Classifying clinical decision making: a unifying approach

Abstract

This is the first of two linked papers exploring decision making in nursing which integrate research evidence from different clinical and academic disciplines. Currently there are many decision-making theories, each with their own distinctive concepts and terminology, and there is a tendency for separate disciplines to view their own decision-making processes as unique. Identifying good nursing decisions and where improvements can be made is therefore problematic, and this can undermine clinical and organizational effectiveness, as well as nurses' professional status. Within the unifying framework of psychological classification, the overall aim of the two papers is to clarify and compare terms, concepts and processes identified in a diversity of decision-making theories, and to demonstrate their underlying similarities. It is argued that the range of explanations used across disciplines can usefully be re-conceptualized as classification behaviour. This paper explores problems arising from multiple theories of decision making being applied to separate clinical disciplines. Attention is given to detrimental effects on nursing practice within the context of multidisciplinary health-care organizations and the changing role of nurses. The different theories are outlined and difficulties in applying them to nursing decisions highlighted. An alternative approach based on a general model of classification is then presented in detail to introduce its terminology and the unifying framework for interpreting all types of decisions. The classification model is used to provide the context for relating alternative philosophical approaches and to define decision-making activities common to all clinical domains. This may benefit nurses by improving multidisciplinary collaboration and weakening clinical elitism.

Strategies used by nurses for decision-making in the paediatric orthopaedic setting

“…By identifying our use of decision-making theories we can examine how decisions are reached and learn from our experiences. Buckingham and Adams (2000) propose that there is inconsistency in the variety of theories of decision-making, suggesting a single framework to allow unified evaluation, whilst Offredy (1998) identified that the clinical problem dictated the decision model used. An alternative method of decision making is the information processing model or hypothetico-deductive reasoning.…”

“…Determining the strategic process of our decision-making will help in the justification and overall enhancement of our professional status (Buckingham and Adams, 2000). This paper describes the strategies used by nurses when assessing and determining a clinical problem.…”

Classifying clinical decision making: interpreting nursing intuition, heuristics and medical diagnosis

“…A brief overview of clinical decision making theories was given in Buckingham & Adams (2000). These theories will now be compared to classification behaviour to draw out their similarities and differences.…”

“…In the linked paper ‘Classifying clinical decision making: a unifying approach’ (Buckingham & Adams 2000), it was argued that nurses and their employers would derive important benefits from a better understanding of nurses’ decision making. These include enhanced clinical and organizational effectiveness, improved ability to work in partnership with patients, better protection against litigation, and facilitation of quality management.…”

An Oil and Gas Decision-Making Taxonomy

“…Outside the upstream oil and gas industry a few taxonomies of decision-making have been published to date [12][13][14][15][16]. Addressing similar needs in the information systems, nursing, engineering and strategic decision-making fields, these taxonomies were constructed using empirical or other observational means and are thus specific to their industry.…”