Decision Making Process - Essay Example

?Decision Making Process Introduction Decision making is one of the critical aspects of any profession. Although it can be simply said as "the cognitive process of reaching a decision”, there are a lot more complex issues that need to be taken care of behind the words “cognitive process” (freedictionary, n.d). On a practical note, decision making involves identifying all possible choices of solution, analyzing the pros and cons of choosing each decision and finalizing on the appropriate one. The choice of appropriateness is further befuddled by number of other aspects. The perfect choice depends on identifying the stakeholders involved in the decision, the impact of it to them, the moral values, the ethical goodness and finally, the desired result. So, decision making even in its ubiquitous explanation, involves so much complication. In addition, if there is an added pressure that human lives are at stake at every decision being made, then every simple decision needs a humongous amount of thinking and courage to be put in by the decision maker. Such is the profession of nursing where the nurses are made to make decisions, day in and day out. Over the years, the facilities and teaching processes that back the profession of nursing have improved so much that the current generations of nurses are equipped very well on how to execute any decision that is made but there is still an element of uncertainty involved in their profession – the real time decision making process. Several researches have been done and methods have been proposed that guide the nurses in these decision making processes. Also the nurses are put under these situations every day and as a result, reflective learning has become one of the best options to learn from each of their daily experiences. Presented here is a reflective case study of a situation where a decision making process by an inexperienced nurse is involved. The 3 most critical influences that guided her to make the decision are analyzed based on Barbara Carper’s 1978 model of Knowing. The following paragraphs describe about the decision made, the elements involved in the process and the major influences on her decision (Carper, 1978). Summary of the Decision As a qualified theatre nurse and being a fresher to the nursing job with an experience of just one week, the young nurse found herself in a precarious situation while taking care of a patient. The patient was operated for inguinal hernia mesh repair and had a LMA (laryngeal mask airway) in-situ to allow him to breathe as he recovered from the operation. The problem that she encountered in this setting was when the senior nurse decided to leave her in-charge for few minutes as she had decided to take a break. The fear of facing any emergencies alone; the possibility of aftermath that she had to face in case of any mishaps and, her inexperience prompted her to make the decision of questioning the senior staff. The inquiry included a question about the repercussions of leaving an inexperienced nurse alone with a just operated patient and a suggestion of possible replacement till the senior nursing staff returns. Patterns of Knowing Barbara Carper, in 1978, established four fundamental patterns of knowing in the belief that it could help a great deal for the betterment of the nursing profession both in teaching as well as learning aspects. It becomes mandatory to give a brief description about the four patterns of knowing before divulging more about their relationships with the decision made (Carper, 1978). Empirics: The science of Nursing According to this knowing, nursing is a science where the knowledge mainly focuses on empirical data. According to Barbara, nursing in this aspect is researched and theorized in terms of factual data so that most of the empirical knowledge can be analyzed to form laws and regulations that could provide a structure to the study of nursing. There is a strong urge among the nursing practitioners and researches in identifying the structures and models of nursing. And the output of such immediacy is the new concept of considering health to be a volatile concept, largely dependent on its interaction with its internal and external environments. The result of which is that many researches have started exploring concepts about health which were not even in the picture till this perception came into existence. One major term that needs to be given attention here is ‘adaptation’ (Carper, 1978). Adaptation to factual data and empirical knowledge allows for easy verification of the results and definitions that are proposed by the researchers in the field of nursing. Esthetic: The art of Nursing This section of knowing deals with the aspect of empathy among the nurses towards patients. It can be explained as the ability of the nurses to gauge with the emotions of the patients so that they are able to meet the necessities of the patients at the earliest. Barbara defines nursing to be an art but at the same time contradicts the notion of considering nursing to be an art. It is because, art is a vast concept and it cannot be scrutinized to give a single definition for the field of nursing. She further explains that nursing is referred to the concept of art because it depends on how well a nurse treats and responds to her patients. She further explains that such kind of empathy comes to a nurse along with experience and the more experienced a nurse becomes, the better she can exercise her duties. With experience comes knowledge of alternate ways of decision making and hence the complexities involved in a decision making process further increases. In the end, the author concludes this section by saying that,” The esthetic pattern of knowing in nursing involves the perception of abstracted particulars as disatinguished from the recognition of abstracted universals. It is the knowing of a unique particular rather than an exemplary class.” (Carper, 1978). The component of personal knowledge According to the author, “Passionate Participation in the act of knowing” is what constitutes this knowing (Polanyi, 1964). The reason to consider personal knowledge as one of the fundamentals is because it is the most difficult to acquire and if acquired, the most essential in establishing a successful nurse- patient relationship. Nursing, according to Barbara, is all about “interpersonal communication” and hence, the ability of the nurse to accept their self and their client is a primary need for nursing to be practiced efficiently (Carper, 1978). The author further explains that one can understand the self only if the person is willing to explore the unknown, accept the ambiguous things and admit the faults. In conclusion, the author believes that a nurse should understand more than what the general facts about the nature of a particular human being indicates. The nurse should understand in person – the true self. Only then the personal knowledge comes into action and provides a sense of integrity and completeness to the relationship. Ethics: The Moral Component The moral component of knowing deals with the knowledge about ethics and morality. Ethics is prevalent in any profession. In nursing, there is a greater importance placed on ethics and morality as the entire functioning of this profession depends on communication and trust. In decision making, nurses have to trust themselves while making decisions and the patient has to trust on the nurses whilst they treat them. A patient’s trust can be obtained only if the ethics of the nurse, such as maintaining the privacy of the patients, having a confidentially agreement between them and respecting the human rights of an individual is observed. While necessitating treatment, it is the responsibility of the nurse in an ethical perspective, to get the consent of agreement from patient about the treatment. Also, on a moral thinking basis, it is about the perspective of the nurse to identify the right from wrong in situations where there is a moral dilemma (Thompson, 2000). Elements of the decision making process In the given case study, there are five elements involved in the decision making process. They are Knowing the problem There is a clear rationalization involved in identifying the problem and the rationalization meant that there is a decision to be made involving the decision making process. The rationalization that was given included the facts that the nurse is relatively new to the work, the patient is just out of an operation, no senior staff to accompany and lack of knowledge on processes to implement in case of ad-hoc situations. Criterion identifications Having established the reason for involvement of decision making process, there is need for establishing the boundary conditions that will be satisfied by the decision that is made. They include the presence of a senior staff in charge, treatment in case of emergencies that can be done in consultation with the senior staffs and most importantly, ensuring the safety of the patient. Identification of right decision The right decision was made considering the fact that the higher officials were in concordance with the decision, even reprimanded the senior staff and asked the others to assist the inexperienced ones. Second reason being that the patient was not put under any difficulties as the young nurse was restricted from taking full responsibility (Payne et. al, 1993). Action The action taken by the junior nurse was inquisition of the senior staff. As a result, the decision made by the nurse was implemented. Implementation of the decision is one of the prime elements of an effective decision making process. Outcome Outcome was that the safety of the patient was ensured and the young nurse was saved of any troubles. Irrespective of the scolding from the senior staff, a positive feedback was given by the higher department on her decision as they enacted a new policy that the junior staffs always work under the supervision of the senior staffs (Heath, 1998). Influences on the Decision making process There are three major influences with respect to the decision making process associated with the scenario. They are 1. Feminism. 2. Legal influences 3. Ethical and Professional influences The influences of each of them are critically analyzed below. Feminism "As a world view that values women and that confronts systematic injustices based on gender" (Chinn & Wheeler, 1985) is the explanation given for feminism. Feminism and women go hand in hand. Both have equal influence on each other as feminism is based on empowering women from their context of experiences. Only with the will power of the women, their vision to enlighten their gender fights against the ignominies happening across the world. As feminism took its shape, the same force and will is pushing the nursing profession, consisting of majority of women, towards developing theories and laws that execute and rule the nursing practice (Bunting & Campbell, 1990). Under this context, feminism has helped women to work and believe as a homogeneous group, act against sexual oppression and fight against any irregularities that occur to them just because of their gender. “Nursing Science”, as termed by Barbara in her model of ways of knowing, is no exception to feminism. According to Macpherson 1993, the feminist methodology has made several changes in stating facts and theories in the field of nursing science. (MacPherson, 1983) Several feminist movements had opened a window for the inclusion of feminist theories in this field. But, in reality, feminism and nursing have not gone down well among the nurses in the past. The nurses continued to be non-feminists because feminism makes them devoid of the caring aspect – the essential aspect in nursing profession. But, as time progresses, literary critics are of the opinion that nurses would learn to value their true self and once they realize that, they will progress towards eliminating the inequalities in their profession and commit for changing the status quo (Baumann &Bourbonnais, 1982). The decision made here could be considered as an influence of feministic approach. The reason behind this is that the junior nurse has defied the odds and mustered courage to act against the decision of her senior staff. Under the conditions, considering there is an irregularity in the decision made by the senior staff and there is possible hints of commandeer of the senior staff over junior nurse, the decision made by the junior nurse, in every right, is influenced by the attributes of feminism. Legal influences Legal issues always surface at the top of every decision-making process done in a clinical setting. Consent with the patients regarding the treatment given to them is one of the very critical issues that every nurse needs to do before proceeding with any decision. In situation where the patient is unable to respond, such as the patient discussed in this situation, more often than not, the consent is an implied one and treatments are carried out. According to the patient-self-determination act of 1991, the role of the nurse is added up with the responsibility of explaining all the legal issues in advance to patients who may become unconscious or could not render their thoughts during treatment. But, in case of patients who are kept in critical care, decision making capacity of the nurses should be at their highest level. In such cases, legal issues play a major role in influencing decisions (Harbison, 2001). In the current scenario, if in case, the young nurse had opted for individual care in the absence of the senior staff and, if a situation had arisen where her decision, taken during that time caused catastrophic results, then there is every chance for her to get penalized and get indicted. Hence, her personal knowledge - one of the fundamental ways of knowing and her socio-political knowing allowed her to understand the legal influences that she might have to face and helped her in acting against the decision of individual care (Thompson & Dowding, 2002). Ethical and Professional influences There are certain situations in decision making where the physicians try to encourage the kin and relationships of the patient to support a decision step taken by the physician for treatment, provided the patient is unable to respond. In those situations, nurses play a very minor role. So, when they are attending such cases and if an emergency occurs, although they can make a decision with their experiences and skill gained, they cannot do so because of lack of prior information about the decision made by the physician. As a result, there decision making process gets clouded with confusion and uncertainties. The scenario stated above is an example of how professional influences can affect a decision making process (Cassells & Gaul , 1998). Professional influences always play a major role in the process of clinical decision making. As Barbara mentioned in one of her knowing pattern, the art of nursing - with more experience in the profession, comes great skills and added complexities in decision making. In this scenario, because of lack of experience, the young nurse is unable to cope with the pressure of handling the patient alone and hence goes for the option of confronting the senior staff. Professional experience has influenced the decision she made in a great way (Clark, 2002). Ethics, on the other hand, as described by the model of knowing is an essential aspect for any nurse to make a decision. Understanding the role of ethics in a decision making process goes a long way in establishing the interrelationship trust between the patient and nurse. The decision made here was thoroughly influenced by ethics. The reason to support this claim is that, though the young nurse had personal knowledge about ethics in profession, still claiming courage, defied the decision made by the senior staff. The reason for disagreeing with the senior staff is because she cared for the patient’s health. Showing care is the reason for which people opt for nursing and she justified her ethical responsibility by making this decision (Fedorka & Husted, 2004 ). Conclusion Nursing is a profession that is gaining importance every day in a clinical setting amongst several other clinical professions. There is always scope for improvement and reflective learning is one such method that allows for continuous learning. The scope of working areas for the nurses are growing wider with many legal and ethical issues scrutinizing their everyday decision making process. Hence, it becomes all the more important to gain knowledge about the radical components of the nursing profession. The science of nursing was explained with Barbara’s model of knowing and the 3 most critical influences that guided the young nurse under discussion to make the decision were also analyzed. References Bunting, S. & Campbell, J. C. 1990. Feminism and nursing: historical perspectives. Advances in Nursing Science, 12(4), pp.11-24. Chinn, P. L. & Wheeler, C. E. 1985 Feminism and nursing. Nursing Outlook, 33(2), pp.74-77. MacPherson, K. 1. 1983 Feminist methods: a new paradigm for nursing research. Advances in Nursing Science, 5(2),pp.17-25. Cassells, J.M. & Gaul, A.L. 1998. An ethical assessment framework for nursing practice. Maryland Nurse, 17(1), pp.9-12. Clark, C. 2002. Ethical decisionmaking in the business of healthcare. [online] http://itc.boisestate.edu/mediashowcase/media/EDM_Spring_2002.pdf [Accessed 25 Feb 2011]. Fedorka, P. & Husted, G. 2004 Ethical decision-making in clinical emergencies, Topics in Emergency Medicine, 26(1), pp.52-60. Thompson C, Dowding D. Clinical Decision Making and Judgement in Nursing. London: Churchill Livingstone; 2002. Harbison J. 2001. Clinical decision making in nursing: theoretical perspectives and their relevance to practice. J Adv Nurs. 35(1), pp. 126–33. Heath H. 1998. Reflection and patterns of knowing in nursing. J Adv Nurs. 27, pp.1054–9. Carper BA. 1978. Fundamental patterns of knowing in nursing. Adv Nurs Sci. 1(1), pp.13–23. Payne JW. Et. al, 1993. The Adaptive Decision Maker. Cambridge: Cambridge University Press. Thompson, C. 2000. Clinical decision making in nursing: theoretical perspectives and their relevance to practice – a response to Jean Harbison. Journal of Advanced Nursing, 35 (1). pp. 134-137. Polanyi, M. 1964. Personal knowledge. New York: Harper and Row Baumann, A. and Bourbonnais, F. 1982. Nursing decision making in critical care areas. Journal of Advanced Nursing, 7, pp.435–446. FreeDictionary.n.d. Decision Making Definition. [Online]. Available at: http://www.thefreedictionary.com/decision+making [accessed 25 Feb 2011] Read More