hamilton (2011) assessed that, in the context of clinical settings lack of
familiarity and uncertainty is one of the main factors that have significant influence on the
decision making aspect of nurses negatively. In the study, author clearly exhibited that intuitive
and associated analytical process was used by the nurses for the purpose of decision making.
Further, study conducted by Standing (2008) revealed that nurses or participants lacked
knowledge regarding pharmacology and unable to assess issues were facing by patients. Due to
this, difficulty was also faced by the nurses in relation to providing patients with proper or
suitable medications. Hence, findings of such concerned study that nurses, who assessed
patient’s issues, had used intuitive decision making process. Referring this, it can be depicted
that in the lack of having knowledge about the specific area, consideration of intuitive decision
making will be problematic.
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Illustration 1: Cognitive Continuum Theory
(Source: Custers, 2013)
By doing assessment, it has been identified that for the purpose of effective nursing
practice, cognitive continuum theory proves to be highly suitable. The rationale behind the
selection of such decision making tool is that it lays high level of emphasis on considering task
properties. Hence, considering task properties such as well or ill structured nurses can take
suitable judgement that provide patients with high quality care or services. Hence, well-
structured tasks usually induce analytical approach. Moreover, such tasks have high level of
decomposition, degree of certainty and time to resolve (Nurses' Decision Making and Pain
Management Outcomes, 2017). On the other side, ill-structured properties induce intuitive
approach for decision making. In the context of nursing practice such as Post-exposure
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prophylaxis, cognitive continuum will help in taking suitable judgement on the right time.
Moreover, in relation to such nursing practice, concerned authority must have ability in relation
to assessing issue and providing patients with suitable medications. Such theoretical framework
is highly significant which in turn gives clear idea to the nurse about the approach or practice
that needs to considered for the purpose of decision making. Cognitive continuum theory of
judgement develops high level of link or association between mode of cognition and task
features. By taking into account the aspects of such theoretical framework it can be stated that in
the case of having proper or enough knowledge regarding PEP process intuitive approach of
decision making needs to be followed by the nurses. Hence, considering such theory quality of
the decision making regarding nursing practice such as preparation of PEP process can be
improved significantly.
According to Sundberg, Garvare, and Nyström (2017) it is very essential to analyse the
information of patient while providing care facilities. This helps in giving effective treatment to
them. This theory states that human mins is like a computer. It receives input, process it and
deliver the output. The information that is received is stored in brain and is used whenever
needed. In a research conducted by LoBiondo-Wood, and Haber (2017) it was observed that the
dimensionality of using this theory reduces the complexity of brain. It emphasis that information
is processed in various ways such as perception, attention, etc. that affect the ability to access
information later on. It shows the degree to which information was learned will affect than it was
elaborated. Ferrell and Fraedrich (2015) elucidated that information can be easily retrieved if it is
learned in similar manner. The information is stored in different parts of brain that are connected
in a network. It will affect the retrieval if single piece of information is arrived. In a study
conducted by Broom and et..al (2018) it was found that information processing theory uses
different models of processing framework. The first model is serial processing that means one
process has to be completed before starting another. The second one is parallel that states all
processes are involved in cognitive task that occurs at same time. Therefore, it is difficult to
determine whether a process comes in parallel or serial model. This depends on which process is
used to solve task and the amount of practise for doing that task. As said by Abdulrahman and
et.al., (2015) parallel processing is highly used than serial because is focuses on specific task and
skills of a person. For example- a typist will focus on several letters but a novice just focus on 1
letter at a time. On the contrary Mora, Ames and Manson (2016) said that computer information
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processing approach is limited. It will generate information as per data entered in it because it is
based on serial processing while human brain have capacity of parallel processing. Moreover,
humans are influenced by various emotional and motivational factors. This theory is based on
several scientific conditions. Is uses two methods that is qualitative and quantitative. Qualitative
includes development of more effective strategies by retrieving more information while
quantitative means that tasks that involving numbers. Example of qualitative includes measuring
verbal representation of memory.
According to Burford (2017) social content and influences are ignored in this theory. This
is done so that it can focus on internal systemic processes. The information received in this
differs from person to person and situation. It is based on nature and nurture. Nature provides
hardware system for effective processing for getting specific stimuli whereas nurture present
environment that provides stimuli as input. Also, it is based on short and long term memory.
Where stimuli is in putted then brain process it with previously stored information. This helps in
storing it in long term memory.
In nursing practice, this theory is highly used as it provides various types of information
related to care services. It includes promoting health, preventing illness and providing care to
groups, individuals or families. As stated by Katz, Webb, and Committee on Bioethics, (2016)
information processing theory helps in taking decisions by collecting the data. But in social
judgement theory evaluates the idea by comparing the current attitudes of individual. It helps in
identifying their needs and accordingly providing care. This theory is entirely based on
perception of person. With this the change in attitudes of persona is identified that differs in
various situations. Sundberg, Garvare, and Nyström, (2017) elucidated that nursing practise is
based on how effectively decisions are taken by analysing the situation and needs of person. This
will be useful in solving problems. Besides this, as said by LoBiondo-Wood, and Haber, (2017)
identifying care needs is essential as it helps in dealing with different people.
The pros of this theory is that it highlights people through process by looking at how
brain interprets stimuli. This helps in understanding how their brain works. It helps in improving
behaviour of person. Also, it can be combined with other approaches easily. With this, positive
results can be attained. Moreover, it is a combination of both cognitive and behaviour approach.
On the other hand, its disadvantage is that it ignores the crucial factors in human behaviour. The
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factors such as genes, experiences, etc. are not considered while taking decisions. It changes the
behaviour of individuals and their through processes. Besides this, this theory is based on
experiments. It means that scientific methods are used in getting response of stimuli.
For post exposure prophylaxis, this theory will work as decisions will be taken on the
basis of person experience. The person will be provided care by analysing at what stage he or she
has reached. The data collected will show what care and precaution is given to them previously.
Then after that, the information will be processed and decision will be taken. For example- the
person might have given care that has affected his behaviour. So for this, the factors such as
time, person needs, etc. will be analysed. It will help in providing effective care to person.
All the theories are having inconsistencies between them. The decision making theory is
used when a decision has to be made from the information available. But information processing
theory first input data and then process it to make decision.
Expected utility theory is proposed by John von Neumann and Oscar Morgenstern with the help
of book which was economic behaviour and theory of games. As per (Moscati, 2017), evaluation
of impact of medical intervention is the crucial part of nursing practice because it derives
behaviour of people in risky situations. In this theory, the author focused on prediction by
concerning preferences and health outcomes related to decision making in specific emergency
scenario. In accordance to research it is the process which rely on different medical treatment
reliable for PEP and their effectiveness for certain case. Medical treatment and their outcomes
can be predicted in advance therefore, expected utility theory focuses on assumption and
prediction of treatment which helps in seeking consent on different clinical practices for one
emergency situation. It is considered as viable decision making process because it assists in
considering all possible health outcomes which can be result to effective decision making.
However, expected utility theory is effective of nursing practices for post-exposure prophylaxis
because it helps to make decision by considering views on information given by service users
(LeGrow and Espin, 2017). It is the process which is risky but on the other hand safe of
managing healthy outcomes in emergency situations. Moreover, expected utility theory is based
on risky choices which are framed on hypothetical assumption considering preferences of service
users but is effective as it reflects healthy outcomes and effective decision making of nurses in
uncertain and emergency situation like PEP. Expected utility theory is expected to be of
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immense help in today’s world of uncertainty. The present section is to relate the chosen theory
of expected utility onto a given nursing practice of PEP. This is basically to take effective and
relevant decisions for the prevention of infections in people who are already exposed to HIV
(Rabin, 2013).
In this context, the expected utility theory is likely to make efficient decisions by the
nurses as a way of assisting the patients in preventing from being infected. Although, it is only
being uses at emergency situations and thus requires specific attention of the nurses to avoid
making any critical choices that are uncertain in terms of preventing the infection. The expected
utility theory is with a special concern of increase the utility of an outcome that in turn in the
risky situations of PEP nursing practice (Starmer, 2010). This presents a choice to the nurses to
choose from the best possible measure to fulfil their main agenda of preventing the disease. PEP
is also required to be done within a time lapse of 72 hours, soon after getting exposed to HIV.
This is for instance of a PEP treatment that has some major number of side effects and thus needs
to done in a proper manner. Although, nausea is the most common side effect that can also be
treated and do not lead to any life threatening aspect (Felder and Mayrhofer, 2017). A proper
implementation of this theory also helps in a structural monitoring of health by the nurses and
other professional bodies treating PEP where it reflects as a guide to create a reinforced bridge of
decisions taken up by the management. It together acts as an analytical quantitative framework
by discoursing upon the possible outcomes of an undertaken action. However, there should be
certain variables chosen to test upon the validity of the undertaken decisions (Levy, 2016). Thus,
it can be said that expected utility theory is apparent to help in framing pertinent decisions under
risky situations. In addition, this theory is depended on hypothesis of what if which can be risky
for decision making in post-exposure prophylaxis treatment which is emergency situation. This
helps the health practitioners in making decision which is based on assumption but is effective as
it based on individual knowledge, experience and learning in particular field. Expected utility
theory is effective of nursing practices because in this, the health practitioners are focused on
collecting persuasive information on the basis of prediction and hypothesis with concern of
service users (Bombardini and Trebbi, 2012). The theory is focused on prediction and
assumption over individual choices in uncertain situation of post-exposure prophylaxis. It is the
situation of emergency and therefore it is situation in which health practitioners are bound to
make quick decision with 72 hours.
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The major complexities, contradictions and inconsistencies between the Expected utility
theory, Cognitive continuum theory and information processing theory managing decision
making for clinical practices in case of post-exposure prophylaxis. Like, the Cognitive
continuum theory implements the use of complex procedures and facts of making decision which
increases the chance of errors in decision making which can be risky for nursing practices but on
the other hand, implementing this theory helps nurses in evaluating best and reliable decision
which is anyway beneficial for service users, diagnosis management and other clinical practices.
In case of Expected utility theory the major complexity is the evaluation of information because
with the use of this theory the health practitioners are more focused on making quick decision on
the basis of prediction and hypothesis on whole scenario. Nevertheless, as per (Dowding and
Thompson, 2017), it is the theory which is most used for managing clinical practices during post-
exposure prophylaxis because it is enables preferences of services users over different ideas of
medication by comparing related clinical scenarios. The information processing theory on
nursing practices comes with complexity which is exploring possible benefits of implementing
connectionist’ model, which leads to problem in transmitting current data base, but it is
considered as effective theory for managing nursing practices as it provides stepwise process in
one sequence which enables effective communication between service provides and user (Bjørk
and Hamilton, 2011). Moreover, it assists on responding to problems in sequential process which
manages shortcomings and loopholes in decision making for post-exposure prophylaxis.
CONCLUSION
From this theory, it is concluded that there are various decision making theories that have
been covered in this report. It consists of information processing, social judgement and cognitive
continuum theory. In addition, pros and cons of each theory have been discussed. All these are
explained with respect to how it is used in nursing practice of post exposure prophylaxis. This
will help in taking effective decision by considering various factors. Also, it improves behaviour
of individual and helps in providing effective care to patient.
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