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Theories Of Medical Decision Making And Health

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Discuss about the Theories of Medical Decision Making and Health.



The nursing environment is often complex and requires regular and effective decision-making continuously, decisions that have direct implications for the nursing professionals as well as the patient. With the increase in complexity of healthcare, Kydonaki et al. (2016) point out that nurse is forced to rely on effective and sound decision-making skills with the aim of maintaining an up-to-date care ad positive health outcome to the patients. The same study notes that nursing professionals are responsible for the decisions they make at the organizational and professional levels. It is thus necessary for the nurses to be aware of the effects and impacts of the decisions they are making towards their professionalism, the patient, as well as the organization in which they work. Reyna (2012) denotes that decision-making is a professional responsibility in the health industry is also recognized in the code of professional conduct by the Nursing and Midwifery Council.

In a systematic review by Muir (2014), the study notes that there is an increase in the emphasis on adoption of evidence-based practices in the healthcare profession. The same study notes that the conscientious, judicious, and explicit adoption of current best evidence is making the process of focused towards the rights of the patients. It hence makes it clear the need for nurses to using a conscious process of making decisions not only based on the evidence to use but even on the particular patient they are making the decision reference upon. Gaining an insight into the process adopted by nurses in making decisions should also be visible to the management and the healthcare team as they can as well help in making effective decisions depending on the complexity of the situation. Tscharaktschiew (2016) notes that decision-making is an aspect that is beneficial and can improve communication, interprofessional relationships, and patient care.

The objective of this paper is providing analysis of the nursing decision-making process with a major focus on the models used. The paper narrows down to three models adopted by nurses in decision-making where each model is analyzed in relations to its pros and cons within the nursing practice i.e. information processing theory, contingency theory, and cognitive continuum theory. The paper also focuses on Santos (2016) that will apply in my nursing practice with a clear rationale as to why it is the best model. The paper also discusses contradictions, inconsistencies, and complexities for the decision-making making theories discussed with a counter argument of each theory and its effectiveness.

According to Tscharaktschiew (2016), a decision is a point reached, a solution, a resolution, or a conclusion reached after a consideration. The same study notes that effective decision-making in nursing practice is often carried out by adopting some specific models of study based on evidence that is involved in a deliberate mental choice in relation to the secondary sources presented in the study. In his study, Santos (2016) notes that the attempt of describing a decision in clinical setups often focused on certain conceptual frameworks or models that govern the process. Studies show that there are various models adopted in the interpretation and explanation of decision-making. However, the diversity between the models has often been masked by and the common themes between them are not clear.  In their study, Kydonaki et al. (2016) also assert that when making a decision in healthcare using analytical approaches, it is necessary that the nurse making the decision relates the presenting situation to certain roles, often considered the models or guideline principles of decision-making. There are several theories that can be adopted in a clinical setting with the aim of achieving effective decisions for nurses in a clinical setting. These include;


Information Processing Theory

According to Tscharaktschiew (2016), the assumption of the information processing theory is that decision-makers often store the relevant information on their memory and the effective decision reached occurs when the decision-maker retrieves the information from both the long- and short-term memory. With nursing profession considered a profession that requires academic qualifications, Muir (2014) points out that the information gained from education as well as an individuals’ experience is often stored throughout life in the long-term memory of the brain. The same study suggests that clinical experts and nursing professionals often use the short-term memory information in simulating the retrieval of the information in the long-term memory. For example, a nurse dealing with the diagnosis of a leg ulcer will use the short-term memory on the knowledge of the patients’ signs and symptoms to retrieve the information stored in the long-term memory on the symptoms and signs of venous body ulcerations.

In his study, Reyna (2012) denotes that information processing theory often underpins other models of nursing decision-making. For instance, a seven-stage processing model suggested by Thomas and Carnevali (1999) denotes that making a decision in nursing care requires certain procedures that need to be followed for effectiveness. The model describes a seven-step diagnostic reasoning that involves, presenting a pre-encounter data, entry of the data into while shaping the data gathering direction, and coalescing of the information cues into chunks or clusters. Also involved are formulation of hypothesis or activating possible explanations of diagnosis, data-directed search of the hypothesis, testing of the relevant hypothetic diagnosis, and processing of diagnosis.

In other words, the health professional meets the patient and gathers information such as the history of the patients as well as the signs and symptoms of an infection among other vital information. Santos (2016) points out that following the interaction or during the process, the nurse begins to note the key information of the data which are later used for making inferences. According to the theory, this is the point at which both short and long-term memory are both engaged as the nurse clusters the information together while identifying the relevant patterns. It is from the careful considerations of the collected information and the evaluation of the formulated hypothesis that a decision is made on the correct diagnosis of a situation. However, Muir (2014) denotes that information processing theory outlines other important stages of nursing decision-making that are often considered as temporary stages as they do not have to follow a specific linear pattern.  The theory suggests stages such as the recognition of the situation that needs a decision made, formulating an explanation, alternatively generating other possible explanations, searching for information for the clarification of the available evidence and choices, making a relevant judgment of the choice, taking action, and reporting a feedback as pointed out by Dowding (2010, P. 78).

According to Muir (2014), information processing theory is often considered to be flexible at is directly focusing on making effective decisions towards the duties of the nurses. However, the purpose only differs slightly with the cognitive continuum model in that the objective of the decision is often the action rather than the diagnosis process. According to Daviter (2014), the information processing model is often preferred by many nursing professionals as the most flexible decision-making model. The same study denotes that the model often considers pattern recognition on the basis of some critical information. The pattern recognition adopted suggests that every case is compared with other previous cases that are then stored in the short and long-term memory of an individual and categorized or classified according to the similarities between them. In other words, information processing model allows the use of other past experiences and ideas in solving the current situation.


Contingency theory in nursing

According to Daviter (2014), the basis of the contingency theory of decision-making in a clinical setting considers having other alternatives as solutions to a problem rather than just considering a single way as the best in handling any clinical challenge. Whether it is the organization of the entire healthcare setting or planning a patient treatment workflow, the best nursing decision is often influenced by the external and internal factors affecting the predetermined situation as the decision-making style. In his study, Reyna (2012) denotes that in contingency theory, there is a universal strategy for effective health care provision and patient management within a clinical setting. The design of the healthcare setting, structure, and culture of the organization must be in line with the various environmental aspects affecting decision-making. For example, decision-making towards the best way of dealing with a medical complication in the patient will have to adhere to the recommended health care standards and guidelines by the relevant healthcare bodies to ensure a collaborative and corporative process that abides by the guidelines.

In his study, Tscharaktschiew (2016) denotes that applying the contingency theory in nursing leadership and management styles will depend on several factors that govern the need for effective decision-making. For instance, making an effective decision of care for long-term health conditions such as cancer, depression, diabetes, dementia, etc, depends on the social, economic, psychological, and environmental factors affecting the patient and the family. In his study, Muir (2014) denotes that long-term health conditions are often accompanied by the stress of acceptance, poor communication, and social withdrawal, aspects that require an evaluated decision on the treatment process that will be effective depending on the condition of the patient. In such cases, contingency theory becomes very vital in evaluating the most suitable methods of care such as collaborative care or person-centered strategies. Therefore, the nurse-patient relationship, the state of the patient conditions, the organizational structure, and experience of the nurses among other factors are essential for the contingency theory as they have both direct and indirect influences on decision-making towards healthcare.

On the other hand, contingency theory when applied in making a decision in the clinical setting as it has its advantages and disadvantages. Daviter (2014) denotes that the effectiveness of the decision made will depend on the balance of the importance of the decision made. It is also based in how complete the decision-makers are informed on the subject and the likelihood of reception or acceptance of the decision made. Contingency theory hence requires effective communication between the nurse and the patient so that awareness can be made on any unpopular decision to increase the chances of positive results at the end of the decision-making process.

Cognitive Continuum Theory

According to Campbell (2015), all processes of decision-making often involve at some point various forms of comparisons that principally include comparisons between decision situations, between alternatives, as well as between possible attributes of the different alternatives. Cognitive continuum theory of decision-making is identified as one of the recent theories not only in clinical setting but used even in other industries. According to the theory, many clinical judgments are often present information that tends to induce an oscillation between intuitive and analytical cognition (Dowding 2010, P. 78). The theory also suggests that judgments and decision-making processes are often joint functions of cognitive properties and task properties. In other words, the theory suggests that different tasks of decisions should be done by adopting different but relevant cognitive processes.

In a strategic analysis of the study, Lauri and Salantera, (2011) denote that a decision-making task involving various uncertainties tends to be difficult when it should be broken down into different components. In such a case, it is more advisable adopting a more intuitive approach other than a decision task is properly structured with few but more recognizable cues. According to Hamers et al. (2013), cognitive continuum theory has been tested in other non-clinical settings and is accepted as an alternative way of nursing decision-making conceptualization. The theory is hence adopted in many nursing organizations as a tool or instrument of exploring the perception of nurses on decision-making as it influences the method through which nurses arrive at effective decisions in the practical clinical situations in the process of healthcare provision. The theory is hence mainly used in the examination of the cognitive processes often adopted by nurses in making healthcare decisions while correlating them with contextual and demographic factors an aspect that is considered as an advantage to both the nurses and the organization.


Choose one that you will apply to your nursing practice with a clear rationale

In his study, Muir (2014) points out those nurses often make a range of decisions in their daily practices. There are also different perspectives or stances aimed at explaining decision-making that differs in the account of influence as well as the extent at which the decision made is intuitive depending on the model adopted by the nurses. Campbell (2015) also denotes that clinical decision-making is considered an integral aspect of the role of nurses especially in times of decision-making complexities. Information processing decision-making theory will be the most effective for use in any clinical setting as its solutions are reached based on the evidence of the patient's information.The theory often involves situational variables and identified clinical experiences as major influencers of decision-making in relation to the cues retrieved from the long- and short-term memory of an individual.

In a systematic review, Tscharaktschiew (2016) denotes that professional experience, nursing knowledge and skills, and evidence-based perspective often supports effective decision-making models. These factors hence determine the informed values of the patient, the available professional resources, as well as research knowledge on the conceptual nursing issue that calls for the decisions. Information processing theory is hence more advantageous as compared to contingency and cognitive continuum theory.

Complexities and contradictions of the theories and provide one counter-agreement

According to Kydonaki et al. (2016), the development and adoption of descriptive theories in the clinical model have been very dynamic. Despite the development of information processing theory, contingency theory, and cognitive continuum theory many authors have come up with frameworks with the primary aim of a better understanding and comparison of the descriptive theories. Daviter (2014) proposed that the process of human development involves at least one of the three modes of decision-making; matching, reassessment, and consequential choice. The same study denotes that the three modes often form an argument-driven as well as an interactive framework where actions towards decision making are categorized by discussion and argument rather than the choice of forward-looking.

Irrespective of the theory adopted in the clinical setting, it is essential that nurses should be very objective and focus much on the decision itself based on the factors surrounding the decision. These factors can be internal or external but have a direct influence on the kind of decision to be made by the nurse as pointed out by Santos (2016, p. 416).  The same study denotes that many people have often compromised good decisions as a result of self-interests, fear, and feeling from other people hence resulting into negative eventualities. However, adoption of contingency theory often comes with challenges as decisions are at times made on the personal ground and self-interest while neglecting the most effective alternative for the best result.

In a clinical setting, the results of a bad decision can be destructive or can lead to an adverse negative effect on the decision-maker, the receiver, the organization, as well as the community at large. In his studies, Campbell (2015) denote that some of the effects of decision-making models in the clinical settings include lessons being learned in a hard way, loss of property and jobs, time wastage, wrong diagnosis and medication, economic losses, misplaced priorities in terms of both individual and organizational objectives and goals, and in worst cases, loss of life.

Despite the challenges facing the adoption of the theories in a practical clinical decision-making process, Muir (2014) presents a counter argument with the idea that the use of every theory often based on the factors affecting the decision-making process as well as the complexities involved. However, every theory is often practiced at different levels depending on the objective of decision-making.

Depending on the situation, all the theories are effective since they are evidence-based. According to Kydonaki et al. (2016), an effective decision-making theory should be predictive and explanatory since quality in decision-making is essential other than focusing on evaluating every factor involved while missing the objective of the decision-making process. However, information processing theory is preferred by many nurses as it ideally encompasses prior theories and relevant data rather than contradictory evidence by different authors as pointed out by Campbell (2015, p. 6).



Decision-making in any industrial setting is an essential aspect for nurses and other medical practitioners. The more experience one acquires in making a decision, the more one gets familiar with the processes and tools that can lead to effective and sustainable decision-making. Proper decision-making is not only essential to an individual and the receiver of the decision as well as the organization. As a result, it is essential for a professional to learn the theories, models, and tools of effective decision-making in their respective organizational responsibilities and that can aid in making good decisions. With the analysis of the various theories that can be adopted in effective decision-making in a clinical setting, it is essential that every nurse understands the effect and implication of every theory adopted. The process of making effective decisions in nursing practice environment is a very complex process but very integral to the nursing profession. In this report, the process of decision-making is a very dynamic conceptual process that can easily affect not only the nurses but even the outcome of the patients who receives healthcare.

Depending on the theories, decision-making is also affected by the size of the clinical setting or healthcare organization, differences between the nurses and the leadership, operational management styles, government regulations, technologies, socioeconomic conditions, attitudes between patients and nurses, and the corporate cultures.  In other words, nurses are called upon to be very evaluative to understand the aim and effective ways of making sound decisions with a self-reflection idea in developing the process further within their professional environment. Gaining an insight into the process adopted by nurses in making decisions should also be visible to the management and the healthcare team as they can as well help in making effective decisions depending on the complexity of the situation.


List of references

Campbell, S 2015, ‘Cognitive Continuum Theory in nursing decision-making’, Journal of Advanced Nursing, 49(4):397-405, Academic Search Premier, EBSCOhost, viewed 24 April 2017

Daviter, F 2014, 'An information processing perspective on decision making in the european union', Public Administration, 92, 2, pp. 324-339, Business Source Premier, EBSCOhost, viewed 24 April 2017.

Dowding, J, 2010, ‘Commentary on Banning M (2008) A review of clinical decision making: models and current research’ Journal of Clinical Nursing, vol. 18, no. 2, pp. 309–311, 2009.

Hamers, H. Huijer A, Saad, R, & Halfens, G, 2013, ‘Diagnostic process and decision making in nursing: a literature review,” Journal of Professional Nursing, vol. 10, no. 3, pp. 154–163, 1994.

Kydonaki, K, Huby, G, Tocher, J, & Aitken, L 2016, 'Understanding nurses' decision-making when managing weaning from mechanical ventilation: a study of novice and experienced critical care nurses in Scotland and Greece', Journal Of Clinical Nursing, 25, 3/4, pp. 434-444, Academic Search Premier, EBSCOhost, viewed 24 April 2017.

Lauri, K & S. Salantera, 2011, ‘Developing an instrument to measure and describe clinical decision making in different nursing fields,” Journal of Professional Nursing, vol. 18, no. 2, pp. 93–100, 2002.

Muir N, 2014, ‘Clinical decision-making: theory and practice’. Nursing Standard. 18, 36, 47-52. Date of acceptance: January 9 2016.

Reyna, V, F2012, ‘Theories of Medical Decision Making and Health: An Evidence-Based Approach’ Medical Decision Making?: An International Journal of the Society for Medical Decision Making, 28(6), 829–833.

Santos, I 2016, 'Decision-making in Healthcare: Item and factor analytic procedures for model appraisal', Psychological Assessment, 28, 4, pp. 416-428, PsycARTICLES, EBSCOhost, viewed 24 April 2017.

Tscharaktschiew, N 2016, 'The who and whom of help giving: An attributional model integrating the help giver and the help recipient', European Journal Of Social Psychology, 46, 1, pp. 90-109, Academic Search Premier, EBSCOhost, viewed 24 April 2017
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