Application of Intuition Decision-Making Theory in the Nursing Care Practice - Essay Example

Running Header: Application of various decision making theories in the nursing care practice Application of Intuition decision making theory in the nursing care practice Author’s Name Instructor’s Name Course Number Date of Submission Introduction Nurses are faced with increased demands regarding making decisions of care on a daily basis. However, the process of making a choice which is the essence off decision making is a complex one (Levett-Jones and Hoffman, 2013, 2). Based on O’Neil et al (2005, pp.66) the complexity of clinical decision making calls for broad knowledge base as well as access to reliable information sources while working in a supportive environment. The decisions made by nurses in giving care largely influence their effectiveness in clinical practice while making an impact in the lives of patients as well as experiences with healthcare without regard to where the nurse is practicing in. It is worth noting that decision making by nurses is a complex process that requires making choices between limited options while the decisions have multiple foci for instance diagnosis, interaction, intervention and evaluation in changing contexts with a diverse knowledge base and with multiple variables and various individuals involved. In addition, such decisions involve situations of uncertainty with scarcity of relevant information (Banning, 2008, pp. 187). For this reasons, decision making models are found necessary in guiding the decision making process. Thus, adequate knowledge on nurse’s decision making is vital while knowing the nurses decision making models or theories is vital tool in facilitating the learning and development of decision making skills by the nurses. Thus, this paper studies intuition as a decision making theory in a bid to explain how nurses make decisions in their practice. In so doing the paper will critically examine the theory in terms of its merits and demerits before discussing the complexities, contradictions and inconsistencies associated with the theory with supporting counter arguments. Finally, the paper will offer practical applications of intuition theory in nursing as the most appropriate decision making theory in nursing practice by offering real life application examples. Intuition theory As stated above, nurses are on a daily basis involved in making decisions concerning patient care which are aimed at making a difference in patient outcomes. Many decisions made are linear in nature involving a set process of assessment, knowledge, action and evaluation. This is a linear process of thinking. However, decisions in the nursing practice vary since they invariably involve complex elements which call for analytical as well as non-linear thinking process (Levett-Jones and Hoffman, 2013, PP. 2). Intuition theory thus comes into play within the non-linear thinking process where it plays an integral role. In this regard, nurses use intuitive knowledge through drawing on experiences, sensing of subtle qualitative changes, linking of perceptions from the past with what is expected to happen in the future and hence taking an appropriate action. This is what is called intuition. Simply put, intuition is the human ability for knowing or doing without adequate reasons. It is a way of recognizing of the truths without rational thinking (Thomson, 2014, p. 35).The intuitive-humanist model’s application in nursing decision making has been greatly researched by Levett-Jones and Hoffman, (2013, pp. 2). There have also been several definition of intuition. For instance, it has been defined as understanding without rationale (Benner and Tanner, 1987, p.23) or a perception of possibilities, meanings and relationships by way of insight as stated by Gerrity (1987, p.63). The essence of intuition is in the ability to recognize patterns of cues which according to Levett-Jones and Hoffman, 2013 (2013, p. 7) develops with experience in the management of patients in the nursing field. On the other hand, Thompson (p. 1224) states that the basic idea of the intuitive humanistic model is that intuitive judgement distinguishes between expert and novice in that the expert no longer relies on analytical principles in connecting his understanding of the situation to the appropriate action. Intuition theory thus makes sense since it not only describes what occurs but also finds reason for making a certain decision according to Gobet & Chassy (2008, p.30). Intuition also involves prediction of the problem, analysis of inferences and provision of information regarding counter inferences, explanation of reasons and hence enabling making of informed decisions through its numerous processes according to (Benner, 1987, pp.25). As stated above, the ability of a nurse to apply intuition is based on their experience which may result from participation in society or past experiences of similar situations thus enabling the nurse to analyze symptoms and hence determine the best medication on the basis of intuition. According to Gerrity (1987, p.63), it would be hard for a nurse to determine what to do without intuition. For a novice nurse however, analytical principles are the guiding principles in decision making. Use of intuition allows nurses to look at the problem as a whole without breaking it into its constituent parts as advocated by other analytical models and hence using intuition, nurses are able to arrive at decisions fast. Thus, the greatest advantage of the model lies in its allowing for speedy and quality decision making (Shaban, R.Z 2005, pp. 13). This is because in the complex decision making environment discussed above, intuition is able to rely on past experiences to arrive at a judgement without need for analytical procedures. Through past experiences, nurses using intuition are able to promptly arrive at decisions in similar situations. This is important since as stated above, nurses usually make decisions under conditions of uncertainty and risk as stated by Light hall and Vazquez-Guillamet (2017, p. 156). For instance, when an unknown accident victim arrives at the hospital, there is little data available concerning the individual while the nurses must act fast to save the victim’s life. As such, a decision must be arrived at promptly and hence nurses will often apply intuition decision making models (Efken, 2001, pp. 246). Another advantage of intuition lies in the associated application of emotions, its holistic approach to situations and ability to perceive changing scenarios and hence its ability to expand the decision making process by incorporating both memory (experience) and perception (Banning, 2008, pp. 187). Intuition theory has however been criticized for its overreliance on past experiences and perception of a situation. Thus, nurses without experience are not likely to apply the theory in decision making since they don’t have the requisite exposure and knowledge in comparison to their experienced counterparts as stated by Pearson (2013, pp. 212). In addition, overreliance on intuition stemming from such factors as overconfidence, lack of time or even fatigue may lead to undesirable consequences especially for inexperienced nurses owing to making the wrong decisions. Furthermore, Lighthall & Vazquez-Guillamet (2017 , pp. 156) argues that nurses heavily dependent on intuition have knowledge constructs which are only applicable in specific contexts implying that undesirable results may be obtained if intuition is applied in the wrong context. Furthermore, intuition theory has been criticized for ignoring analytical principles and hence its accurate applicability is questionable since the rational for application cannot be tested anywhere. As stated above, there is a wide held view that intuitive theory is based on the nurse’s experiences and career development which is the basis of the theory’s critique (Banning, 2008, pp. 30). The applicability of the theory is somehow possible with experience since as one gets exposed to various experiences in the nursing field, they tend to use intuition more often. This is also true since expert nurses apply not just the linear thinking process in solving complex problems concerning patient care but also intuition. They have an intuitive grasp of the situation at hand and hence are able to see the whole picture and hence reorganize patterns in line with previous experiences. However, it is worth noting that not all experienced nurses are capable of using intuition as a decision making model. Intuition is not another name for experience but experience is its component. Another criticism is that at times the less experienced and novices may still have better intuition in some cases but this may not have much influence on decision making. This is always the case when expert opinion is always taken into consideration ignoring the novice hence making the intuition approach discriminatory. However, where there is cooperation and engagement between novices and experts, this may not necessarily be the case (Gobet and Chassy, 2017, pp. 187). Of late, there has been more collaborative working environment with everyone’s opinion being taken into consideration in decision making in the nursing field. Thus, the argument of experience and expert opinion is not necessarily what the theory entails and hence the theory is not necessarily discriminatory. Applying the intuition theory in nursing practice Based on the discussion above, intuition theory is chosen as the ideal decision making theory for the nursing practice. This is because it is based on generative as well as probabilistic programs and thus makes use of cognitive skills as well as computational variables in influencing the decision making process while providing explanation on why a certain decision is adopted. The theory is ideal for the nursing profession as it supports prediction (Shaban, R.Z 2005, pp. 13). Thus making use of the theory allows nurses to predict what is likely to happen in the future on the basis of the present case based on Gobet & Chassy (2008, pp. 130). For instance, nurses understand that various nursing procedures have to be applied in nursing care and if such procedures are not integrated in a patient’s treatment, then the patient may not get better. In this regard, nurses do not have to use any analytical reasoning in making clinical decisions which saves a lot of time. It is worth noting that nursing decision making processes do not necessarily call for analytical or scientific knowledge and hence the theory’s preferences. Furthermore, it is possible for all nurses whether experienced or novice to apply the intuition theory as stated above unlike other theories. All that is needed is for the nurse to have the intuition to make the right decision. Intuition also involves making of inferences regarding the cases at hand (Banning, 2008, pp. 187). For instance, a nurse by observing a patient will be in a position to make inference on what could be the cause of the patient’s condition (Gerrity, 1987, pp. 63). Though uncertainties may exist for conditions sharing similar symptoms, there are many health conditions where use of inference is appropriate (Thompson, 2014, pp. 35). Nurses will for instance be able to make inference regarding such conditions as malnutrition. Through intuition, the nurse is able to infer some of the causes including poor eating habits, as well as social and environmental causes (Efken, 2001, pp. 246). By understanding the causative agents, the nurse is able to come up with a program to counter this. Intuition is thus helpful in providing solutions for addressing the patient’s condition at hand (Gobet and Chassy, 2017, pp. 25). For instance where a patient has obesity, the nurse through intuition may suggest such solutions as changing the bad eating habits, attending the gym, a walking program among others solutions to effectively deal with the situation(Pearson, 2013, pp. 213). Nurses also employ hypothetical reasoning as part of intuition approach in minimizing the effect of the patient’s condition. This involves weighing options. For instance, suppose the obese patient is given medicine, will it address the problem? What about an exercise program? In arriving at a judgement, the nurses usually bear in mind the causative agent for the condition. Intuition theory also allows the nurse to employ counterfactual inferences in decision making. For instance, for a malnourished child, the nurse would ask such question as what it the mother had some knowledge on nutrition. What if the government had provided a school feeding program for poor children? What if the hospital introduces nutrition lessons for new mothers? Through asking such questions, the nurse is able to decide on the best treatment approach for the issue (Banning, 2008, pp.187). The nurse will also figure out what the case would be the case had there been good feeding and good nutrition. The patient would not be in the hospital and would probably be active in school or at work. Through such intuition, the nurse will be able to make decisions that would address the issue in the entire society for instance by providing information on malnutrition and how to avoid it. Thus through intuition, the nurse is able to explain about the whole issue the patient is faced with. For instance, the nurse is able to explain the causes of malnutrition including how to overcome it (Thompson, 2014, pp. 75). In addition, the nurse is also able to point at those factors that are not likely to cause malnutrition such as gender since malnutrition does not affect a specific gender (Gerrity, 1987, pp. 65). There are obvious reasons that cause malnutrition such as bad eating habits as well as lack of food which may largely be referred as environmental factors. However, the nurse may find it challenging in analyzing reasons that are not obvious in causing malnutrition. However, through intuition, the nurse is able to decide what is right to do in such circumstances. There are other numerous ways in which nurses use intuition in the nursing practice. Through intuition, nurses will be able to solve numerous challenges that patients face by understanding their causes while being able to provide programs for overcoming the issues (Efken, 2001, pp. 247). Patients normally experience differing conditions despite the fact that their causes may be similar since how each patient is affected is dependent on other factors including genetics, emotional and cognitive factors (Gobet, and Chassy, 2017, 15). Thus by using intuition, nurses are able to analyze the varying scenarios thus enabling them come up with the right strategies to mitigate the patient’s situation depending on their unique factors as explained above. Real life experiences in my nursing practice Benner developed the Novice to Expert Model that is based on ascending levels of proficiency. According to the model, one component of the expert stage is working from an intuitive base meaning that experienced nurses are more likely to apply intuition than the novice (Shaban, R.Z 2005, pp. 13). One day I was in charge of flow in the ED. A nurse rolled a patient in one of the trauma rooms’ triage. This to me was a surprise since I had not been informed that any patient needed the room despite the fact that communication between the triage nurse and the flow is very open. On enquiring what was going on from the nurse, I was informed that the patient had complained of chest pain and was in a bad condition and hence had to go to the trauma room as she suspected the patient was experiencing a heart attack. After five minutes, tests were conducted on the patient and they confirmed that indeed he was having a heart attack. I concluded that since the nurse had twenty years of experience, she was able to identify and conclude on what the patient was suffering from through intuition. This was a surprise to me since she even had not done the triage or taken vitals which I would have conducted as I have no such experience and hence has to follow the normal procedures. In another occasion, a fellow nurse told me about an interesting case of a young man who was brought owing to shortness of breath. The patient had a history of asthma and appeared to be having an asthma attack. As such, they administered multiple breathing treatments and steroids to the patient and his situation normalized. However, the nurse was still not convinced that the patient should be sent home though he had no more symptoms. When she told the doctor about her feelings, they decided to do an echo on the patient and true to her suspicion, the patient had an ejection fraction of 35%. He was thus taken to cardiology and hence his life was saved before he had an MI. These are practical cases of how experienced nurses are able to use intuition to make sound judgements regarding patient care something which less experienced nurses like me rarely use. I guess that owing to lack of great intuitive skills, I would had to perform analytical procedures before making such decisions as opposed to the nurses who have a lot of experience and are hence able to use intuition in making accurate nursing judgements. This is in line with Banner’s novice to expert model on more experienced nurses being able to use intuition more than the novice. Conclusion Decisions made by nurses largely influence the recovery process of a patient while they also have a bearing on their profession as nurses. As such, nurses are called upon to employ sound decision making techniques so as to ensure high quality decisions are made. This is the essence of application of various decision making models so as to ensure quality of decisions and hence deliverance of proper care to the patients. In this regard, nurses employ intuition theory as one of the decision making theories as discussed above which act as guidelines for decision making in the nursing practice. Nurses apply intuition theory in arriving at decisions especially when there is scarcity of information and time and with enough experience of past events. Intuition is seen as important as it allows inference while decisions made can be explained and have certainty hence aiming in delivering of quality judgements. Through intuition, nurses successfully identify various patient related issues and hence provide the right intervention programs. References: O’Neill, S, Dluhy, M&, Chin, E2005, Modelling novice clinical reasoning for a computerized decision support system, Journal of advanced Nursing, vol. 49, no. 1, pp. 66-77. Banning, M2008, A review of clinical decision making: models and current research, Journal of Clinical Nursing, vol. 17, no. 2, pp. 187-195. Benner, P&, Tanner, C1987, How expert nurses use intuition, American Journal of Nursing, vol.87, no. 1, pp. 23-31. 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