Decision-Making Process

Decision-Making Process

Decision-Making Process
In nursing, as in life, we are constantly making decisions, some bigger than others, and some more difficult than others.
Think about a recent decision you made that required nursing judgment. Choose one you made at your job, or, if you are not employed, in a past nursing situation. Describe your process for decision-making or problem solving.
Decision-making research has emerged from various fields. Nursing science has built on this early research in decision-making to facilitate understanding and inform nursing education and practice to enhance patient care. A background in the evolution of decision-making research provides an understanding of factors important to decision-making and can inform future nursing research, practice and education.
Early decision-making research
Early decision-making research in economics included a consideration of the influence of motivating forces (Johansen & O’Brien,

2015; Simon, 1959). The decision-making process ends with fulfillment of the motivating force (Simon, 1959). In this research, fulfillment of the motivating force was referred to as satisficing to indicate that a satisfactory rather than ideal result is acceptable (Simon, 1959). This early work also describes the importance of perception as an influence on decision-making (Simon, 1959). The decision-maker’s perception is described as influenced by their environments, goals, and values (Simon, 1959). The combination of satisficing and perception emphasizes the importance of human elements to the decision-making process.

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Early medical decision-making theories focused on the approaches of coherence and correspondence (Hammond, 1996). Coherence explored the rationale behind a decision using a mathematical approach based on logic (Hammond, 1996). Using coherence, the decision-making process, rather than the end result, was evaluated (Hammond, 1996). Traditionally, physician decision-making was evaluated using coherence (Hammond, 1996). With correspondence, the accuracy of a decision was emphasized without regard for the rationale behind the decision and the experience level of the decision-maker was important to this process (Hammond, 1996). Coherence and correspondence were viewed as complimentary (Hammond, 1996). For the decision-making process, correspondence represents an inference stage and coherence provided the justification stage (Hammond, 1996). The work on correspondence and coherence stages of decision-making reflects the importance of both inference and justification to decision-making providing a more complete representation of the decision-making process.

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Other medical decision-making research explored the influence of experience. In describing the education of medical students it was observed that while students are taught a systematic approach to decision-making, experienced decision-makers appeared to make decisions without obviously following a formal decision-making procedure (Hamm, 1988). This informal decision-making procedure was intuition (Hamm, 1988). Intuition was described as going beyond merely a lack of analysis and included the experienced decision-makers’ depth of knowledge facilitating an ability to predict circumstances effectively (Hamm, 1988). The combination of intuitive and analytic approaches allow medical decision-makers, with varying level of experience, to make decisions in a variety of situations with differing contextual features (Hamm, 1988).