Running head: NURSING 1

THEORIES OF DECISION MAKING

Name

Institution
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Introduction

The field of nursing is a delicate and engaging profession that requires individuals

commitment. In this profession, one has to make a critical decision that is a bit essential to the

health of the patient. Therefore, the absence of senior nurses or doctors makes it tougher to make

these decisions. Professionals in the field of nursing, therefore, have to rely on a set of theories

to guide their decision-making process. This essay will focus on four commonly used methods

and models used in the decision-making processes. More specifically, the relevance of Intuitive

Theory, Information Processing Theory, Analysis Theory and the Social Judgment Theory, are of

great essence to the field of nursing. The main aim of this paper is to come up with an analysis

that sheds light on these theories. Among these theories, one stands out as being the most

relevant and widely accepted. The Intuitive approach bears a lot of significance to the medical

profession and more specifically to the field of nursing. Decision-making is a process that we

cannot escape and as Sartwell, clearly points out any decision is better than none (Malewska,

2015 pg 9).

Background of the theories

The four theories of decision-making play a vital role as the nursing profession is

concerned. In light of this, it would be wise to consider what each of these theories address. The

process of clinical decision-making involves making a choice between two almost similar

alternatives.

The Intuitive Theory of decision making

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The Intuitive theory is also known as intuitive humanistic theory (Jefford, Fahy, & Sundin, 2011

pg 247). The Intuitive-Humanistic Theory has some close correlation with decision-making in

the nursing profession. There is no defined and well-outlined consensus in literature reflecting on

the role played by intuition in the process of decision-making. Among definitions relating to

intuition, you can hear a statement such as understanding without rationale or acting on a

sudden acquirement of knowledge that is associated with prior experience, viewed as a whole,

and particularly hard to articulate. The process of decision-making can be linked to five distinct

levels; (Jefford, Fahy, &Sundin, 2011 pg 249) expert, proficient, competent, advanced beginner

and novice. Many studies and research point to the fact that majority of the novice nurses make

decisions basing on the hypothetical-deductive reasoning. The more experienced and senior

nurses relied upon their intuition to come to correct decisions. Accordingly, An expert nurse

will automatically undertake an instantaneous categorization while screening the available

options intuitively. In the process, the nurse will eliminate those options that seem irrelevant to

the judgment and decision-making process, adds (Jefford, Fahy, and Sundin, 2011pg 250). A

nurse relying on intuition ends up making quick and spontaneous decisions. While at the same

time, operating with a knowledgeable understanding without necessarily being in a position to

articulate the perceived understanding as far as this theory is concerned. For a more experienced

nurse, knowing the right decision to take relies largely on the pattern matching of intuition.

Pattern matching as defined in (Jefford, Fahy, and Sundin, 2011pg 252) is, The process of

making a judgment by a few critical pieces of information. The Intuitive-Humanistic theory

used in the decision-making process base on the assumption that decision making is a necessary

process is relevant for nursing as well as other disciplines in the health sector.

Pros of the intuitive theory

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The advantages of intuitive theory are that; decision making is quick, it can be relied upon in the

short term, it does not require extensive research and also that it can be used by any nurse

without the need for vast experience in the field (Carl et al., 2014 pg 40).

Cons of the intuitive theory

The disadvantages include the fact that this theory cannot be relied upon for long-term decision

making, it is considered to be baseless, it does not use evaluation or analysis as well as that the

decision making is inaccessible under the intuitive approach.

Information Processing Model

The principles of decision-making are to the greatest extent related to the information-processing

model as outlined by (Vocht & Nyatanga, 2012 pg 4). The information processing assumes that

the nurses making the decisions keep in memory all the necessary information that could be

relevant to the process of decision-making. The information stored is both short and long-term

memory. Short-term information is relevant in making decisions. One-time decisions require the

nurse to process information relevant to that particular problem. The nurse making the decision

has to rely on the information gained previously to make sound and appropriate decisions.

Shaban (2015 pg 3) provide us with crucial knowledge on the process of information

acquirement. Clinical experts also use the information stored in their short-term memory storage

to gain access to the long-term stored information. An example from (N, 2004) provides us with

a better understanding of this concept:

"Consider an experienced nurse is making a diagnosis of a leg cancer patient; the nurse will

resort to short-term memory in which the patient's information is stored. The short-term memory
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is also relevant when evaluating the signs and symptoms. The short-term memory can then create

a path for the nurse to retrieve information from the long-term memory regarding symptoms and

signs of a particular condition such as a venous leg infection."

The information processing theory on decision-making lays out diagnostic reasoning comprising

of seven stages. Wallace, et al., (2013 pg 76) points to these steps as follows;

1. The pre-encounter data exposure stage

2. Data search field entries and arrangement of the gathered data

3. Collecting and grouping of cues into clusters

4. Activation of the potential explanation of the diagnosis

5. A data-directed and hypothetical data field search

6. Testing of the potentially correct hypothesis of the diagnosis

7. Final diagnosis

In this model, the nurse making the decision makes contact with the patient and acquires

information. This information includes symptoms, signs as well as the patients medical history.

The nurse will then identify relevant cues portrayed in the data. Therefore, the conclusion

concerning the various signs and symptoms are identified after proper analysis of the patients

diagnosis. As the nurse clusters the necessary signals together, the short-term and long-term

memory comes into play.

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The information-processing model of decision-making makes use of a hypothesis. The

hypothesis acts an explanation to the information-based situation. The information-processing

model, therefore, forms a hypothesis to help nurses get additional information. It is also relevant

in the interpretation of the cues. The additional information and the interpreted are fundamental

in refuting or confirming the stated hypothesis. The hypothesis makes up an invaluable aspect of

the decision-making process. As Wallace et al (2013 pg 75) confirms, The evaluation of a

hypothesis is a key component in the process of decision-making of nursing practitioners.

A careful consideration of the cues as well as the assessment of the hypothesis can help a nurse

come up with the right and accurate diagnosis. We can consider the example from (Goodhew,

2016 pg 76); A nurse making a decision as to which mattress to offer the weak patient considers

the following question, "For the old and inactive patients in need of surgical intervention, which

is the best pressure relieving mattress to counter the development of pressure ulcers? In the

information processing approach, reasoning is a fundamental consciousness that incorporates

speculation as well as educated evaluative concepts.

The following excerpt from (Wallace, et al., 2013 pg 78), among health care professionals, due

regard has been given to nurses as critical decision makers. Therefore, nurses uses available

evidence to the best of their knowledge when making their judgments as well as when coming up

with decisions. Prescriptive evidence-based models for decision-making together with the

process of search-appraise-implement are considered as the active process. Health service

providers aim to implement a research-based approach in the clinical settings tends to forget that

seeking information is only just but one of the many potential responses to the irreducible

uncertainties experienced in clinical practice. Hence, nurses are likely to regard their colleagues
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as useful human resource data information that is readily available than all other forms of

research. Colleagues of training are therefore able to deliver, and clinically relevant, information

that is context-specific which therefore accounts for the decision needs or judgment situation

thus requiring the least critical appraisal. Furthermore, an argument can be made that the

implication made here is a fit of a certain degree. This fit exists between the burden of making

a decision, and the information availed. This argument may not necessarily be of high-quality

information provision. Clearly, this illustration wraps up what nurses have to go through in their

daily operations on the issue of decision-making;

Pros of this theory

Human cognitive is a fundamental concept in the information process model. As such, human

cognitive bears a direct relationship to the process of decision-making. As (Skulimowski, 2011

pg 105) outlines, the human cognitive concept bears a lot of benefits to the information

processing theory. Some of the advantages of the information processing theory include the fact

that its bases its arguments on background patient information, it is highly reliable, that it is

analytical hence risks can be predetermined. Also the information processing in this theory is

relevant for both long-term and short-term memories.

Cons of this theory

On the other hand, disadvantages include that fact that the processing procedure is time

consuming. Also the process requires in-depth knowledge about patient history hence cannot be

relied upon in first instance treatment. Finally, the theory of information processing can be

challenging to new nurses

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The Expected utility theory of decision-making process

The models incorporated in the process of decision-making can be classified into categories.

Among these categories is the normative approach to decision making. The normative theories of

decision-making are positivist as well as classical in their nature. They are of the view that we

were born from a mathematical, statistical and economic philosophy, (Skulimowski, 2011 pg

109). The focus of the normative approach of which the Utility Theory is a part of is centered on

the discovery of how decisions are made by rational people. It aims to state how these decisions

ought to be made, hence the phrase, normative, to mean the normal way it should be. The

remaining part of this section shall refer to normative approach as a general class, which includes

the expected utility theory.

The normative theory clearly states out to redefine the decision-making process. Under this

approach, decisions should be made basing on a logical and predetermined conclusion. The

conclusions that are known beforehand must be supported by probable and definite evidence.

The normative theory is often based on statistics, and it is probabilistic. The expected utility

theory as a subclass of the normative approach seeks to provide a more acceptable method of

coming to decisions that are sound and achievable outcomes.

The normative model disregards how ordinary individuals make decisions on a daily basis and to

this ends up giving no due considerations to the environments around which such ordinary

decisions were made. The normative approaches are mainly concerned about what the optimal

environment and condition are. They regard nurses making decisions as being very irrational

with undue regard to real world decision making (Skulimowski, 2011 pg 111)
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The core concepts of decision making under the normative approaches are risk assessment and

evaluation. Under the expected utility model, a comprehensive process of analyzing risks is

undertaken. The expected risk showcases explicitly presented and measured. Nurses can use this

process to come to conclusions and present their decisions. As (Skulimowski, 2011 pg 102 pg

114) further illustrates, decision trees can be used basing on the predictability of events

statistics and probability occurrence to assist in making judgments and decisions in clinical

medicine. Several techniques used in clinical decision analysis to make the decision-making

process explicit; this is achieved by breaking down the decision making into processes and

components such that the effect of different probabilities, actions, utilities as well as observations

can be analyzed. The decision trees work in such a way that problems are broken down into

choices and smaller decisions. These trees add a numerical value such as event probability to

every section of the decision.

The Expected Utility theory faces one major criticism, which makes it perhaps not ideal for the

process of decision making by novice nurses. The normative approach fails to capture the actual

circumstances surrounding decision-making processes in the medical profession. This theory

cannot be solely relied upon as (N, 2014 pg 59) clearly states especially in the field of nursing.

The normative theories are characterized by relatively incomplete information regarding the

present alternatives. There is also an absolute lack of probabilistic data that can be relied upon.

However, as a counter argument, we can say that the Expected Utility theory incorporates some

few but acceptable techniques that are employed in gauging the utility of the patient.

Pros of this theory

The key advantage is that the process is analytical hence can be relied upon to a greater degree
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Cons of this theory

Some of the advantages include the fact that, the theory makes unnecessary assumptions, its

reports are sometime bias and also that it has difficulty in accounting for risks.

The Social Judgment Theory

The best alternative process of viewing the judgment is made through comparing the judgment

quality and process. The degree of accuracy taken as a measure of the quality of judgment and

decision-making is popular spanning a broader spectrum of philosophies and disciplines.

Among the popularly known theoretical frameworks of decision-making, the Social Judgment

Theory is an alternative that offers the best mechanism for measurement of the accuracy of

decisions. The Social Judgment Theory makes one core assumption, which states the

judgment of an individual is related to their socio-environmental reality. This particular

environment could be represented in the form of lens series." (N, 2014 pg 50). Under the Social

Judgment Theory, we use an approach, which proposes theoretical framework and scope for the

analysis of judgment. Therefore, the approach is identified as Lens Model. The social judgment

theory can be relied upon due to some advantages it bears

Pros of this theory

The theory is associated with two advantages i.e. it uses relevant outcomes in decision making

and also that it is a great tool for measurement of decision accuracy

Cons of this theory

The theory makes irrelevant assumptions which may be confusing to novice nurses
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Intuitive Model as ultimate theory of choice

The intuitive theory although not reliant on any proposed framework, seems to be an ideal

theory in the decision-making. Reasons for this are vast but to start with, both novices and expert

nurses can use the intuitive theory. Novice nurses are those who recently joined the nursing

profession and therefore do not have the experience required to make use of the advanced

theories such as the information processing. The intuitive theory is straightforward and easy to

relate as well as making a comparison to other theories that highlight the same concept. More

often than not, the intuitive theory considers what seems to be the right option in the most

difficult circumstances.

Throughout the world, health professionals have always emphasized the need to utilize care

based on evidence when making decisions. Nevertheless, (Skulimowski, 2011 pg 102) suggest,

professional decision making is not necessarily best evidence-based, but rather in an intuitive

and subjective judgment of a nurse regarding the most relevant decision to pursue any clinical

challenge faced.

Complexities, Contradictions, and Inconsistences in Decision-Making Models

In my review of the four models widely used in the process of decision -making, several

disparities and inconsistencies were quite prevalent. While making decisions, the decision maker

must go through several phases. During these faces, the convergent and the divergent

explanatory phases, some inconsistencies tend to occur. This paper will evaluate some of these

inconsistencies and contradictions:

Intuitive theory
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The intuitive model in itself is a result of unconscious reasoning, and it differs widely from the

classical rational because it does not satisfy inter subjective verifiability to counter this argument.

However, we can argue that, in practice, we can always logically justify the result of this process.

Information Processing

The information processing theory is inconsistent with its address patient data and retrieving of

information from the short and long-term memory. In this regard, there is no definite way to

classify information as relevant for storage in the short or long-term memory.

As clearly defined in (Lehner et al., 2015 pg 69), making a decision in the initial problem, the

individual making the decision must account for anticipated outcomes of each linked future

decision problem. This is the approach taken by the information-processing model when it

comes to making decisions.

Expected Utility Theory

The expected utility theory lays emphasis on estimations and statistical data. As a result, the

decisions made are dependent upon what the decision maker perceives to be approximate and

futuristic. In clinical practice, several factors can alter the patients condition unexpectedly; as a

result, it is hard to rely on a probabilistic approach.

Nevertheless, we can counter this argument by categorically stating that the expected utility

theory as a decision-making strategy that has embarked in providing us with a more detailed rich

source of applications. (Lehner et al., 2015 pg 67)

The Social Judgment Theory

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The Social Judgment has a lot of positivity but it incorporates some issues that are contradicting.

In light of this, I must mention that the theory makes an omission on the credibility of a source.

This factor is crucial in affecting the attitude of the nurse making a judgment or a decision.

(Lammond & Thompson, 2012 pg 33), further clarification of the complexities of the social

judgment is outlined here is that before coding any message, one needs a cognitive map.

However, questions arise such as the case when an individual is dishonest when providing data.

This condition leads to the incorrect structure of attitude in addition to the wrong cognitive map.

This incorrect attitude structure will lead to failure when you attempt to send a persuasive. As a

result, the human nature cannot be controlled, and this restricts to some degree the social

judgment theorys effectiveness. Despite this, in defense of the social justice theory, a very

systematic approach that satisfies all the stages recommended in the process of decision-making

relies upon the main foundation (Anon, 2012 pg 270).

Conclusion

The field of nursing is advancing as the medical profession expands beyond expected borders.

We must, therefore, equip our nurses with some relevant and updated methodologies of decision-

making. This essay, clearly points out why some of the models above of decision-making are not

favored in the field of nursing. The evidence provided herein is subjected to updates from time to

time, and hence due diligence should be observed when related to them. The nursing profession

requires enthusiastic and hardworking individuals, who can come up with decisions at crucial

moments. Decisions worth relying on and which will make proper sense to the patients and their

relatives. It is for this reason that one might consider disregarding the intuitive approach to

decision making. However, this approach does not only cause impact to the nurses only but also
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to the patients close relatives. Therefore, there is a reason for recommending it as a relevant and

accessible strategy that will comply with the approach in the process of decision-making.
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References

Anon., 2012. Economics of Uncertainty. [Online]

Available at:

https://www.princeton.edu/~dixitak/Teaching/EconomicsOfUncertainty/Slides&Notes/N

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Carl, T. et al., 2014. Nurses, information and clinical decision-making real world potential for

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Goodhew, S., 2016. Sustainable Construction Processes: A Resource Text. 2nd ed. s.l. Routledge.

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Jefford, E., Fahy, K. & Sundin, D., 2011. Decision-making theories and their usefulness to the

midwifery profession regarding midwifery profession and practice. International

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