Demonstrates complete or considerable understanding of decision making in practice.

According to the professional code of conduct of the nursing and midwifery board of Australia or NMBA, the nursing professionals are accountable for a robust and effective decision making process in the clinical scenario and based on their effective clinical decision making they are responsible for planning and implementing appropriate care for the patients (Nursingmidwiferyboard.gov.au  2018). Now, decision making can be defined as the continuous procedure of effective information collection, interpretation and evaluation based on which the nurse is required to take an evidence-based clinically reasonable  action for the patient. According to Thompson and Stapley (2011, pp. 881-893), Clinical decision making is an integral component of care program or scenario and as a result, it has been discovered to be playing a crucial role in the quality, safety and efficacy of the care that is being provided to the patients. However, it also needs to be discussed in this context that decision making in the clinical scenario is a highly complex phenomenon and it requires critical analytical thinking skills, clinical expertise, knowledge, and skills in order to combine and implement evidence-based practice in the entire process.

Hence undoubtedly, decision making is an extremely important aspect of the care that is provided by the nurses to the patients, similarly it is crucial for the nursing decisions to be accurate, safe and in accordance with the best practice evidence; which often can become a very difficult pursuit for the new nurses to implement in practice. However, there are various decision-making theories and the help of these theories and models can be taken to improve the safety and efficacy of the decision-making process in the care practice. This essay will discuss three decision making theories, their importance and relevance when used in the nursing care scenario, followed by focusing on one decision-making theory and its applicative benefits in the practice scenario, concluding with complexities, contradictions, and inconsistencies between the theories (Shaban 2015, pp. 8-13). Importance Of Decision Making Theories In Nursing Practice Discussion Paper

As mentioned by the Saintsing, Gibson and Pennington (2011, pp. 354-359) in their article, the impact of the clinical decision making is imperative on the care delivery and the professional progress of the nursing professional engaged in the clinical practice. In support, the authors have stated the fact that poor or inadequate decision making by the nurses in a clinical scenario can lead to significant adverse events and can enhance the probability of negative consequences for the patients by more than 50%. In a recent study (Adams et al. 2011, pp. 3-8), it has been discovered that the up to 65% of the adverse events in a clinical scenario that potentially harms the patients are preventable with better, more effective and evidence-based decision making by the nurses. Given the high importance of the process in the care setting, it is very important for the nurses to have a flawless and quick decision-making ability and the decision making theories can be a great assistance to the nurses to acquiring and enriching this ability or professional skill.

Relevance Of Decision-Making Theories In Nursing Practice

The first theory that has been chosen for the essay as a model framework for decision-making process for the nursing professionals includes the information processing theory. This particular theory is also called as hypothetico deductive theory and ever since its introduction in healthcare industry; it has been a dominant approach to the clinical decision-making process with respect to the health sciences (Marcum 2012, pp. 954-961). This theory had been a central component of the Western sciences coined in the late 17^th century. This theory is based on the human judgment and its relation to the reasoning capabilities of a human being. This theory can be defined as the “standard research method of empirical science in, which hypotheses are formulated and tested by deducing predictions from them and then testing the predictions through controlled experiments, hypotheses that are falsified being rejected and replaced by new ones”. One of the fundamental pillars of this particular theory is the incorporation of the process of decision making into a science with systemic, logical identification and evaluation. With respect to the ideas of medicine as a discipline, the process of clinical decision making has always been considered as a scientific pursuit based on logic, critical analytical thinking, evidence and knowledge (Ammenwerth et al. 2011, pp. 25-38).

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As mentioned by Thompson, Moorley and Barratt (2017, pp. 1097-1110), scientific reasoning is based on logical development of theoretical knowledge and its application against the empirical data. Hence, in simplification, it can be stated that application of this particular theory provides the nurses with the opportunity to take the best alternative decision among a few option depending upon the rationality of the decision and its empirical precision. This theoretical model is divided into four interrelated stages, cue recognition, hypothesis generation, cue analysis and evaluation of hypothesis. The first stage of the theory is based on the preamble or first initiative of the decision making process that the nurse is going to engage in, followed by the second stage where the nurses are supposed to develop a tentative hypothesis based critically on the specific information that has been generated from the information collection process. In the next stage the hypothesis will be tested on the basis of cues collected and in the final stage the decision will be evaluated for both pros and cons to arrive at the best possible decision (Marcum 2012, pp. 954-961).

There have been arguments and speculations with respect to the efficacy of this model as a decision-making framework, however, there has been empirical evidence justifying the use of this particular theory as the most plausible decision-making framework. For instance,   decision in a real-world practice scenario often relies on not just the experience and skills of the decision makers, a scientific and clinically reasonable decision making process relies on the factual data and information shared by the patients as well, along with the previous knowledge of the nursing professional (Pearson 2013, pp. 212-215). For instance, many nursing credibility studies have focused fundamentally on the hypothetico- deductive approach to decision making with respect to medication management, quantitative client assessment and even in care planning as well. Hence, this theory is one of the easiest and most effective theories to be implemented in the clinical practice by the nurses. However, a few limitations of this theory includes wrong hypothesis leading to fundamentally inaccurate outcomes (Lin 2016, pp. 1144-1154).

Three Decision-Making Theories And Their Importance In Nursing Care

The second theory that needs to be used in the decision-making models for nursing can be the cognitive continuum theory. This theory can be considered as a systematic and scientific model combining human judgment with cognitive processing. This theory was introduced by Hammond in the year of 1981 as a descriptive theory illustrating the relation between human judgment and cognitive. According to Macken and Hyrkas (2013, pp. 987-988, it can be mentioned that the any judgment is the collaborative function including task properties and cognitive processes. This theory has six broad modes of decision making on the basis of cognitive continuum, and the cognitive continuum, ranges from intuition to analysis. Two of the continua are cognitions and judgments, and each of them has lower to higher arrangement starting from intuition to judgment, ill-arrangement to well. Similarly, this theory also includes 3 different form of cognition like analysis, Intuition and quasi-rationality. Considering the effectiveness of the theory with respect to the clinical decision making scenario, it has to be mentioned that Hammond has provided a general explanation linking the concept of the tasks and the modes of the cognition and the impact of the same on the decision making (Dhami & Thomson 2012, pp. 316-326).

In the context of the cognitive continuum theory, the definition of the intuition is the immediate action of a human being while with the unconscious mind with lack of awareness, self-confidence and cognition. The second mode of cognition is the analysis, which can be defined as the conscious and consistent process that provides high cognitive control, slow data processing, high conscious awareness, task-specific organizing principle and high confidence in the method. The third dominant mode of cognition is the Quasi-rationality, which also is the central element of the concept of a cognitive continuum. Many authors have considered the idea of Quasi-rationality to be the amalgamation of both intuition and analysis and the origin of the cognitive continuum theory is based on the social judgment theory (Pretz, & Folse 2011, pp. 2878-2889).

Considering the applicative benefits of the theory in the nursing scenario, evidence can be found from the fact that in the most of the cases the nurses utilize the cognitive continuum theory is the most applicable theoretical concept, especially for the medication management. along with that the cognitive continuum process provides the nurses with the opportunity to develop different skills for acquiring decision making proficiency, even in the crucial or critical scenario. For instance, the study by (Dhami & Thomson 2012, pp. 316-326) stated, Cognitive continuum is a tool provided to the nursing professionals to evidence based transparent decision making . It can mentioned in this context, that the introduction of the evidence based literature in the nursing practice scenario, the nurses are increasingly being encouraged to incorporate a analytical approach in their professional responsibilities including their decision making abilities. As the cognitive continuum theory is based on a quasi rationality of both analysis and intuition, this theory can serve as a effective framework so that they can incorporate analytical aspects along with intuition or knowledge while taking any clinical decision in the care scenario. However, there are certain drawbacks of application of this theory in the clinical decision making as well. First and foremost, it has to be mentioned that in order to be able to utilize this particular theory without any error the nurses require proper training and education. Along with that, it cannot be ignored in this scenario that cognitive continuum theory is a highly complex nursing theory which has multiple overlapping elements and it requires a significant amount of time for the nurses to apply this particular theoretical model into practice without prior training (Tiffen, Corbridge  & Slimmer 2014, pp. 399-405).

Information Processing Theory: A Dominant Approach To Clinical Decision Making

The third and the final theory that is going to be discussed in the assignment is the social judgment theory, which bears a strong connection with the cognitive continuum theory. This theory can be defined as the self-persuasion theory proposed by Carolyn Sherif, Muzafer Sherif, and Carl Hovland. In the description of the theory, it can be stated that the social judgment is the meta theory that attempts to explore the human judgment with respect to the cognitive perspectives of the human beings. Researchers are of the opinion that social judgment theory can be very easily applied to the construct of the medical judgment (Payne 2015, pp. 223-228).

Elaborating more, it has to be mentioned in this context that the social judgment theory is intricately associated with lens model of cognition. In here the nursing professional has the choice to differentiate a true state and a judged state of the patient’s condition. This theory allows the nursing professional to draw a parallel of the perceived state of condition of the patient, followed by which the nursing professional will need to collect information cues and perform analysis of the cues based on evidence and cognition and arrive at the judged state of the patient. The nurse will take the clinical decisions based on the judged state of the patient and will need to take actions based on the judged state of the patient (Evans 2008, pp. 255-278). Along with the decision making process in the clinical scenario, this theory has been considered to be the most effective and applicable in educational intervention as well. There are a few drawbacks of this theory as well; first and foremost, this there is also time-consuming with extremely interrelated and interconnected steps which can be extremely difficult for the nurses to implement on their own without prior knowledge or training. Hence there is need for proper training and educational intervention planned and implemented in the nursing courses so that the nurse can take the assistance of social judgment theory in decision making processes. Along with that, the judged state of the nurse of the condition of the patient has to be based on the clinical expertise and evidence based practice, for novice nurses, any error in the identification of judged state can lead to faulty decision making process as well. Hence the need for proper skills on evidence based practice and critical analysis combined with proper training and guidance is required to successfully apply this theory into practice and be able to avail positive outcomes (Johansen & O’brien 2016, pp. 40-48).

Cognitive Continuum Theory: A Systematic And Scientific Model For Decision Making In Nursing

For my personal experience, I would like to implement the information processing theory as the decision making model in the practice scenario and there are a variety of different contributing factors behind the choice. First and foremost, this theory is one of the most pioneer theories on decision making and had been utilized abundantly by the health care professionals in the clinical setting. Importance Of Decision Making Theories In Nursing Practice Discussion Paper The information processing theory is the foundation behind the Hypothetico deductive theory. This theory is based on data stored in human brain as the memories. Along with that, it has to be mentioned in this context that the impact of the stimuli on the memory chunks is the trigger that recognizes the similar patterns to fit the person’s personal experience. Hence, this theoretical model will not only benefit the nurses in the process of evidence based decision making but it also helps in avoiding past mistakes or errors from reoccurring (Payne 2015, pp. 223-228). Another very important fact is that this decision making model or theory is based on specific stages that are systematic and logical. This step by step procedure is easier to be followed in the clinical scenario and can be successfully implemented even by the novice or newly graduated nurses like myself.

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Along with that, the decision making process with respect to this theory is based on developing a hypothesis which is derived from a thorough assessment of the patient situation (Marcum 2012, pp. 954-961). Followed by this step the nurses will be required to be analyze the care cues collected and among the alternative options of decision the most plausible or best fit decision is chosen by the nurse. Hence, it can be mentioned that the decision making model can be very easily aligned to two critical nursing care processes, evidence based practice and the clinical reasoning cycle. Hence, this is the most fit nursing decision making model that can be used in the clinical practice scenario and I will be utilizing this theoretical model or framework in my professional practice or PEP.

In order to compare and contrast all three theories that have been discussed in the essay, a few inconsistencies and contradictions can be found. Focusing on the information processing theory or the hypothetic deductive model of decision making, it can be stated that it is the simplest and easiest decision making model with only 4 clear steps to the decision making process. It also needs to be mentioned here that this particular model of decision making is also associated with a problem solving approach to the decision making process based on logical and systematic integration of experience expertise and analytical power. However the only drawback of this theory had been the fact that the hypothesis of the nurses in this context is based on their previous knowledge and expertise, which can be flawed (Thompson, Moorley & Barratt 2017, pp. 1097-1110). On the other hand, the cognitive continuum theory provides a completely different take to the decision making process. This theory provides a rather complex conception of intuition, analysis and Quasi-rationality having a significantly profound role in decision making of individuals. However, the inconsistencies of this theory are the fact it has 6 interrelated decision making modes and three elements of cognitive continuum. Although, this theory provides a modern and relevant take to the decision making process involving analytical data, this is a rather complex model with contradictions and complexities that can serve as barriers in the application in the clinical setting. Lastly, the social judgment theory is more related to the cognitive continuum theory with respect to social judgments which are applicable to the clinical scenarios. One of the most poignant and significant benefits of this particular mode is the integration with the lens model. This theory provides a parallel real state and judged state analysis of the problems or patient situation that the patient is in. However, this is also based on the experience and judgments of the patients and can be biased and flawed based on the level of knowledge and expertise of the nurse (Saintsing, Gibson & Pennington 2011, pp. 354-359).

Benefits Of Using Decision-Making Theories In Nursing Practice

On a concluding note, decision making is a fundamental requirement of the everyday professional responsibilities of a practicing nurse. There is a myriad of different scenarios and situations where a nursing professional will require to take clinical decisions that are both evidence-based and in accordance with the different practice standards and protocols. Along with that, nurses are also required to ensure that the clinical decisions taken by the students are safe and can effectively address the needs and requirements of the patients and do not have any potential to cause harm to the patient under any circumstances. As mentioned above the need for optimal decision-making abilities in a nursing professional is acute, as the lack of it can easily lead to various errors in the clinical scenario potentially harming the patient. The decision making theories or models can be potent tools for the nurses to engage in optimally safe and relevant decision making. Among the three different theories that have been discussed in the essay each had particular benefits and drawbacks. However, the most plausible and easy to implement model identified for my professional practice or PEP is the information processing theory, which provides a simple systemtic model involving four steps to effective and evidence based decision making in nursing practice.

References:

Adams, JA, Bailey, DE, Anderson, RA & Docherty, SL 2011. Nursing roles and strategies in end-of-life decision making in acute care: a systematic review of the literature. Nursing research and practice, 2011 pp. 3-8.

Ammenwerth, E, Rauchegger, F, Ehlers, F, Hirsch, B & Schaubmayr, C 2011. Effect of a nursing information system on the quality of information processing in nursing: An evaluation study using the HIS-monitor instrument. International journal of medical informatics, 80(1), pp.25-38.

Dhami, MK & Thomson, ME 2012. On the relevance of Cognitive Continuum Theory and quasirationality for understanding management judgment and decision making. European Management Journal, 30(4), pp.316-326.

Evans, JSB 2008. Dual-processing accounts of reasoning, judgment, and social cognition. Annu. Rev. Psychol., 59, pp.255-278.

Johansen, ML & O’brien, JL 2016, January. Decision making in nursing practice: a concept analysis. In Nursing forum (Vol. 51, No. 1, pp. 40-48).

Lin, HC 2016. Impact of nurses’ cross?cultural competence on nursing intellectual capital from a social cognitive theory perspective. Journal of Advanced Nursing, 72(5), pp.1144–1154.

Macken, L & Hyrkas, K 2013. Contemporary issues in nursing: patient safety, decision?making and social support in challenging economic times. Journal of nursing management, 21(8), pp.987-988.

Marcum, JA 2012. An integrated model of clinical reasoning: dual?process theory of cognition and metacognition. Journal of evaluation in clinical practice, 18(5), pp.954-961.

Nursingmidwiferyboard.gov.au. 2018. Nursing and Midwifery Board of Australia – Professional standards. [online] Available at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx [Accessed 3 Jun. 2018].

Payne, LK 2015. Toward a Theory of Intuitive Decision–Making in Nursing. Nursing science quarterly, 28(3), pp.223-228.

Pearson, H 2013. Science and intuition: do both have a place in clinical decision making?. British Journal of Nursing, 22(4), pp.212-215.

Pretz, JE & Folse, VN 2011. Nursing experience and preference for intuition in decision making. Journal of clinical nursing, 20(19?20), pp.2878-2889.

Saintsing, D Gibson, LM & Pennington, AW 2011. The novice nurse and clinical decision?making: how to avoid errors. Journal of Nursing Management, 19(3), pp.354-359.

Shaban, R 2015. Theories of clinical judgment and decision-making: a review of the theoretical literature. Australasian Journal of Paramedicine, 3(1) pp. 8-13.

Thompson, C & Stapley, S 2011. Do educational interventions improve nurses’ clinical decision making and judgment? A systematic review. International Journal of Nursing Studies, 48(7), pp.881-893.

Thompson, S, Moorley, C & Barratt, J 2017. A comparative study on the clinical decision?making processes of nurse practitioners vs. medical doctors using scenarios in a secondary care environment. Journal of advanced nursing, 73(5), pp.1097-1110.  Importance Of Decision Making Theories In Nursing Practice Discussion Paper