Part 1 (1000 words)
Discuss two decision making theories you have covered in your tutorials for this topic. What are the identifying features of the theories? How do they develop in nurses? When would you chose to use one theory over another? What are the strengths and limitations of these theories? You must support with relevant, current literature and demonstrate a link to nursing throughout.
Part 2 (1500 words)
Consider a patient you cared for during your recent 6-week PEP block for NURS3002.
Outline this patient in no more than 250 words to provide the clinical context for the rest of the paper. Ensure you deidentify the patient and do not use their real name. Discuss their reason for admission and their care needs. Provide relevant medical and social history as required to provide context.
Discuss three issues the patient was facing at the time you cared for them. These need to be issues that you were involved in assessing and managing while on PEP. Be explicit in detailing your role. Discuss why these were issues for this patient, how do they relate to this admission? How did you assess them? Link this to the decision-making theory you used and the clinical reasoning you undertook when assessing this patient.
Discuss how you addressed each of these issues in terms of nursing management and providing care. Again, you need to support with evidence-based literature to support your therapeutic interventions. You need to identify which decision-making theory you used here and how you moved through clinical reasoning to manage the care of this patient.
Undoubtedly, nurses are constantly aware that their choice has a critical impact on patient outcomes. Also, nurses rely on evaluation and use EBP to prove their expertise and the necessary clinical guidance (Evans et al. 2015, p 60). This essay aims to explore the understanding of decision-making theories and their application in clinical nursing practice. Firstly, two decision-making theories that are useful in making clinical decisions will be discussed. It will be followed by a study of the strengths and limitations of these theories. A case study will then be presented from a patient from a recent 6-week PEP block. Finally, a conclusion will be derived regarding the importance of decision making in clinical nursing setup.
The humanistic-intuitive model and the information-processing model are the two decision making theories that have been covered in this essay. Clinical, core decision making models are formats that describe the procedures that people use to make informed choices. They provide a possible structure that separates unpredictable choices into smaller components, each of which can be experimented and approved. There are three huge models in the literature, the humanistic-natural model, the data processing model, and the hypothesis of a subjective continuum (Evans et al. 2015, p 60). The humanistic instinctive methodology emphasizes the individual, passionate and important components of the central leadership. The main focal point of this model is to describe the adjustments in the decision making procedures between an experienced and an inexperienced nurse (Gallagher et al. 2015, p 94). As a beginner, the nurse will use a more efficient and intelligent (as per theoretical concepts) technique to solve by ignoring the situation’s rationale components. Whereas, a specialist or an experienced nurse will make flexible, instinctive solutions that represent the choice for taking peculiarities. There are different written meanings of instinct, but most scholars agree that intuition is phenomenological in the soul and depicted as a sense of knowing something without utilizing any conscious rationale (Evans et al. 2015, p 60).
In the information-processing model the choice is done intentionally and scientifically. They take an arrangement of methods that depict understanding of the hints, speculative design, rapid understanding, and theoretical assessment. Instead of natural methodologies, the data preparation model is constantly defined and is said to apply to all major leadership situations. Correspondence and clarity of choice are the core qualities of this model. Since a regular Nursing professional can outline how they land in decision-making and what factors they consider before making a particular decision, this model is more preferred by the nurses in clinical decision making process (Gallagher et al. 2015, p 94).
The model is an efficient, well - ordered technique using reasonable standards that can be taken up to the moment the choice is made. . It is also called a hypothetical-deductive strategy. The data processing model is a mental hypothesis that is widely used in the consideration of basic Nursing leadership and is presented in a logical way to solve the problem (Tiffen, Corbridge and Slimmer 2014, p 99). Four broad phases of this nursing process such as collecting key clinical data for the patient, creating speculative patient theories, translating initially recorded predictions in the light of temporary theories, and analyzing the choice of factors that were previously used to make a decision, which fits best in the view of the gathered evidence (Johansen and O'brien 2016, p 40). The predetermined knowledge of the situation or circumstance is included in this procedure.
The intuitive model is one of the best models in clinical decision making process in nursing. Intuition is characterized in several different ways, such as "understanding without a reason" or "impression of potential results, consequences and relationships through a method of knowledge." Intuition is related to the ability to perceive hints from the situation. This is the capacity it creates with its involvement in patient supervision in the field of nursing. The basic idea of the intuitive model is that "instinctive judgment differentiates an experienced nurse from a beginner, and an experienced nurse never depends on the logical standards to link their understanding of circumstances to the association with an activity."
Recently enrolled Nurses have limited ability to participate in clinical decision making process but are expected to resolve clinical issues arising on a daily basis only after a short span of time. While many pioneers can adapt to the required condition required by clinical practice, literature statistics prove that that a large number of amateurs nursing personals are not well-ordered. Around sixty percent of the drug errors and adverse events were caused due to inadequate decision making ability of the inexperienced nursing professionals who failed to make correct decisions at the right time (Reem, Kitsantas and Maddox 2014, p 24). Bad choices can cause adverse events and have negative outcomes for patients. Given that decisions made by nursing staff have such high results, it is reasonable to incorporate the decision making theories in actual clinical practice. The information-processing model can be used by nurses who are beginners in clinical decision making. This model required thorough analysis of facts and collect cues from the situation. Also, it helps to arrive at a conclusion after a systematic analysis of facts and information. However, an experienced nurse can utilize intuitive model in clinical practice (Gallagher et al. 2015, p 94). An experienced person can make decisions by subconsciously considering and gathering the data on the basis of his/her experiences of the past. Utilizing these models in the daily decision making process can help the nurses to incorporate them in practice.
Age and Educational Level: Age and the instructive level are the most thoughtful variables of clinical leaders. Information is mostly unclear and difficult to assemble and these factors can simply to be used as actual covenants. Intuition model can be used by nurses having better knowledge and are practicing since a young age (Johansen and O'brien 2016, p 40).
Experience, Knowledge, and Cue Recognition: the basis of primary leadership is knowledge and awareness as informed choices cannot be achieved without a certain level of basic awareness. Learning enables nurses to distinguish between the data signs that identify the issue of choice. If the learning base of the interlocutor is limited or cancelled, fewer warnings will be perceived, and the choice will be based on incomplete data, resulting in worse choices (Johansen and O'brien 2016, p 40). In information-processing model the choice is done intentionally and scientifically which required nursing clinical experience and knowledge.
Complexity: The most important environmental factor of the main clinical decision making is the complexity of the decision task. Multilateral or complex nature of an activity can include any number of variables that extend the intellectual burden on the decision maker (Bratzke et al. 2015, p 44). The most widely recognized factors that increase the complexity are the amount of unnecessary suggestions, rejection signals, and signals that show positive or negative changes or an increase in the number of minor hints (Gallagher et al. 2015, p 94).
Time Pressure: Another factor that prohibits primary clinical management is the pressure of time. Nurses have dealt with the choice of mediation either without time constraints or with limited time. More experienced Nurses have decided to make better decisions when they were self-governing, but under time constrained situations all nurses performed ineffectively (Bratzke et al. 2015, p 44).
From the perspective of nursing decision making theories, it is nothing but strange to imagine how reflections on the choice that nurses are looking for in clinical practice can influence their behaviour. Undoubtedly, some basic elements of the nurse-based confirmation procedure can serve to optimize opportunities (Tiffen, Corbridge and Slimmer 2014, p 99). In particular, the improvement of centralized clinical queries in information-processing model can be conceptualized as a component of evacuating part of the dilemma that encompasses solutions and helps concentrate attention on critical populations, outcomes, medications and the centre of vulnerability (symptomatic, mediation, or prognosis) (Yost et al. 2015, p 98).
Several studies have shown that there were certain variations in decision making by nursing professionals per the field of education and their nation. In connection with the different phases of the main leadership process, clinicians observed that intuitive decision making was not practiced in any of the four phases. Although, information-processing model was utilized by several nursing professionals as it helped to gain information that prepares and distinguishes evidence of problems (Johansen and O'brien 2016, p 40), however; the alternate phases of the decision making process were quite inconceivable. The clinicians were cautious about making any broad conclusions about the variables that are fundamental to the differences in the ownership of those making clinical decisions, but recommended that it is reasonable to expect that "the theories were helpful and allowed the nurses to decide in an informed decision making process (Tiffen, Corbridge and Slimmer 2014, p 99).
The patient, whose name is changed to ensure privacy, is Richard. Richard is a 70-year-old male who was admitted to the hospital with the diagnosis of pneumonia. Richard was diagnosed with dementia three years earlier and his well-being and, health was steadily decreased since that time. His wife Anne takes care of him and gets general help and assistance from her two daughters.
After suffering from a viral disease, Richard developed pneumonia and had dyspnea, high grade fever, and weakness symptoms. He was admitted to an emergency ward, and at that time he was examined by a multidisciplinary team (Reem, Kitsantas and Maddox 2014, p 24). His pneumonia responded well to antimicrobial treatment, and he received health supplements and helps with his ADLs.
He experienced side effects of dysfunction of memory and depression, lack of care, weakness, withdrawal, timing, correspondence and meandering. One of the Nurses in the group protested against him being an outpatient care receiver as she felt that his condition will improve rapidly if he remains in an inpatient unit. However after discussion Richard was discharged home with a promise of regular follow up. His wife helped him with his ADL (Tiffen, Corbridge and Slimmer 2014, p 99). His appetite was decreased and he required help with dressing, showering and other self-maintenance exercises. Anne helped him deal with his decision.
Richard's well-being had improved adequately to allow the treatment group to conclude that he was ready for release from the curative department. Initially, the release plan was clear and was begun by confirmation and was completed by the nursing group that took care of Richard. Richard had to be released home in his own house, contributing to the care of the net. Nevertheless, given his degenerative state and his present state of well-being, one of the Nurses in the group protested against this agreement and concluded that this would be an ideal opportunity to think of the best place to look at Richard as an in-patient (Tiffen, Corbridge and Slimmer 2014, p 99). In the view of his discharge to the recovery specialist and the main care expert, a full case collection and multidisciplinary audit was convened to investigate the release plan (Yost et al. 2015, p 98). Various experts were available: physicians, social workers, a nursing leader, a nurse practitioner, a delegate of the group for psychological health department, a Richard’s record keeper and an SHO.
Each expert introduced the case to them and explored Richard's current state of well-being and help, care and the information he required (Tiffen, Corbridge and Slimmer 2014, p 99). As a result of the his increasing health deterioration, mental health disturbance and requiring help in activities of daily living, it was decided that Richard should not be released at home, but rather a place should be found in a nursing home at emergency medical unit, where he can get the level of support which is considers to be vital to him (Tiffen, Corbridge and Slimmer 2014, p 99). He agreed that a nursing home near his own home would be chosen in order to have the his wife have the capacity to visit him, but the house he found was eight miles from home and when Anne was informed about this, she was worried. She needed Richard at home and insisted she adapt to her proposal (Yost et al. 2015, p 98). She further specified that the cabinet they had offered was not on a seamlessly open course on transportation and would take two types of transport and a lot of time to leave home to visit it. Nevertheless, she was educated that the best place for him is now a nursing home, as his well-being is in danger, and eventually agreed that he would be released in this home later when a room becomes available.
My feelings were particularly compassionate to Anne, who needed Richard to relax in his recognizable home, but also a sense of concern for Richard, his security and well-being and the consequences of his care plan on his wife. Nonetheless, I also felt that she was required to be included in the multidisciplinary team meeting. I also felt Richard had to be advised about whether he likes to be discharged home or not. In spite of a communication gap, there were times when it was compulsory to inform Richard about his environment and conditions, and I felt that somebody have tried to explain Richard about the positive and negative aspects of both the decisions with more clarity. I feel that the multidisciplinary group was working adequately that they were communicating clearly and professionally to the reasoning, however; Richard was not involved in the decision making process. Instead, I felt that they saw him with great regret over the questions he could probably put on the care of the administrations. I also suspected that this was not the best decision in support of such a critical, life changing choice..
The profitable part of the experience included the understanding I gained from the co-ordination between the members of the multidisciplinary team. Each of the experts concerned was ready and diplomatic and keen to hear each other & listen to the meetings of individuals to think about Richard and discuss whys and wherefores of his case and discharge choice (Reem, Kitsantas and Maddox 2014, p 24). It is evident that they all focused on Richard and his wellbeing and his fast recovery, and they also focused on the well-being Anne who was the most important person who cared for him.
In any case, negative parts of this are mostly Anne and Richard's avoidance of the meeting and the lack of consultation from Richard’s general physician or from any person who was in a position to better understand the conditions of his home. I feel that no one could say for sure what the conditions of his home were. In addition, I thought the group had to consider the impact on his wife living without her husband, as it could lead to psychological, social and even financial concerns (Yost et al. 2015, p 98). Although Richard is the prime focus for attention, however; the financial and social regarding the prosperity of their lives may have influenced their decision.
Making an intervention plan for the elderly patients suffering from dementia, of any kind, is challenging, because so many parts of their lives are affected, not just their ability to cope with themselves. The NSF for the Elderly concludes that all considerations for a more affiliated adult should be based on patient cantered approach, addressing individual needs, and pursuing individuals with regard to their social lives and domestic life. In any case, as elderly patients are likely to be dependent on others, examining each of the problems of the patent can be a complex issue requiring rationale decision making (Shaban 2015, p 3). The literature suggests that despite the government's focus and the on-going effort to improve the care for the elderly population, the principles of clinical decision making in this area are not yet equal to what they should be (Tiffen, Corbridge and Slimmer 2014, p 99). This recommends that significant changes be made to the ways in which such an individual is thought, as well as to specify the types of choices offered to them.
In the end, I came to realise that this clinical case study is a reminder that it is essential to pay attention to the choice of care and the necessary clinical decision process. Nurses are gradually perceived as prime clinical decision makers in a multidisciplinary healthcare group. Nurses are also expected to use the best evidence available in their judgments and decisions. The quick recognition of hints from a situation before making any significant decision is an important aspect of nursing. While this can be supplemented with clinical experience, learners must have sufficient awareness and knowledge. In addition, we need to understand that only mapping the central decision at the centre of the choice (for example, whether it is a vulnerability for analysis, treatment, or expectation) is essential but is not a condition for deciding whether the data is considered applicable or rejected as insignificant.