Decision Making in Nursing Practice in Preparation for PLACEMENT - Essay Example

Decision Making Essay Name: Course: Instructor: Institution: Date of Submission: Decision Making in Nursing Practice in Preparation for PLACEMENT Introduction Decision making in nursing ensures that nurses can improve the quality care by improving the decision making processes through using diverse methods, plan of care and other theories. Decision making in clinical practices is a significantly vital skill to ensure the nurses/ students perform their responsibilities in a systematic manner. The nurses must develop safe and appropriate decisions for their patients and they included. Thus, decisions in nursing or during placement should include a number of various kinds of making decisions (Roxburgh, 2012). The report evaluates the theories that nurses should understand to make appropriate decisions in placement. Thus, the theories include the information processes theory, expected utility theory, social judgment theory, and intuition. Placement in nursing is the process of undertaking practice in nursing under supervision. The research evaluates the first three theories and makes a recommendation on the best theory for decision making in nursing practice while focusing on placement. Decision Making Theories a. Information Processes Theory The theory includes the mechanisms that learning is presented. Thus, it is related to the aspects of memory retrieval and encoding. The theory stipulates that the mind of any human being is similar to a computer in terms of processing information. The theory is related to the computer mechanism regarding receiving inputs, processes and the delivering of output where it is stored in the brain and the output is the behavioral response (Atkinson & Shiffrin, 1968). Atkinson & Shiffrin, (1968) depict the stage theory through the input process as shown and the output through the behavioral output. The process of the human is guided though the control processes, which dtermine the processes of how and when the information flows through the system (Brennan & Casper, 1995). The human brain like the computer has three main steps of processing information. The steps include encoding where the information is processed into the memory system; storing information, and the retention period of the encoded material given a certain period of time. During decision making the retrieval process of attaining the information stored in the memory is presented (Atkinson & Shiffrin, 1968). The nursing placement decisions are related to the nursing intervention through making judgements based on the problems of a patientThe relationship is formed through the probem solver (nurses/ students, in decision making processes) and the environment (the situation and condition of the patient). Thus, it presents the problem solving task to make a decision on the condition of the patient (Wyer, 2014). Patienta are analyzed in different kowledge states, where the information of the state is analyzed to make quality care decisions (Holland & Roberts, 2013). Thus, the information process theory is applied in a sequence of knowledge untill the problem is solved (Wyer, 2014). The information processes theory is used in decision making through handling the processes of information acquisition though both external and internal sources through knowledge acquired and stored in the memory (Brennan & Casper, 1995). Information theory can occur as the process the clinical physicians reason when making decisions (Atkinson & Shiffrin, 1968). Examples 1. The first example is related to Mrs. Green. Using the information theory, the nurse should gather information regarding Mrs. Green. The nurse should search for the clinical information of Mrs. Green. The information includes the age of the patient, medical backround and symptoms. This information is then used by the nurse/ doctor to make a hypothesis regarding her condition. This information is all stored, though in writing, it is also stored in the momory of the individual. The hypotheses could be one or many. Fo instance Mrs. Green hypothesis could be pain due to old age, chest pains could be a result of smoking in the past, indigestions or it could be heart conditions among many others. After this, one begins the reasoning process, where the information gathered is interpreted. For instance, depending on the clinical information gather, one may conclude that Mrs. Green had a heart attack based on the information collected of her EGG. 2. A patient is re-administred in a hospital with a wound bleeding after a complicated surgery. Thus, the nurse uses information model by collecting information. The nurses determines the patient was in surgery and is now coughing blood; while there is blood on the wound. Thus, using hypothesis, the information stipulates that possibly, the wound could be open or the patient is bleeding inside. Consequently, the reasoning process is used to determine that due to the coughing of the blood, the patient is bleeding inside, which leads to the application of the necessary procedures to treat the patient. 3. Assumining Mrs. Jane is a patient with Rheumatoid Arthrits. Over the years, Mrs. Jane has been on steroid treatment to deal with the trauma. The nurse in placement should assess all the medicines and clinical issues of Mrs. Jane to understand why she has been feeling more pain. Using the information above, the nurse develops some hypothesis. Thr pain is mainly on her lower part of the stomach. After this information, the nurse decides to test Mrs. Jane for an ulcer. After the ulcer results are out, if negative more hypothesis will be used to make a decision. On the other hand, if the result is positive, the doctors/ nurses can now treat Mrs. Jane effectively. b. Expected Utility Theory The expected utility theory stipulates that the individual making the decision has to choose between decisions that are risky and the uncertain prospects in relation to the utility values. The utility values include the weighted sum of the values by addition the outcomes multiplied by the probabilities. The benefit of the theory is perceived through handling the important questions when relating to making a decision (Shoemaker, 2013). The expected utility theory is perceived as a prescriptive theory that imposes logical structures that increase the consistency of responses and results. The theory assumes a formal probability process on making decisions. The theory involves a set of rules and the possible beliefs, utilities, probabilities and preferences to ensure quality care in decision making. The theory presents the prescriptive models to describe the automatic processes, and simple processes that show the thoughtful deliberation in judgement. Thus, the theory describes the consistency in making clinical decisions. The theory refers to the recognition of the utility numbers by describing the value scale they belong to referring to the certainty decision making choices they represent. It also includes the sum of the probability and the identified utility values. It evaluates whether the sums attained are intuitively or alternatively attractive modelling through solving the conflict. Thus, the theories process of making decisions is reliant on the probability values. Thus, the uncertainty of the theory, which opposes the risk when considering the explicit probabilities due to the decision process. The theory is applied in decision making as either a positive or normative theory of the prescriptive theory. The expected utility theory is well evaluated in two versions as presented below (Mongin, 1997). Subjective expected utility theory assumes an economic perspective (Edwards, 2013). The theory assumes that when making a decision, one should follow the issue of rationality when certain events or decisions lead to the given probable outcomes. It presents an expected utility value (Quiggin, 2012). Von Neumann Morgenstern Theory also deals with rational behavior axioms where one is faced with a risky decision (Edwards, 2013). Thus, the analysis of the choice to be conducted is based on the outcome expected, and the probable outcome from the choice given. The EU theory undertakes a rationality behavior in making decisions through expectation maximization. It is the theory that ensures risk aversion is done in a manner that the expected values are maximized. Examples 1. Mrs. Jane who has Rheumatoid Arthritis needs medical care due to the increasing pain and inflammatory activities. Thus, using the expected theory, the nurse understands that patients with this kind of condition have significant pain in short periods, and can face long-term disabilities. Thus, when one has pain, the nurse will use the techniques available to deal with such conditions. Thus, the nurse assesses the pain and medical history of the patient, if the pain is not significant and cannot cause long-term disabilities, the patient is given steroids and other pain management medicines. On the other hand, if the pain is way high and the patient has been under pain management medications, the nurse decides that the patient needs additional physical therapy support to help management the pain. 2. Also, Mrs. Green has RA for about 15 years now, she is 65 years old, and she has come to the hospital for increased inflammatory activity. Her medical history information stipulates that she has been treated with chloroquine, a few years back the medication was changed to methotrexate while engaging standard assessments. After using the methotrexate, Mrs. Green developed a flare, where the RA activity decreased as well, but with increase in doses of the methotrexate. Thus, the issue of inflammation activity increasing in this patient can only be handled as it has been other days through the methotrexate medication. This is what is expected and the most opportunistic utility function since it stops the inflammatory activity and has been used to treat the patient for a period of time. 3. As a placement nurse, a 29year old man (John) walks into the hospital. As a nurse, one takes the clinical background of the patient. John is a strong smoker for nearly 15years now, his wife is pregnant. John wants to stop smoking, before the baby is born. The baby will be born in 7months time. In the past, John tried and failed while using the nicotine placement therapy twice. Thus, he is consulting on other techniques that will help him effectively in such a short period. Thus, as a nurse, based on this information, the expected treatment is enrolling John in a group or telephone based support. That is; it is more effective when you know you are not the only one trying and that others have succeeded. 4. Based on the above examples, one perceives that the expected utility theory is based on providing value for the patient at a cost. It involves using the best option available. Another example is when the nurse works in a women’s hospital. Thus, a patient, Mrs. Jackling 50 years needs advice due to the menopausal distress she is experiencing. After some thought, and considerations of her condition, including age, the nurses proposes the hormone replacement therapy, which is the best option compared to Non-Hormonal replacement therapy. HRT will not only relieve the menopausal symptoms but also help avoid possible health problems such as stroke and osteoporosis. The Non-HRT may be difficult, since at her age, changing her lifestyle among others may be challenging. Thus, utility value lies in the HRT treatment for the patient. c. Social Judgement Theory The social judgment theory is centred on the persona individual’s judgements that relates to the social environment reality. That is; it presents how certain information relates to the reality of making judgements in relation to the environment. Thus, it relates to the ecological situations (Dowding & Thompson, 2003). The social judgment theory presents a persuasion theory to show the ideas and change perceptions on an issue or attitude. Social judgement, therefore, involves evaluating the idea one persuades others to conform to by evaluating how the rest of the society will perceive it by placing it on a moral scale. The theory presents the process of problem solving, which also includes conflict resolution and understanding how other perspective from various people mainly the society accept the given solution or decision (Wyer, 2014). Thus, the social judgement theory presents new views that maybe adopted may not be effective. The theory presents that though sometimes people already have preconceptions regarding certain issues that makes them make decision regarding certain issues. However, if a convincing argument was to be made, the preconception/ opinion may be changed leading to the adoption of the new argument (Thompson & Dowding, 2001). The social judgment theory is related to the regression statistical analysis method as well as the multiple correlation method (Cooksey, 2010). Therefore, the theory presents the process of analyzing the human judgement through ecological conditions. The theory helps in identifying and the nurses/ students having the capability to predict patient outcome while basisng the results in clinical assumptions (Thomposon, et al., 2005). In relation to the theory, judgements derive from numerous sources in the environment. The judgement is related to cognitive feedback that supports the learning process. The theory also makes judgements after a decision is made by analysing the judgment implications. It uses multiple regression method to make the aalysis based on the ecological systems of the patients to eliminate unwarranted generalizations of issues (Cooksey, 2010). Social judgement theory deals with acceptable and unacceptable ideas, reasonable and unreasonable ideas. In clinical placements for students the theory may come in play through accepted ideas such as an inclnication that the overweight people are lazy, which is why they are fat or they eat too much junk food. Accepting such an idea may hinder one from identifying the accurate health condition of an overwieght person. Examples 1. Adriana is a Muslim, as she comes to the hospital, the pregnancy tests determine that she is pregnant. However, her pregnancy is very risky and may cause the death of either her or the child during delivery or both before the delivery. The doctor understands, that in her background and family, abortions are not accepted. Thus, based on the social judgment of her background, the doctor can only ask Adriana and her family to take extra care on her pregnancy. 2. Ms. Easter is an 87 year old woman living by herself. Easter has no close family or friends and she always keeps to herself. In her society, there are no many old people. Thus, she makes a short call to the public hospital before she can talk more of her condition. The emergency plane gets there and within 15minutes she is admitted to the hospital for problems in breathing. She is admitted to the ICU and administered with a medical ventilator. However, the society is against this, as they feel she should just be left to die and let other younger people use such resources. However, irrespective of such society comments, the nurse makes the right social/ moral judgement by ensuring she is given a medical ventilator to help her breath. 3. An overweight women, aged 32 is brought to the hospital for the development of a weight management program. The nurse evaluates the situation and gathers information regarding the patients’ health and when the issue started. Thus, the nurse provides a weight management program that constrains even what one eats. However, the nurse also refers the patient to an endocrinologist after evaluating the consequence of this outcome. Thus, the nurse judged the outcome socially, and how beneficial it would be to the clinical treatments for the patients, influencing her decisions on how to advice the patient. Recommendation For a theory to be accurate, it needs three elements. The elements include ensuring that the judgment, assertion, and responses are considered. The standard criterion of truth should be applied (Brennan & Casper, 1995). The process of making decisions varies between task environments and the individual’s conditions to use the number of strategies to make the decision. The placement practice presents a position where under supervision, the student apply their learned knowledge and skills to make clinical decisions. The practice placement also stipulates that the students can provide the full range nursing care of the patients, demonstrating the appreciation on the learning opportunities to enable the theory application practice (Holland & Roberts, 2013). The recommendable decision making process is the expected utility theory. That is; nurses are accountable to the law, the profession, and their employers and to the public. Thus, using the social judgment theory and information theory may lead to wrong judgements based on long-term memory mistakes or stereotypes/ biases leading to mistakes in the information and social theory respectively (Cooksey, 2010). To avoid this issue, the nurse should follow a procedure that they could be accountable to without threatening their practice. Individuals in placement practice are advised to use the information theory for making decisions. The information may be beneficial from the work experience, training or education. However, this is dependent on the information retention of the memory. The possibility of forgetting refers to the interface where it may not be wise to use it since information may be blocked. That is; either new or old information may be blocked leading to the problem in the placement practice (Wyer, 2014). Therefore, the expected utility theory stands as the only theory that is best suited for the placement practice. The theory deals with eliminating uncertainty during decision making and averting risks (Quiggin, 2012). To make decisions effectively, one must ensure that they are certain of the outcome mainly in placement practice as identified above. Uncertainty increases the possibilities of risks that may impact the outcome. Thus, the Expected utility theory eliminates uncertainty, reduces is leading to a perfect decision regarding the issue and incorporates both the information and social judgment theories in making decisions (Edwards, 2013). In placement practice, certainty is one of the issues that increases the positive and successful outcomes. Thus, when decision making in placement practice follows a certainty theory, both the patient and the nurse/ student practice quality care provision. The theory assumes that in making decisions a choice is analyzed through the possible outcome utilities, where the expected value is also compared against the certain value of the utilities given to make the decision. The decision can also be developed through the probability of the events that compute the subjective utility (Mongin, 1997). Thus, the theory is the best option since it is normative in decision making in nursing practice mainly in the placement practice. The increase of certainty that the theory provides is the main reason that the theory is regarded the best option for the placement practice. Conclusion The expected utility theory presents following consistency in making decisions. The expected utility theory occurs as the best decision for solving problems since it involves following consistency. The expected utility theory due to consistency and certainty has been referred to as the best option for making decisions in the nursing practice, mainly the placement practice. References Atkinson, R. C. & Shiffrin, R. M., 1968. Human memory: A proposed system and its control processes. Psychology of learning and motivation, Volume 2, pp. 89 - 195. Brennan, F. P. & Casper, R. G., 1995. Modelling for Decision Support. Nursing Informatics: Part of the Series Health Informatics, pp. 287 -294. Cooksey, W. R., 2010. The Methodology of Social Judgment Theory. Journal Thinking and Reasoning, 2(2), pp. 141-174. Dowding & Thompson, C., 2003. Measuring the Quality of Judgement and Decision Making in Nursing. Journal of Advanced Nursing, 44(1), pp. 49-57. Edwards, W., 2013. Utility Theories: Measurements and Applications: Studies in Risk and Uncertainity. Illustrated ed. New York: Springer Science and Business Media. Holland, K. & Roberts, D., 2013. Nursing: Decision-Making Skills for Practice. Illustrated ed. New Yrk: OUP Oxford. Mongin, P., 1997. Expected Utility Theory. In: Handbook of Economic Methodology. London: Edward Elgar, pp. 342-350. Quiggin, J., 2012. Generalized Expected Utility Theory: The Rank-Dependent Model. reprint ed. New York: Springer Science & Business Media. Roxburgh, H. K., 2012. Placement Learning in Surgical Nursing,A guide for students in practice,1: Placement Learning in Surgical Nursing. New York: Elsevier Health Sciences. Shoemaker, H. J. P., 2013. Experiments on Decisions under Risk: The Expected Utility Hypothesis. Illustrated ed. New York: Springer Science & Business Media. Thomposon, C. A., Foster, A., Cole, I. & Dowding, D., 2005. Using social judgement theory to model nurses' use of clinical information in critical care education.. Nurses Education Today, 25(1), pp. 68-77. Thompson, C. & Dowding, D., 2001. Clinical Decision-Making and Judgement in Nursing. 1 ed. New York: Elsevier. Wyer, R. S., 2014. Knowledge and memory: the real story: advances in social cognition. 8 ed. New York: Psychology Press. Read More