Clinical and Ethical Decision-Making Models - Essay Example

Clinical and Ethical Decision-Making Models Abstract The aim of the work is to consider the nursing case study, and to make the best decision in the critical situation described through the use of one of the decision-making models. The key words are: decision-making, model, cognitive continuum model, intuitive model, outcomes, values, probabilities. Nursing case study The case study to be considered in this work is very complex and involves a number of ethical and clinical issues for the discussion. However, the case will be looked from the viewpoint of nursing decision-making. It should be noted, that in nursing decision-making process several decision-making theories can be applied, and here we will try to make use of Hammond's stages of cognitive analysis, which he has shaped into the form of Cognitive Continuum Theory, and Benner's Intuitive Approach, which is used by nurses rather frequently. The combination of these two theories is implied here by the suggestion that intuitive and cognitive approaches will ultimately lead to the most optimal decision in the situation described; we often use our intuition and experience to judge on the actions and take decisions, this is why our cognition, and especially in nursing practice, will always work together with intuitive ideas. Based on the Hammond's cognitive theory, and the stages of decision-making described there, it is possible to see the situation as follows. I stage. Identification of potential choices of action. First of all, the amount of information John has at his disposal does allow him to make reasonable steps in the attempt to protect young mother on the legal basis. The young lady has full right to sue the 21-year-old father of her child for physical abuse; moreover, the event took place in public with lots of witnesses. The teenage mom states that her mate takes drugs on the daily basis. In relation to John the moral and mental stress has caused him chest pain, and taking into account he has already had serious problems with his cardio health, the whole situation won't work for his benefit. From the ethical and nursing viewpoint, he may leave the idea of interrupting with the case, which will save his health in normal state and won't let him suffer physically either of heart problems, or from the threats of the young boy, who is unpredictable in his actions. On the other hand, his inactivity makes the life of teenage mother and her child indefinite and puts it under threat. Thus, there are the two principal outcomes and choices, which both have their advantages and disadvantages. Both decisions include physical and ethical issues. II. Assign values to possible judges/ outcomes. Both outcomes have their values. The value of John staying indifferent towards the course the events take is in his care for his health. This value is important from the nursing viewpoint, but from the ethical and human viewpoint it is not perfect. Ethics (and intuition is also involved here) suggests, that the teenage mother needs assistance, moral, physical and legal. Her parents are able to provide her and her child with everything necessary and let her finish her higher education; but the threat on the side of the young father should be eliminated. The value of John taking care of the situation is in saving the life of the young girl, trying to explain to her the values of her coming back to parents and continuing education. It also involves the threat for John's health, but this threat can be lessened through John involving legal assistance (police) into the resolution of the issue. It is clearly seen, that the case cannot be solved without police interruption, but as the teenage Mom refused to press charges, the whole case becomes even more complicated. Thus, the value of the second outcome when John will have to rule the whole situation and take the decisions as for what legal assistance should be addressed in the case possesses more values from the nursing and ethical viewpoints in relation to the teenage Mom, though less ethical and nursing values in relation to John himself. III. Assign probabilities to uncertain events. There are a number of uncertain events in the present case, and this is why it has been stated that intuition is necessary to make the proper option. The principal uncertain event is whether the young man will realize his threat for life of teenage Mom and her child. Based on the fact, that he has already applied physical force towards the girl, the probability of more serious consequences is rather high. In addition, the young man is stated to take drugs on the regular basis, which makes him emotionally unstable and thus able to commit any dangerous actions. Another probability to be discussed is whether there is risk of John having another heart attack. The case study notes, that he used to strictly compliant with all the demands of his doctor. Moreover, the previous myocardial infarction has not caused him any serious residual damage. In the clinical perspective, even when the consequences of infarction for the patient are minimized, strict control of the further lifestyle should be provided. The break of the previous schedule and reverting to the old habits, in addition with the statement of the new chest pain as a result of moral stress, makes it probable that if John does not eliminate the stress, he may have another heart attack. IV. Combine values with probabilities and evaluate the outcomes. In the desire to come to the one and the best decision, it is essential to compare and relate the values and probabilities to the outcomes. The probability of the young man killing his mate and her child makes the decision for John to interrupt into the case valuable; however, another probability is involved here, and this is the probability that he may have another heart attack; the probabilities seem to be equal, and if one of them increases the value of this decision, another one absolutely neutralizes it. The negative aspect of the heartache probability may be decreased through the use of legal assistance; though the probability that the teenage Mom would finally agree to press the charges is not very high. However, taking into account that she has agreed to move into her parent's house, she may change her mind, and thus John will have to apply additional efforts to sue her child's father which will eliminate the threat of her being hurt and the threat of John's another infarction. From the ethical viewpoint John is not able to let the case take free course, and is to control every step of both the teenage mother and the child's father. Moreover, he has also to give the young girl understanding that she has to study, though this may also negatively impact his health. The outcomes connected with John's inactivity give him full chance to avoid any heart attacks; but from the nursing viewpoint this decision will be a complete failure to resolve the situation, bearing in mind that both the probabilities of the child's father killing his child and the girl's coming back to him under his threats are high. V. Select the best option. The best option here is to be active; this option may be taken as beneficial for all sides of the conflict; there is one more probability which has not been discussed earlier, and which is more related to the use of the intuitive decision-making model – if John decides to be inactive and this inactivity causes serious fatal consequences for the teenage mother and her child, this will be a serious moral stress which may result in heart attack. This is why it is essential to persuade the young mother to live constantly with her parents, continue her education and in case she is seriously threatened by her ex-mate, she will have to press charges against him. Conclusion The use of the various clinical and ethical decision-making models is appropriate when the situation is thoroughly considered and there is no need in taking immediate crucial decisions; on the other hand, even in the critical situations, when the mind works fast, we still go through the similar decision-making processes and weight all probabilities and outcomes with their values, but it happens simultaneously and much faster than usually. In both clinical and ethical perspectives such models are extremely useful, because they allow seeing the situation from different angles. In the case described there were two principal outcomes considered; the probabilities were connected to those outcomes as well as the values. The analysis has been conducted through the use of cognitive continuum model involving certain assumptions of the intuitive decision-making structure. The basis for such choice lied in understanding that intuition often works effectively in clinical perspective, though in combination with cognitive mind it produces the best results. References Hammond, Kenneth R. (1999). Judgments under stress. Oxford University Press. Read More