Decision Making in Practice - Theories, Models and Application to Practice - Essay Example

Name of student Name of instructor Literature Date Decision Making In Practice Introduction Notably, decision-making in nursing plays a critical role in ensuring that the right judgments are made with the objective of providing quality health care services. The professionals in the nursing professionals are expected to make decisions that have a positive impact on the medical field. Judgment in nursing is considered to be a professional choice, but not a task in the real life practice (Brennan and Bakken, 2015, pg. 481). The uncertainties that face the nursing industry can better be addressed using proper decision-making strategies. Based on this premise, the quality of the decisions made is primarily determined by the qualitative judgments of the professionals in the healthcare industry. The stressful moments in decision making arise when the decision makers operate under uncertainties. Besides, having similar goals in decision making among the nursing practitioners is crucial in ensuring that high-quality judgments are delivered. In this case, theories of clinical judgment and decision-making play an instrumental role in providing the basis on which nurses and clinical offers, as well as other healthcare practitioners can make well informed judgments. For this reason, this essay explores different theories that are necessary for decision-making with the aim of explaining the most suitable theory in the process of preparing for PEP. There are several theories that can be used in making decisions in the decision-making process by the nursing professionals. The theories that are discussed in this essay include descriptive theory, normative theory, and social judgment theory. Analyzing the Three Theories Descriptive Theory The descriptive theory is primarily concerned with providing the necessary guidelines that are needed in achieving the targeted objectives. Apparently, descriptive theory is actually behavioral as well as naturalistic in nature. Therefore, this theory originates from the both professions of philosophies of psychology and behavioral science. In particular, however, descriptive theories are mostly focused in analyzing the way in which individual’s do, as they engage in the process of making decisions as well as judgments (Ahtisham & Jacoline 2015). For instance, in a healthcare facility, a nursing staff can make use of the descriptive theory in the process of deciding the best guidelines to help in achieve objectives, such as knowing the number of patients that have been admitted in a ward. At the next placement they will be in a position to apply the experience they have gained in the practice especially in making the necessary decisions that can help in improving the service delivery to the clients. However, Brennan and Bakken, (2015, pg. 480) greatly challenged descriptive theory. According to Brennan and Bakken, (2015), there has been a discontentment as well as the opposition to the dichotomy of this theory when it comes to analyzing decision making process. Therefore, Brennan and Bakken observe that the theories should improve the quality of the judgment and decisions in practice. Moreover, they emphasize that the central purpose of analyzing the judgment and decision making is actually to assist people in making decisions that are better. However, the majority of the researchers have been focusing mostly on devising ways that can incorporate the insights that are acquired from the descriptive theory in a manner which recognizes the limitation of individuals in terms of cognitive. On the other hand, some of the researchers and scholars are concerned in giving an explanation about the rational models in a way that is appealing to the ordinary people. In a given placement, a clinical nurse is expected to make some decisions that entail making judgment on various issues. As a result, one need to develop some skills to be in a better position when it comes to applying in the other engagements, hence improving one’s decision making skills in the field. Ahtisham and Jacoline (2015, pg. 2) introduced a third philosophical domain that was referred to as the descriptive theory, for also analyzing the judgment and decision making. Apparently, the descriptive theories usually focus on some areas which include; contexts, environments, and actual conditions in which they are made. The descriptive theory is in most cases utilized in the operational research and also in the management sciences in attempting to assist individuals in making correct decisions. In addition, descriptive theory is mostly focused on improving the judgments as well as the decisions of people by conducting an investigation on how individuals make their decisions. Further, the prescriptive theories usually assist individuals in improving their judgments. For example, in the last placement the staff members could conduct investigations of improving the judgments when making decisions. According to some nurses from the facility, in the next placement they will be in a better position to improve their judgment when making decisions. However, the descriptive theory does not actually consider if an individual is either rational or logical, or even irrational and illogical, but this theory concentrates more on understanding how the people make their decisions as well as their judgments in a real world (McCrae, 2012, pg. 225). Normative Theory The normative theory entails making decisions while determining the actions that are wrong and that are right. The theory involves seeking what need to be done in different situations to come up with the most ethical decision. The normative theories of the judgment and decision making are always positivist and also classical in nature. In this case, the two theories result from the mathematical, economic and also statistical philosophies. In the normative theories, the decision theorists who are also known as the researchers usually propose the various procedures which should be followed in making decisions which are logical. For example, in the last placement clinical nurses could make decisions based on logical and probable evidence necessary for enhancing decision making. Based on this experience, they will be in a position to make decisions in a way that is more logical while guided by ethical principles. The normative theory which are usually based on the statistics and also probabilities under the positivist domain always propose how to make good judgments and also how to achieve good outcomes from a decision making. The normative theory in most cases is used in multiple contexts and settings while making decisions that require some ethical and moral principles that are needed in the field of medicine which aims at improving the clinician (Shen, 2015, pg. 320). For example, in the placement clinical staff members could make judgments concerning clinical setting with the aim of making the most suitable decisions. In this way, they will also be in a position to use the experience to improve decisions concerning the clinical policies and also the clinical guidelines. Notably, the clinical policies are used by the practitioners in making decision about which is the best healthcare that should be provided to a patient at particular circumstances. The clinical guideline usually provides an outline for the operational procedures which are known as the protocols, whose basic aim is to develop the health care and also standardize the care. Importantly, the clinical guidelines act as mechanisms for reducing various variations in the clinical practice as well as discouraging practices that lack sufficient evidence (Lisko and O'dell, 2010, pg. 107). Critical to note is that the normative theories in most cases are always concerned with the environments and also optimal conditions, whereby they make an assumption that the decision makers are super-rational hence do not lay much emphasis on how judgment and decision making take place in a real world. In addition, both expected utility theory and also the subjective expected utility theories are actually the normative approaches which are known to be the gold standard for the optimal decision making. The subjective expected utility theory usually puts into account the values of the decision makers in a rational context and also facilitates the calculation of the probability for the occurrence outcomes before the identification of the optimum decision. The theory of the multi-attribute utility is usually a normative theory for the decision making which has multiple goals. The normative theories do not actually consider how ordinary individuals make their judgments in reality and also in their daily practice, whereby the normative theories do not lay any emphasis in the context of the judgment. Social Judgment Theory The theory of social judgment is usually a framework that studies about how people make judgments. The theory is a meta-theory that focuses its research on the cognitive perspective that deals with the perception of the situations. According to the study conducted by the researchers, it was realized that the psychological processes of an individual are usually adapted to the various environmental factors (Riegel et al. 2012). However, both motivation and the cognitive capacities are the major variables in the social judgment (Riegel, Jaarsma and Strömberg, 2012, pg. 200). The social judgment theory rose from conducting a comparison between the judgment process and the quality of judgment. The aspect of accuracy is usually a measure of the quality of judgment and decision making, which is popular in wide range of disciplines and philosophies. In the last placement, for example, nurses were involved in making judgment on various issues such as when trying to understand the communication behavior of new patients in order to make well informed decisions on how to improve interpersonal relationship with patients for quality delivery of services. Consequently, they have acquired the necessary experience that can be of use in improving their decision making in different situations. The major theoretical framework which provides a method of measuring the judgment accuracy is known as the social judgment theory, which assumes that people`s judgment in most cases relates to the reality of the social environment. The central theoretical approach for the SJ theory proposes that the theoretical framework establishes the judgment analysis referred to as the “lens model”. However, the approaches for the social judgment make use of the relationship that exists between certain information and the targeted outcome as their basis (Shen, 2015, pg. 310). Furthermore, lens model is usually an alternative approach which is used in studying the human judgment, thus constructing a judgment analysis. Importantly, an individual is usually depicted as the lens since they collect information from various cues which emanate from an object. The Applicable Nursing Theory: Normative Theory Normative theory is the most applicable nursing theory in the PEP. The theory can help in making decisions that can be significant in providing nursing care services that are effective. The normative theory is essential in the process of guiding the necessary nursing practices for development in the health sector. For instance, the normative theory can be essential for making decisions that ensure the patients are satisfied with the medical care provided. At the same time, it is the normative theory that can be used in improving the way nurses provide care services that can help make the patients comfortable (Perry, 2009, pg. 40). Furthermore, the common normative approach for the judgment and decision making is usually the Bayes Theorem for the judgments whereas the central aim for the normative theories is actually the assessment of a risk (Clark, 2016). Therefore, in the process of determining how both judgments and also decisions are made, a comprehensive analysis of the risks should be undertaken and then the various risks are weighted. However, decision analysis is usually the direct implementation of the normative theories for particular decisions (Shen, 2015, pg. 310). In the placement, the clinical nursing staff could consider the values of the decision makers while using a normative approach to make decisions that are rational. Admittedly, the experience they gain in the placement is likely to improve their practice while making decisions in their future placements. The analysis of decision making is usually used in multiple settings which are helping women to make a decision whether to continue with the pregnancy and bear the risk of Down`s Syndrome during childbirth. The second setting where the decision analysis is used is in making decision on which kind of interventions should be employed by the psychiatric patients who have violent tendencies. In some cases, the use of the decision analysis is usually criticized especially where there are probabilities that are based on the societal norms (Watson, et al, 2012, Pg. 2740). Some of the risk assessment instruments such as the tools, measurements and also the scales have been employed in the field of medicine for the several years and are usually prolific to the scientific literature. In addition, these instruments of assessing risks in most cases aim at making the various risks to be known. The rationale for choosing the normative theory can include the fact that it ensures the necessary decisions that are in place to improve the health care services. Besides, normative theory takes into account the wellbeing of the patients, making it the best nursing theory that can be applicable in the PEP. For instance, through the use of normative theory in decision making, the nursing professionals can be in a better position to foster an environment that is able to make the patients conformable and feel satisfied by the health care services offered. Practically, under the last placement in the healthcare facility, most of the clinical officials were exposed to different settings and environments while making decisions, hence expected to apply this knowledge in their next placement for the improvement clinical practice. Complexities and Counter Arguments of the Three Theories Descriptive Theory Under the descriptive theories, one of the key terms used is “irrationality”. The term “irrationality” in descriptive theories usually refers to the various instances whereby people do not think deeply in the process of decision-making and therefore they end up being unable to make the correct judgment. The descriptive theory tends to seek knowledge concerning the cognitive capabilities of the ordinary individuals as well as determining whether the behavior of the people is consistently rational. However, the context, ecology and the interactions are actually the main areas of interpretation in this study of the descriptive theory. Importantly, the descriptive theory which is most influential and also frequently utilized in nursing and in midwifery is the “Information processing theory.” The information processing theory is also known as the “hypothetic-deductive approach” which usually suggests that the judgment of people, as well as their reasoning reality, is always limited to the human memory capacity. Furthermore, as part of descriptive theories, the information processing theory argues that the individuals who are in the process of making decisions proceed in a number of stages which are predominately guided by obtaining cues in their environment. In addition, the descriptive theories usually lay a lot of emphasis in investigating about the heuristics, biases, uncertainty, and also any error present in the judgment and decision making. The term heuristics refers to the simplifying strategies which are used in making decisions thus making it easy to encounter the problem of uncertainty and also limited information during the decision making. However, heuristics are usually divided into various categories which include; the availability heuristics which mostly base its decisions on the current events which relate to the situation being judged (Shen, 2015, pg. 310). Another category for the heuristics is the Representativeness heuristics which usually base its decisions on the similarities which exist between a certain situation and its stereotypes of the similar occurrences. There is also another category which is known as the adjustment heuristics, which bases its decision making in the incremental adjustments to the original value that is usually determined by a reference point. Notably, one of the criticisms about the descriptive theory include the fact that even though the heuristics are of great significance in handling uncertainty. In some cases, the heuristics result in systematic errors which negatively impact the quality of the decision making. Therefore, in the nursing profession, a lot of research has been conducted concerning the descriptive theory. Furthermore, the distinct characteristic of the descriptive theories is that they do not actually consider the judgment quality or even the outcome of a certain decision making in a qualitative way. In addition, the evaluation for both decisions and judgments under the descriptive theories are usually based on to the extent in which a certain model corresponds to the choices observed during the decision making (Shen, 2015, pg. 320). Normative Theory The counter arguments against the normative theory include the use of predictions in the process of making decisions that can result in errors. The main criticism concerning the normative theoretical approaches is actually their failure in capturing the reality in the health-care decision situation, and also the absence of a reliable probabilistic data. Furthermore, the normative theories mostly rely on the quantification of a risk in a complete way as well as a known way. The analysis of the decision-making, as well as the usage of the decision trees which are based on prediction for the statistics occurrence, is mostly used in judgment and decision making in the field of medicine (Shen, 2015, pg. 320). Additionally, the analysis for the clinical decision makes use of techniques in order to break down the decision-making the process into processes and components so that the different observations of individuals can be analyzed. At the same time, the decision trees in most cases work by breaking down the problems into small decisions and also by adding numerical values which include event probability to every part of the decision (Shen, 2015, pg. 320). Moreover, the model of the expected utility theory attempts to increase the probability of the event which is desirable thus making the individual who is making that judgment to be known. Social Judgment Theory The primary counter-argument concerning the social judgment theory is the variations that are associated with the decisions made using this theory. For example, there are many variations found in the lens model whereby each variation lays emphasis on a particular context for the social judgment. In addition, the social judgment makes an attempt in generalizing the findings of the social judgment. In most cases, this theory focuses on the internal processes of an individual`s judgment (Mitchell, 2013, pg. 35). The social judgment theory also specifies the prevailing conditions in which an attitude change usually takes place. Moreover, the researchers for this theory have made a claim that the expectations concerning the attitude change are mostly based on the involvement level of the message receiver. Furthermore, the social judgment theory shows how individuals contrast their individual positions on the various issues surrounding them. Conclusion The essay focused on the decision making among nursing professionals where different theories have been explored. The best theory that can be applicable for PEP has been selected based on critical analysis of the applicable theories. Decision making in the nursing field has been considered crucial in ensuring that the necessary strategies for achieving improvement in the provision of health care. Nursing professionals are expected to come up with the necessary theories that they need to base their judgment on when making decisions (Mitchell, 2013, pg. 35). However, it can be critical to engage different stakeholders in the process of making the most appropriate decisions with the aim of improving the health care provision. Many health care professionals ensure that the relevant stakeholders are considered in the process of providing the necessary judgments concerning their service delivery. The nursing theories are important in making decisions that foster improvement of the health care services. For instance, the normative theory can be applicable during PEP as it is important in providing the best healing environment necessary for improving the health care services. References Ahtisham, Y. and Jacoline, S., 2015. Integrating Nursing Theory and Process into Practice; Virginia's Henderson Need Theory. International Journal of Caring Sciences, 8(2). Brennan, P.F. and Bakken, S., 2015. Nursing needs big data and big data needs nursing. Journal of Nursing Scholarship, 47(5), pp.477-484. Clark, M. J. D. (2016). Community health nursing: Caring for populations. Upper Saddle River, N.J: Prentice Hall. Lisko, S.A. and O'dell, V., 2010. Integration of theory and practice: Experiential learning theory and nursing education. Nursing Education Perspectives, 31(2), pp.106-108. McCrae, N., 2012. Whither Nursing Models? The value of nursing theory in the context of evidence‐based practice and multidisciplinary health care. Journal of Advanced Nursing, 68(1), pp.222-229. Mitchell, G., 2013. Selecting the best theory to implement planned change: Improving the workplace requires staff to be involved and innovations to be maintained. Gary Mitchell discusses the theories that can help achieve this. Nursing Management, 20(1), pp.32-37. Perry, R.B., 2009. Role modeling excellence in clinical nursing practice. Nurse Education in Practice, 9(1), pp.36-44. Riegel, B., Jaarsma, T. and Strömberg, A., 2012. A middle-range theory of self-care of chronic illness. Advances in Nursing Science, 35(3), pp.194-204. Shen, Z., 2015. Cultural competence models and cultural competence assessment instruments in nursing: a literature review. Journal of Transcultural Nursing, 26(3), pp.308-321. Watson, R., van der Ark, L.A., Lin, L.C., Fieo, R., Deary, I.J. and Meijer, R.R., 2012. Item response theory: how Mokken scaling can be used in clinical practice. Journal of clinical nursing, 21(19pt20), pp.2736-2746. Read More