Decision Making Models in Nursing

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Decision-making is very crucial in nursing practice. The Nursing and Midwifery Council identifies the professional responsibility in the code of Professional Conduct (NMC, 2002). Nurses are expected to be responsible for their decision-making and planning appropriate care for their clients (NMC, 2002). This responsibility results to positive outcome in a professional and organizational level. It is very important for nurses to make an appropriate decision in what caring actions to use and to which patients as emphasized by Sackett et al (1996) on evidence-based practice in health care.

Discussion Theories of Decision-making There are several theories regarding decision making in the healthcare settings. According to McGrew and Wilson (1982), it is essential to have models or concepts in the attempt to make an explanation. This serves as a starting point in deriving a decision. The Analytical Framework Fonteyn and Ritter (2000) suggested that a set of rules and principles are often expressed in information-processing terms in which the decision maker is set to follow these rules.

In this model Fonteyn and Ritter (2000) explained that through education and experience, the individual stores important information in his or her memory which results to effective decision-making by retrieving the information stored in case problem occurs. In addition, Carroll and Johnson (1990) suggested an alternative information-processing model that will draw around sequential stages. These stages are flexible and focus directly on decision-making.

The models they suggested (Carroll and Johnson, 1990) requires recognition of the situation, how to formulate an explanation, how to alternatively create other explanations, how to search for information that clarifies choices or judgment in action and feedback. This model is considered by Bryans and McIntosh (1996), and Kennedy (2002) as applicable in decision-making in the community nursing. The Intuitive Framework Intuition in nursing is regarded by Carper (1978) as an alternative explanation for how nurses make decisions.

Intuition is defined by Benner and Tanner (1987) as understanding without rationale. In its abstract sense Pyles and Stern (1983) described it as a gut feeling, an insight, and an instinct or a hunch. Buckingham and Adams (2000b) and Cioffi (1997) explained intuition in the term of heuristics referred to as the rule of thumb. In this model, strategies used by decision makers are created only on certain cues that are identified in huge amounts of information, and suggest that this is based on past experiences (Cioffi, 1997).

Nurses use neither the analytical nor the intuitive models in decision-making in the nursing practice, and knowledge and experience is a significant influence in decision-making (Fleming and Fenton, 2002). Theoretical knowledge is the rules, principles and practical knowledge gained from experience (Benner, 1984). Luker and Kenrick (1992) proposed that nursing knowledge is prepared through clinical decision-making. Their research identified that clinical decisions were learned through knowledge based on study and tested hypothesis, knowledge based on practice and of nursing experience and knowledge that is common sense and up to date.

Thompson (2002a) found that in order for the decision to become successful it needs to incorporate elements of available resources, the patient’s informed values and the research knowledge that will support the success of the decision. Conclusion Clinical decision-making is an important part of the Nurses role. Nurses, who can identify the different models of decision-making in clinical practice lead to positive patient’s outcome. In addition, the nurse can identify any knowledge and skills deficits and plan strategies to improve nursing care for a more reliable and positively viewed health care organization.

References

  • Benner, P. (1984). From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Addison-Wesley, MA.
  • Benner, P. & Tanner, C. (1987). Clinical judgement: how expert nurses use intuition. American Journal of Nursing 87, 23–31.
  • Bryans, A. , McIntosh, J. (1996) ‘Decision making in community nursing: an analysis of the stages of decision making as they relate to community nursing assessment practice’. Journal of Advanced Nursing, 24: pp. 24-30.
  • Buckingham, C. D. & Adams, A. (2000). Classifying clinical decision making: a unifying approach. Journal of Advanced Nursing 32, 981–989.
  • Carper B (1978) Fundamentals patterns of knowing in nursing. Advances in Nursing Science. 1, 1, 13-23.
  • Carroll, J. S. , Johnson, E. J. (1990). Decision research: a field guide. Newbury Park California: Sage.
  • Cioffi, J. & Markham, R. (1997). Clinical decision-making by midwives: managing case complexity. Journal of Advanced Nursing 25, 265–272.
  • Flemming, K. Fenton, M. (2002). Making sense of research evidence to inform decision making. In Thompson C, Dowding D (Eds) Clinical Decision Making and Judgement in Nursing. Edinburgh, Churchill Livingstone.
  • Fonteyn, M. E. and Ritter, B. J. (2000). Clinical reasoning in nursing. In J. Higgs, & M. Jones (Eds. ), Clinical reasoning in the health professions. Oxford: Butterworth- Heinemann.
  • Kennedy, C. (2002). The decision-making process in a district nursing assessment. British Journal of Community Nursing. 7, 10, 505-512.
  • Luker, K. A. & Kenrick, M. (1992). An exploratory study of the sources of influence on the clinical decisions of community nurses. Journal of Advanced Nursing 17, 957–966.
  • McGrew, A. Wilson, M. (1982). Decision Making. Approaches and Analysis. Manchester, Manchester University Press.
  • Nursing and Midwifery Council (2002). Code of Professional Conduct.
  • London, NMC Pyles, S. H. & Stern, P. N. (1983). Discovery of nursing gestalt in critical care nursing: the importance of the gray gorilla syndrome. Image: Journal of Nursing Scholariship 15, 51 58.
  • Sackett, D. et al (1996). Evidence based medicine: what it is and what it isn’t. British Medical Journal. 312, 7023, 71-72.
  • Thompson, C. & Dowding, M. (2002). Clinical Decision Making and Judgement in Nursing. Churchill Livingstone, London.

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