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Effective Decision Making - Coggle Diagram
Effective Decision Making
Decision
Should temperature be taken
Factors influencing
What is best practice
NICE
Effect of doing it
Effect of not doing it
Risk
Parental input
Bias
What was temp previously
Evidence
NICE
RCN
Clinical Skills.Net
Hospital policy
Collaborative decision making
Patient involvement
Assessment of capacity
Confidentiality
Consent
Rights, dignity, respect
Ethical principles
Communication
Accountability
Duty of care
Negligence
Documentation and record keeping
Risk
Clinical evidence
Evidence base
Guidelines
Evidence from research
Gillick Competence
Theories
Analytical
Hypothetico-deductive reasoning
Normative reasoning
Robust decision making
Clinician not familiar with the situation
Problem representation
Hypothesis generation
Data interpretation
Hypotheses verification
Search for additional; information
Intuitive
Quick decision making
Recognition primed
Deliberation without attention
Heuristics and biases
Clinician familiar with siutation
Immediate recognition of the whole clinical picture
Hypothetico-deductive model
Thompson, C. and Dowding, D. (2009) Essential Decision Making and Clinical judgement for Nurses. Elsevier Limited
Normative approach - systematic and analytical manner
Cue recognition or cue acquisition
Hypothesis generation
Cue interpretation
Hypothesis evaluation
Problems
May be gathering insurrection information
Biases
Incorrect hypothesis come to
O’Neil’s Clinical Decisions Making Model
(CDMM)
Banning, M. (2008) 'A review of clinical decision making: models and current research',
Journal of Clinical Nursing
, 17, pp.187-195
Investigating pre-encounter data - info before meeting the patient
Anticipating and controlling risk - considering degree of risk and ranking the risk
The provision of standard care, situational and client modification - environment, skill mix, knowledge of patient
The intuitive-Humanist Mode
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Banning, M. (2008) 'A review of clinical decision making: models and current research',
Journal of Clinical Nursing
, 17, pp.187-195
Describes the changes in decision processes between novice and expert practitioners
Intuitive
Relationship between experience/ knowledge gained and how it enriches decision making
Links to cognitive continuum
Decision trees
Represents both the decision options and the uncertainty associated with each decision option
Structure of the tree reflects the key elements of the decision and the choices available
Dowie J. (1933) 'Clinical decision analysis: background and introduction'. In Llewelyn H. and Hopkins A. (eds)
Analysing How we Reach Clinical Decisions
, London, Royal College of Physicians
Normative
Duel process theory
Most theories on reasoning are in agreement that there are two cognitive processing systems at play
System one - subconscious decision making
minimising effort
increases cognitive efficiency
System two - conscious, rational deliberation
requires significant contemplation
Evans (2008) Dual-Processing Accounts of Reasoning, Judegement, and Social Cognition. Annual Review of Psychology, 59, pp. 255-278
Croskerry's Dual-Process Model for Diagnostic Thinking
Most HCP use both at the same time
You initially have the intuition and may start acting on it
You also start gathering information and data that will either confirm or not your intuition
Pattern recognition
Compare it to previous problems or experiences
HCP makes a diagnosis right away
Recognising patterns to connect and make sense of information cues in differentiating one condition and level urgency happens subconsciously and more quickly with experience
Buckingham and Adams (2000) Classifying clinical decision making: a unifying approach, Journal of Advanged Nursing, 32(4), pp. 981-989
Dabate - is it just intuition
Criticism - every patient is different, did you just jump to conclusion and could miss something
Descriptive theory
How decisions are actually made
Personal judegement
Normative theory
How decisions sould be made in an ideal world
Evidence based
Prescriptive theory
Combines normative and descriptive - aims to improve judgements and decisions by the use of guidelines
Cognitive Continuum
Acknowledges differences between information processing, intuition and rational logical decision making (Hamm 1988)
Considers
Available time
Health problem
Nursing task
Knowledge structure
Links to intuitive-humanist model
Assessment brief
What factors and circumstances lead to the decision made?
Consider what information was gathered, available and how this influenced you.
Appraise the impact of external and
internal factors upon the chosen decision.
Considering this information evaluate if sources, environment previous experience (and more) influenced how you considered and processed this.
Was weight or greater meaning given to specific aspects or sources?
Consider steps taken to ensure service user safety and optimise their care through the encounter/decision.
Unpick the stages taken as a result of the information available and gathered, and how these cues and factors contributed to the choices you made
Evaluate how such a decision could be made, or enhanced if encountered within practice again to increase aptitude and rigour.
Reflect upon what has developed within your practice or awareness, and how this might influence choices and considerations if a similar situation was encountered again, and why.
Decision making factors
Reflection
Knowledge
Judgement
Reasoning
Experience
Intuition
Clinical decision Making
Tanner et al. 1987 - good definition
Clinical reasoning/judgement making