Decision-making is an essential paradigm in nursing services, where a service seeker can get proper treatment through the proper decision taken by the nurses (Abbott, Mc Sherry & Simmons, 2013, p. 45). Different kinds of theories and models have been used in the nursing practices and this study will focus on the effective theories and models of nursing practices. It needs proper application methodologies, where the service provider can deliver appropriate services to the service users. In this aspect, the nurse should contain proper knowledge for taking a good decision, which will be beneficial for the patients. The study considers some of the important theories of nursing practices and based upon that it will analyse the effectiveness of the theories. It will also focus on the way research theories help to promote good work for the nursing services. Proper application of the theories ensures the ability of the nurses and their efficiency for handling a patient. It also depends on the psychological and behavioural processes to manage a situation in a proper manner. A patient needs to be treated in an empathetic way and the decision of the nurses plays a big role in it. The care services also depend on proper medication and the time to time monitoring of the patient. According to this theoretical aspects, a patient should be delivered proper care service at the time is needed and it is the sole responsibility of the nurse to ensure a proper care service for the patient. This study will highlight the significance of the theoretical models and practices for effective decision making in nursing services.
Outlining proper decision making theories along with its pros and cons
This study is based on decision-making practices in nursing services and depending on that, some of the theories have been considered for elaborating the viewpoint of each of them. In this regard, four topics have been chosen for illustrating the perspective of the theories and its application methodologies. The theories are provided below in the following manner.
Information process theory
This theory deals with the processing of the information, where the psychological state of the human being is liable for its functionality. It is a common phenomenon of the human brain and proper processing of the information helps to direct a person in a right way. It also increases the capability of critical situation handling. In a clinical environment, a nurse needs to deal with several types of information and the nurse checks medical records of more than one patients (Alligood, 2014, p. 81). For that purpose, she should be capable enough to understand the information instantly and deliver effective service according to it. On the other hand, this procedure enhances the potentiality of the nurses to deliver better services for the patients. This theory considers the psychological aspects of the human brain, where it follows a segmented approach for its functionality. It considers human memory in three segmented parts such as sensory memory, long-term memory and working memory. It is partially related to the subconscious, conscious and unconscious mind of the human being. The sensory memory holds the information, which is necessary for the current context. Moreover, the memory does not hold it for a long time. On the other hand, working memory considers the present working situations and depends on the transferred signals from the sensory memory. This memory performs the maximum amount of work for effective decision-making. This memory tries to perform the work in a logical and meaningful way. Long-term memory works like an archive, where the stored information could be used for the future purposes.
Several advantages and disadvantages are associated with this theory model.
It performs the decision-making process through segregating the human memories in a proper format and it divides the processing of information in a segmented way. The working memory performs the maximum amount of work and prior to that, the sensory memory screens all the required information. On the other hand, long-term memory works as a repository where the knowledge and the experiences can be stored for a long time and it can be used as a future reference in decision-making processes.
The theory model often faces several problems due to lack of proper communication channel, where the thoughts and information could not be verbalised in a proper way. On the other hand, the scarcity of proper knowledge creates a big obligation in this process. Loss of memory and absent-mindedness often create barriers to recall the past events. For that reason, one cannot depend fully on the long-term memory. The workplace hazards and other competitiveness create immense pressure on the working memory. Therefore, sometimes it becomes hard to channelize the information processing in a proper method.
Social judgement theory considers the perspectives of any social occurrences and it produces a behavioural approach towards it. It is a judgemental theory, which analyses a person’s behaviour according to the performed activities. This theory follows a self-analysis methodology and it also judges the social approach of the others. In a nursing practice, the approach of the nurse and the patient both are responsible for representing a proper health care service (Thompson et al. 2013, p. 1725). For that reason, it needs effective judgemental viewpoint. This theory tries to find out the problems related to the service and according to that, it suggests a way-out for ensuring a good position. Critical judgemental viewpoint enhances the decision-making capability in any profession and it considers several perspectives for making the decisions effective in manner. The theory tries to find out proper reasons behind every action, which will be incorporated in the service. According to the justification of the services, it accepts or rejects the changes. Along with that, there are several new services, which create an argumentative viewpoint, and those services belong between acceptance and denial situations. A medical clinic can incorporate several new services within their work environment, but prior to that, it needs proper judgemental viewpoint for each of the processes. Based upon the effectiveness of the services, it could be selected or rejected. A pictorial overview of social judgement theory is given below.
It is a better evaluation process for decision making, where several methodologies try to identify the effectiveness of a decision. Like other theories, this theory also has some advantages and disadvantages. At first, the advantages are given below.
It helps to generate a belief about a particular process
It considers critical analysis of a process, where the acceptance or rejection can produce effective decision making
It is effective for advertising and promoting the service in a proper manner
It enhances the involvement with a particular decision making topic
The disadvantages associated with the theory are listed below.
This theory model does not consider the evidence related to argument and quality
It often shows that people establish their viewpoint without having much knowledge about the changes
This theory only considers the people who are actively involved with the process and otherwise it considers them as non committed members.
The intuition theory deals with the feelings of providing good services to the service seekers. It articulates previous experiences and interactions with several occurrences. Based upon that, it generates a methodology for ensuring well being of the patients. It enhances the probability of providing better services for the patients and it reflects the advance thinking capability of the nurses. The intuition of the nursing service represents the thinking procedure and the belief of the service provider (Shaw et al. 2013, p. 1300). This theory works on the perception and conscious of the service provider. The intuition of the service provider can create great impact on the future works and it represents the analysing capability of the service provider. The intuitive nature of the service provider often creates barrier in the service delivery process, when it is generated without a proper reason. Several factors are responsible for this and they are frequently changing perception, scarcity of knowledge and many more. Therefore, this process also deals with some pros and cons and they are given below.
It produces some imaginative thoughts and ideas
It creates some abstract ideas which could be useful for the future purposes
It represents some constraints of the service provider
It can drive the whole process in a negative way
It may not consider the present situation
It can bring some adverse effects on the service process
Application of Social judgement theory
The social judgement theory is effective for ensuring the nursing service delivery process in a better way. The social judgement considers the effectiveness and significance of the nursing activities and it considers the social acceptance of the services. Based on that, it finds out the way for promoting the activities in a proper manner. The acceptance or rejection of a particular decision can make effective changes in the service process (Shaw et al. 2013, p. 1288). It is a perfect assimilation of psychological and social aspects of the service work. The argumentative situations could be handled through a liberal approach. It also considers the dilemmas of the patients and the nurses during the conduction of the services. Therefore, this an effective theory, which could be implemented in the clinical environment for delivering better services to the service seekers.
Connecting the theory to practice for promoting an innovative piece of work
Social judgement theory can effectively use in the nursing services, where the nurses need to take several decision for ensuring better services to the patients. In the decision-making procedure, the service provider should possess a proper judgemental viewpoint and according to that, the decisions could be taken. The service provider needs to analyse the effectiveness and relevance of the new decisions and based upon that it should be selected or rejected. In this context, the ethical dilemmas could be considered where the nurses service delivery process could be hampered though this. The probable ethical dilemmas are in nursing occupation are listed below.
Patient may refuse proper medication and supervision
Patient may refuse blood transfusion process
At the time of providing care service the patient may comes under any physical attack
Care service for the end of life
Staffing ratios is a big concern
The ethical dilemmas could be accepted or rejected according to the relevance of it. The main objective should be designed for providing effective care service for the patients. It also considers the qualification and experiences of the nurses. The persuasive position could be determined through considering the latitude of acceptance, non-commitment and rejection (Riegel, Dickson & Topaz, 2013, p. 95). For that reason, it needs to bring proper uniformity in the work process and the decision needs to be taken for the interest of the patients. For example, a decision could be analysed in a following manner.
Nurses should provide good health care services
Proper apparatus should be provided to all nurses
Proper medication and treatment facilities should be provided to the patients
Nurses are the main decision makers in the medical services
Nurses should take patient’s opinion prior to make any decision
In the above, five activities related to nursing services are provided among which, the social judgement could consider four activities based on its relevance. It is the first and foremost responsibility of a nurse to provide good health service and the health service should be provided for improving the health condition of the patient. On the other hand, the statement four is not fully correct, where nurses are not only the decision makers in a clinical service system. Several doctors and medical practitioners are equally responsible for the wellbeing of a patient. The choices and preferences of the patient changes from place to place. It depends on their culture, belief and religious viewpoint. Therefore, the patient’s opinion must be considered before taking any decisions for the interest of the patient. Along with that, the medical services should be equipped with proper apparatus for measuring the health status of the patient. In the Australian context, the ethical dilemmas could be considered with this theory model. The nurse needs to judge the viewpoint of the patient and the service should be distributed for the interest of the patient (Langley et al. 2014, p. 15). The acceptance of the services is dependent on the structure of the health clinic and a proper monitoring service should be incorporated in the process. The implementation procedure considers proper employment of the nurses on the respective job roles and they should be experienced enough to deliver proper services. The implication strategies of the theory are listed below.
Work should be regulated in the acceptance latitude
Assuming changes in the long time span
Ego involvement should be considered
The first point considers the implementation of proper communication and monitoring services for the service seekers. The second point considers the effectiveness of the process on a long-term basis. The impact of the changes should be analysed by the service provider on an early basis and based on that the service should be delivered. The egoistic approach is not considerable in this regard, where the nurse needs to work for the betterment of the patient. On the other hand, the irrelevant demand of the patients should be handled with proper empathetic and logical approach (Laiho et al. 2013, p. 834).
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Discussing complexities, contradictions and inconsistencies between the theories
In this study, the chosen theories represent different behavioural and psychological approaches related to a nursing service. The information process theory only considers the processing of the relevant information and it depends on the mechanism of the memory. The psychological parameters and the memory management technique of human brain control this process. The sensory memory gathers the information through proper screening of the information and it sends the signal to the working memory (Kilicarslan-Toruner & Akgun-Citak, 2013, p. 180). The individual capacity of the human being controls the power of the long-term memory and the repository works as per the need of the person.
On the other hand, the social judgement theory focuses on the judgemental viewpoint of incorporating a new service within the system. The advantageous perspective should be considered in this regard and the service should be introduced for the betterment of the patients. It is not similar to the information process theory and it considers selective information for the conducting a better service. The effectiveness of this theory model depends on the selection of particular service for the service users (Dillworth et al. 2016, p. 5). This process especially considers the dilemmas associated with the nursing services and the rejection and selection should be performed according to the needs of the patients. Along with that, it also represents an argumentative viewpoint, where the condition of the patient and the inner belief of the patient should be considered. The ego- involvement is considerable in this regard.
The intuition theory talks about the inner belief and the future prediction of the medical occurrences. It also represents the other side of the intuition, where the lack of knowledge and the false prediction can affect severely on the service delivery process. It represents a complicated approach where the service provider can develop different future prediction for the limited knowledge and resources (Holm & Severinsson, 2016, p. 412).
The counter argument could be developed with respect to each theory model, where the decision making process could suffer several obstacles. According to Bradbury-Jones, Taylor and Herber (2014, p.140) the information process model should be followed as per the mental capacity of the human being. Different people gather knowledge from different sources and the capability of the sensory memory varies from person to person. The information screening procedure could not maintain uniformity in all situations. Therefore, it can affect on the working memory and the functionality of the service provider. As suggested by Cerit and Dinç (2013, p.205) the long-term memory works as a repository of information, but it should be capable enough to deliver information on proper time. The recalling of the information should not face any obstacle and the person should retrieve the information properly when it is needed. It is dependent on the capacity of the memory of the person and the instant reaction of the person for making a particular decision.
As suggested by Coyne et al. (2014, p.277) the social judgement procedure is a complex mechanism where the decision maker needs to go through a turmoil situation. The decisions should be implemented through considering all the perspectives of the care services. The acceptance and denial of the decisions are complicated in nature and it should meet the expectation of the service seeker. In this regard, some of the effective decisions may be cancelled.
As mentioned by DiCenso, Guyatt & Ciliska (2014, p.76) intuition may be the cause of extra knowledge and efficiency. The intuitive nature of the service provider could incorporate effective decisions in the service process.
This study focuses on the decision-making in the nursing services. Several theories and models have been considered for illustrating the concept of this study. It also identifies the effective theory through which the decision-making service could be designed. The liability of the nurses and the service regulations rules have been described in this study. For ensuring effective decision-making three theories have been considered in this study and those theories, produce effective decision-making strategies. All the theories focus on the psychological and behavioural approach of the decision maker. The study also selects one effective theory model, which could enhance the service delivery process. The practical implementation of the theory model is helpful for understanding the effectiveness of the theory model. It also demonstrates the viewpoint through which the service delivery process could be improved. The comparative study of several theories presents a proper overview of the concept of proper decision-making. In this study, the social judgement theory has been selected for analysing the effectiveness of the theory in nursing practices. It also talks about the functionality and the implementation strategy of the theory model. The comparison of the three theories is helpful to identify effect theory among them. The counter argument also highlights the different perspectives for each theory model.
Abbott, P, Mc Sherry, R & Simmons, M eds. 2013, Evidence-informed nursing: A guide for clinical nurses, Routledge, Abingdon.
Alligood, MR 2014, Nursing theorists and their work, Elsevier Health Sciences, Amsterdam.
Bradbury-Jones, C, Taylor, J & Herber, O 2014, ‘How theory is used and articulated in qualitative research: Development of a new typology’, Social Science & Medicine, vol. 120, pp.135-141.
Cerit, B & Dinç, L 2013, ‘Ethical decision-making and professional behaviour among nurses: a correlational study’, Nursing ethics, vol. 20, no. 2, pp.200-212.
Coyne, I, Amory, A, Kiernan, G & Gibson, F 2014, ‘Children's participation in shared decision-making: Children, adolescents, parents and healthcare professionals', perspectives and experiences’, European Journal of Oncology Nursing, vol. 18, no. 3, pp.273-280.
DiCenso, A, Guyatt, G & Ciliska, D 2014, Evidence-based nursing: A guide to clinical practice. Elsevier Health Sciences, Amsterdam.
Dillworth, J, Dickson, VV, Mueller, A, Shuluk, J, Yoon, HW & Capezuti, E 2016, ‘Nurses' perspectives: hospitalized older patients and end‐of‐life decision‐making’, Nursing in critical care, vol. 21, no. 2, pp.1-11.
Holm, AL & Severinsson, E 2016, ‘A Systematic Review of Intuition—A Way of Knowing in Clinical Nursing?’, Open Journal of Nursing, vol.6, no.05, p.412.
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