Decision Making procedure in clinical practice

easy guide for clinical decisions

1. DECISION –MAKING IN
NURSING

2. 2
Decision –Making In Nursing
The process of selecting one action
from alternatives
Decision making is the learned &
scientific problem solvingprocess.
Managers spend much timemaking
decisions and solving problems,
especially non routine situations

3. 3
Decision Making Process
1) Identify the problem:
-Defining the problem. What is wrong?
Where is improvement needed?
-Begins when the nurse manager
perceives a gapbetween what is
actuallyhappening and what should
behappening.
-The nurse manager can identify the
problem by analyzing situation.

4. 4
-What is the desirable situation?
-What are the presenting symptoms?
-What are the discrepancies?
-Who is involved?
-When? Where ? How?
* Develop Feasible hypotheses, and
elimination of hypotheses that fail to
conform to the facts.
-Feasible hypothesesshould be further
tested for causal validity.
-By analyzing available information,
manager should begin exploring possible
solutions

5. 5
2) Explore alternatives:
-If situation is not covered by policy,
manager must draw on his education
and experience, but it may be
inadequate.
-more experiencedmanager had more
alternativesto be suggested for solving
a variety of problems.
-Health care is changing rapidly, manager
should learn how othersare solving
similarproblems.
-This can be done through continuing
education, professional meetings,
review of the literature, and

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3) Choose most desirable alternative:
-One alternative is not always clearly
superior to all others.
-Managermust try to balance multiple
factors such as pt safety, staff
acceptance, morale, public acceptance,
cost, and risk of failure.
* The following questions may be
asked:
-Will this decision accomplish the stated
objectives? (yes or no)
-Doseit maximize effectivenessand
efficiency? use available resources
before seeking outside assistance.
-Can the decision be implemented? If
not, it will not solve the problem

7. 7
4) Implement decision:
-The manager will need to
communicatethe decisionto
appropriate staff smoothlyto winthe
cooperation
5) Evaluate results:
-Evaluate the results of the chosen
alternative.
-Be alert: solutions to old problems
sometimes create new problems, so
you need additional decisions.

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Creativity In Decision Making
The ability to develop and implement new
and better solution
The creativity has four stages.
1) Preparation:
-Acquiring information to understandthe
situation. through observation and
extensive use of data collection.
2) Incubation stage:
-Is a period for pondering لمأتthe
situation.
-Repetition of the same thoughts.
-No new ideasor interpretations.
-Reexamine the situationand review the
data collected.

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3) Illumination (insight):
-Is the discovery of solution may be during
performance of another task.
4) Verification:
-Experimentation of solution (succeeded or
failed
Ethical Decision Making
Ethics:
-Moral philosophy.
-Science of judging the relationship of
means to ends.
-The art of controlling means.
-Involves conflict, choice, and conscience

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*Why ethicsbecame greater dimension
in decision making?
A . Increasing technology, and regulatory
pressures.
B . Competitivenessamong health care
providers .
C . Nursing shortages, and reduced fiscal
resources & spiraling costs of supplies
and salaries.
D . The public’sincreasing distrustof the
health care delivery system and its
institution.

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EthicalDilemmas
Choose decision between two equally
desirable or undesirable alternatives
Values, beliefs, and personal
philosophy play a major role in the
ethical decision making.
If no right or wrong answer exists? Or
if both answers are right or wrong?

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Characteristics of Ethical Dilemma:
1.Problem cannot be solved using
only empirical data.
2.Problem must be so
perplexingةريحمand making the
decision is difficult.
3.The result of the problem must affect
more than the immediate situation .

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Ethical Problem Solving And Decision
Making.
Systematic ethical decision making and
problem solving:
-Reduces personal bias
-Facilitates betterdecision-making
-Managersfeel more comfortable about
decisions they have made.
If problem solving approach is used:
-Gathering datais adequate
-Alternativesare analyzed
-Manager feels that the best possible
decision wasmadeat specific time and
available information regardless of the
outcome.

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MORALDecision -Making Model:
Crisham(1985)
-M.—Massage the dilemma.
Collect data about the ethical problem.
-O.—Outline options.
Identify & analyze alternatives and
consequences of each.
-R.—Review criteria and resolve.
Weigh the option's effect in the decision
-A. —Affirm position and act.
Develop implementation strategy
-L.—Look back.
Evaluate the decision making.

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Ethical Frameworks For Decision Making
Not solveethical problem, but assist
manager in clarifying personal values
and beliefs
1) Utilitarianism:
-Make a decision based upon providing
the greatest good for the greatest
numberof people
Ex. :using travel budget money to send
many staff to local workshops rather than
sending one or two individuals to attend
a national conference.

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2) Duty –based reasoning:
-Some decisions must be made because
there is a duty to do what is right
3) Rights based reasoning:
(Rights are different from needs, wants, or
desires)
4) Intuitionist framework:
-Decision maker reviews each ethical
problem on a case-by case basis
comparing the relative weights of goals
duties and rights.
* Determined primarily by intuition.
-What the decision maker feels is rightfor
the particular-situation
-Disadvantages are subjectivity and bias.

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Models For Ethical
Relationships:
1. Priestly model:
The manager is paternalisticand make
decisions without considering other’s
values. ‘Autocraticleadership may use
the priestly model”
2. Engineering model:
Suggests that one person presents facts
to another and sets aside his own ethics
to do what the either wants.
“Staff working for line authority may be
an example of this model”

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Models For Ethical Relationships.. Cont.
3. Contractual model:
-Contract that identifies general
obligations and benefitsfor two or more
people.
“Deals with morals of both parties and is
appropriate for superior-subordinate
relationships”
4.Collegial model:
Individual's share mutualand reach
decisions through discussion and
consensus.
(build teams and minimize conflict).
*The result of ethical decision must be
ethical & not to be unethical.

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Selec1ing Decision Making Styles
Continuum of participation:
Members of a group or organization
Participate in decision making. The extent of
participation depend on organizational
philosophy, managerial style.
-Agencies allow greaterparticipation are
democraticin nature, & those discourage
participation are autocratic
**Tannenbaunand Schmidt:developed the
continuum of leadership and participation
related to the degree of authority used by the
leaderand the freedom of subordinatesin
decisions.
Extreme leftcharacterize the manager who
maintains a high degree of control, whereas
the right characterize the leader who releases
a high degree of control.

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12 3 4 5 6 7
Use of authority by manager
Area of freedom for subordinates
Manager
Makes
Decision
And
Announces
It
Manager
sells
Decision
Manager
Presents
Ideas
And
Invites
Question
Manager
Presents
Tentative
Decision
Subject
To
Change
Manager
Presents
Problem
Gets
Suggestion
Makes
Decision
Manager
Defines
Limits
Asks
Group
To make
Decision
Manager
Permits
Subordinates
To function
Within
Limits
Defined
By superior

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رارقلا ةعانص بيلاسأ
.1 ددحي ريدملار ذخأي لاو رارقلا عنصيو لئادبلا عضيو ةلكشملا يأ
دحأ.
.2تب نيرخلآا عانقإ لواحيو رارقلا عنصيو ةلكشملا ددحي ريدملا لبق
ةلوهسب رارقلا
.3حاضيتسلااو ةلئسلأل نيرخلآل ةصرفلا حيتيو رارقلا عنصي نكلو تا
رارقلا ىلع ريثأتلا نود
.4لا رارقلا ذخأي مث نمو نيرخلآا لعافت ةفرعمل تقؤم رارق ذختي يذ
مهروعش يعاري
.5ب راتخي مث مهتاربخ نم ةعبانلا تاحارتقلاا ذخأيو ةلكشملا ددحي ليد
مهعم ةكرتشملا لئادبلا نم بسانم
.6 رارقلا ةعانصل نيرخلآلو هسفنل دودح عضي(عم ةعاس فصن لاثم ان
رارقلل )
.7و هيف دعاسي لا وأ دعاسي امبرو رارقلا ةعانصب نيرخلآل حمسي يف
درف يأك هتطلس نوكت ةلاحلا كلت

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Manager can be autocratic or democraticin
decision making depends on the
following factors:
1.How important is the quality of the
decision?
2. Does manager have sufficient information to
make a decision? If not, others should be
involved in the decision
3. Is there acceptance of the decision from
subordinates?
-Subordinates should be included in decision
making if they affected with it.

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Outcomes that influence the effectiveness
of decision
1. The quality of the decision .
2. Acceptance of the decision by the
subordinates .
3. Available time needed to make the
decision

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Managercan diagnosesituation quickly&
accurately by answering the following
questions
1. Is there a quality requirement?
2. Do I have sufficient information to make a
decision?
3. Is the problem structured?
4. Is acceptance of decision by subordinates
critical?
5. If you have to make the decision by
yourself, is It accepted by your
subordinates?
6. Do subordinates share the organizational
goals to be obtained in solving this
problem?
7. Is conflict among subordinates likely in
preferred solutions?

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Individuals as decision makers:
Autocratic manager:
-Try to make decision by himself
-Fears that others decisions may be
more costly, less effective and
affecting his power
Everyone has different decision
making style affectedby values, life
experiences, preferences, risks, and
thinking way
People may perceive the same
situation differently

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1. Values and decision making:
(decide mode of conduct)
2. Life experience and decision making.
3. Perception (Individual preference) and
decision making.
4. Individual ways of thinking and decision
making
(Decision is a thinking skill, and Individuals think
differently)
5. Personality
Group factors in decision making:
It is unusualfor an individual to dodecision
making process by himself.
Commitmentto the decisionis important and
increased by participationin the decision
making process
Individuals as decision makers: cont.…

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Advantages of group participation in decision
making:
1.Increase acceptanceand enhanced
cooperationin implementation
2.Broaderexperiences, wider range of
knowledge
3.Timeconsumingto gather
information and analyze it
4.Allows the nurseto expresshis
viewsand persuadeothers
5.Sustain friendship

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Disadvantages of group participation in decision
making
1.Subordinatemay influenced by his
desirefor group acceptanceor be
quite all the timeof meeting
2.Fewpeople may be dominatedthe
group
3.Increase argument more than
determining the best alternatives
4.Consensusmay notselect the
optimalalternative.