The Decision Making and Nursing Process. The nursing process and decision-making are closely linked. The nursing process provides nurses with a framework for making informed and effective decisions in patient care.
What is Decision Making and Nursing Process
The nursing process encompasses a systematic approach to patient care that includes assessment, diagnosis, planning, implementation, and evaluation. This structured approach helps nurses critically analyze patient information, identify needs, develop appropriate interventions, and evaluate outcomes.
Nursing decision-making depends on a variety of patient signals, not limited to physiological ones but also including complex factors such as the progression of changes. Understanding the patient’s condition is an important and complex aspect of nursing decision-making.
In an emergency, making the right decision is crucial. It is a necessary component of professional nursing, and the nursing staff’s ability to make sound clinical decisions is the most important factor in the quality of care.
What is Decision Making
People, in general, make many decisions in an average day. Some decisions are small and are made with little effort (i.e., deciding what to eat for breakfast), whereas others may be more involved and take several days (i.e., purchasing a new car). Regardless of how complex a decision may be, the basic elements of the decision-making process are present. Decision making “is a process of choosing the best alternatives to achieve individual and organizational objectives” (Guo, 2008, p. 118). Nurses at the bedside typically make two types of decisions:
- Patient care decisions, or those that affect direct patient care
- Condition of-work decisions, or those that affect the work environment (Krairiksh & Anthony, 2001).
Decisions made by nurse leaders and managers have a broader scope, in that they can affect many people and can have a greater impact on the overall unit or organization. Decision making consists of the following steps (McConnell, 2000):
- Gathering information involves collecting information that will direct the decision making process. Often, gathering information involves observations. The focus during this step is to gather data that are worthwhile and pertinent to the decision to be made. One shortcoming for most people is the tendency to move from observation to conclusion without enough information.
- Analyzing information and creating alternatives often overlap with gathering information because, in this step, information is logically arranged and put into context for evaluation. As information is being organized, alternatives emerge. The amount of time spent analyzing and creating alternatives is directly related to the weight of the decision to be made.
- Selecting a preferred alternative comes about during analysis, when often the best alternative emerges. During this step, it is important to consider what is a realistic and feasible alternative, keeping in mind factors such as time, money, quality, personalities, and policies.
- Implementation consists of taking the selected alternative and putting it into action.
- Follow-up on implementation includes communication and clarification to ensure that staff members know what is expected of them; checking on the timing and ensuring that the change is not overwhelming to staff because of other factors; performing ongoing analysis and monitoring of any circumstances that may require adjustments to the implementation plan; evaluating suggestions from others; withdrawing a poor choice, if necessary; admitting mistakes; and, in the end, sticking with the right decision. Decision making is a dynamic process and must include evidence-based research.
All nurses have the authority, accountability, and responsibility to make decisions and take action consistent with the obligation to promote health and to provide optimal patient care (ANA, 2015a). Nurse leaders and managers must make autonomous operational decisions with the same considerations.
Decision Making and the Nursing Process
The ANA (2015a) Nursing Scope and Standards of Practice delineates the competent level of nursing practice and uses the nursing process as a critical-thinking frame work to guide nursing practice. The nursing process is cyclical and dynamic, inter personal and collaborative, and universally applicable. It is fundamental to nursing practice and provides a clinical reasoning approach to patient care that uses six interrelated steps (ANA, 2015a).
Nurse leaders and managers integrate the nursing process with leadership and management competencies to effectively make decisions that guide nursing practice, set strategic goals, create and sustain healthy work environments, influence organizational and public policy, resource management (human, material, financial), population health management, legal and regulatory compliance, and promote safe quality patient outcomes (ANA, 2016). Nurse leaders and managers apply the steps of the nursing process when making decisions at the unit and organizational levels:
- Assessment involves continually collecting data in a systematic manner relative to an issue, situation, the work environment, or trends. Nurse leaders and managers use data collected to problem solve, make decisions, identify gaps in care, and identify patterns and variances related to the situation.
- Diagnosis (analysis) includes identifying issues, problems, or trends and validating them with stakeholders when possible. Nurse leaders and managers use data to support and enhance decision-making and document issues, problems, or trends to help determine an individualized plan.
- Outcomes identification includes identifying expected outcomes for an individualized plan of care. Nurse leaders and managers identify expected outcomes for a plan developed to address issues, problems, or trends.
- Planning is the development of an individualized plan in partnership with members of the health-care team and the appropriate stakeholders. The plan is prioritized and includes a timeline. Nurse leaders and managers design the plan by considering the current statutes, rules, regulations, and standards and by integrating best practices.
- Implementation of the plan involves coordinating the implementation of a plan and associated processes in collaboration with the health-care team in a safe and timely manner using evidence-based interventions specific to the issue, problem, or trend (ANA, 2016). Nurse leaders and managers incorporate principles of systems management, new knowledge, and strategies to initiate change, achieve desired outcomes, and establish strategies to promote health, education, and a safe environment (ANA, 2016).
- Evaluation involves ongoing evaluation of the outcomes in relation to structures, processes, nurse-sensitive indicators, and stakeholder responses. Nurse leaders and managers use the results of evaluation analysis to make or recommend changes to policies and procedures as needed.
The nursing process encompasses all actions taken by nurses at every level, provides a framework for critical thinking, and forms the foundation of decision making with the goal of safe, quality, and evidence-based nursing care (ANA, 2015a, 2016).
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