Theories of Medical Decision Making and Health

Question: Discuss about the Theories of Medical Decision Making and Health. Answer: Introduction The nursing environment is often complex and requires regular and effective decision-making continuously, decisions that have direct implications for the nursing professionals as well as the patient. With the increase in complexity of healthcare, Kydonaki et al. (2016) point out that nurse is forced to rely on effective and sound decision-making skills with the aim of maintaining an up-to-date care ad positive health outcome to the patients. The same study notes that nursing professionals are responsible for the decisions they make at the organizational and professional levels. It is thus necessary for the nurses to be aware of the effects and impacts of the decisions they are making towards their professionalism, the patient, as well as the organization in which they work. Reyna (2012) denotes that decision-making is a professional responsibility in the health industry is also recognized in the code of professional conduct by the Nursing and Midwifery Council. In a systematic review by Muir (2014), the study notes that there is an increase in the emphasis on adoption of evidence-based practices in the healthcare profession. The same study notes that the conscientious, judicious, and explicit adoption of current best evidence is making the process of focused towards the rights of the patients. It hence makes it clear the need for nurses to using a conscious process of making decisions not only based on the evidence to use but even on the particular patient they are making the decision reference upon. Gaining an insight into the process adopted by nurses in making decisions should also be visible to the management and the healthcare team as they can as well help in making effective decisions depending on the complexity of the situation. Tscharaktschiew (2016) notes that decision-making is an aspect that is beneficial and can improve communication, interprofessional relationships, and patient care. The objective of this paper is providing analysis of the nursing decision-making process with a major focus on the models used. The paper narrows down to three models adopted by nurses in decision-making where each model is analyzed in relations to its pros and cons within the nursing practice i.e. information processing theory, contingency theory, and cognitive continuum theory. The paper also focuses on Santos (2016) that will apply in my nursing practice with a clear rationale as to why it is the best model. The paper also discusses contradictions, inconsistencies, and complexities for the decision-making making theories discussed with a counter argument of each theory and its effectiveness. According to Tscharaktschiew (2016), a decision is a point reached, a solution, a resolution, or a conclusion reached after a consideration. The same study notes that effective decision-making in nursing practice is often carried out by adopting some specific models of study based on evidence that is involved in a deliberate mental choice in relation to the secondary sources presented in the study. In his study, Santos (2016) notes that the attempt of describing a decision in clinical setups often focused on certain conceptual frameworks or models that govern the process. Studies show that there are various models adopted in the interpretation and explanation of decision-making. However, the diversity between the models has often been masked by and the common themes between them are not clear. In their study, Kydonaki et al. (2016) also assert that when making a decision in healthcare using analytical approaches, it is necessary that the nurse making the decision relates the presenti ng situation to certain roles, often considered the models or guideline principles of decision-making. There are several theories that can be adopted in a clinical setting with the aim of achieving effective decisions for nurses in a clinical setting. These include; Information Processing Theory According to Tscharaktschiew (2016), the assumption of the information processing theory is that decision-makers often store the relevant information on their memory and the effective decision reached occurs when the decision-maker retrieves the information from both the long- and short-term memory. With nursing profession considered a profession that requires academic qualifications, Muir (2014) points out that the information gained from education as well as an individuals experience is often stored throughout life in the long-term memory of the brain. The same study suggests that clinical experts and nursing professionals often use the short-term memory information in simulating the retrieval of the information in the long-term memory. For example, a nurse dealing with the diagnosis of a leg ulcer will use the short-term memory on the knowledge of the patients signs and symptoms to retrieve the information stored in the long-term memory on the symptoms and signs of venous body ulc erations. In his study, Reyna (2012) denotes that information processing theory often underpins other models of nursing decision-making. For instance, a seven-stage processing model suggested by Thomas and Carnevali (1999) denotes that making a decision in nursing care requires certain procedures that need to be followed for effectiveness. The model describes a seven-step diagnostic reasoning that involves, presenting a pre-encounter data, entry of the data into while shaping the data gathering direction, and coalescing of the information cues into chunks or clusters. Also involved are formulation of hypothesis or activating possible explanations of diagnosis, data-directed search of the hypothesis, testing of the relevant hypothetic diagnosis, and processing of diagnosis. In other words, the health professional meets the patient and gathers information such as the history of the patients as well as the signs and symptoms of an infection among other vital information. Santos (2016) points out that following the interaction or during the process, the nurse begins to note the key information of the data which are later used for making inferences. According to the theory, this is the point at which both short and long-term memory are both engaged as the nurse clusters the information together while identifying the relevant patterns. It is from the careful considerations of the collected information and the evaluation of the formulated hypothesis that a decision is made on the correct diagnosis of a situation. However, Muir (2014) denotes that information processing theory outlines other important stages of nursing decision-making that are often considered as temporary stages as they do not have to follow a specific linear pattern. The theory suggests stag es such as the recognition of the situation that needs a decision made, formulating an explanation, alternatively generating other possible explanations, searching for information for the clarification of the available evidence and choices, making a relevant judgment of the choice, taking action, and reporting a feedback as pointed out by Dowding (2010, P. 78). According to Muir (2014), information processing theory is often considered to be flexible at is directly focusing on making effective decisions towards the duties of the nurses. However, the purpose only differs slightly with the cognitive continuum model in that the objective of the decision is often the action rather than the diagnosis process. According to Daviter (2014), the information processing model is often preferred by many nursing professionals as the most flexible decision-making model. The same study denotes that the model often considers pattern recognition on the basis of some critical information. The pattern recognition adopted suggests that every case is compared with other previous cases that are then stored in the short and long-term memory of an individual and categorized or classified according to the similarities between them. In other words, information processing model allows the use of other past experiences and ideas in solving the current situation. Contingency theory in nursing According to Daviter (2014), the basis of the contingency theory of decision-making in a clinical setting considers having other alternatives as solutions to a problem rather than just considering a single way as the best in handling any clinical challenge. Whether it is the organization of the entire healthcare setting or planning a patient treatment workflow, the best nursing decision is often influenced by the external and internal factors affecting the predetermined situation as the decision-making style. In his study, Reyna (2012) denotes that in contingency theory, there is a universal strategy for effective health care provision and patient management within a clinical setting. The design of the healthcare setting, structure, and culture of the organization must be in line with the various environmental aspects affecting decision-making. For example, decision-making towards the best way of dealing with a medical complication in the patient will have to adhere to the recommende d health care standards and guidelines by the relevant healthcare bodies to ensure a collaborative and corporative process that abides by the guidelines. In his study, Tscharaktschiew (2016) denotes that applying the contingency theory in nursing leadership and management styles will depend on several factors that govern the need for effective decision-making. For instance, making an effective decision of care for long-term health conditions such as cancer, depression, diabetes, dementia, etc, depends on the social, economic, psychological, and environmental factors affecting the patient and the family. In his study, Muir (2014) denotes that long-term health conditions are often accompanied by the stress of acceptance, poor communication, and social withdrawal, aspects that require an evaluated decision on the treatment process that will be effective depending on the condition of the patient. In such cases, contingency theory becomes very vital in evaluating the most suitable methods of care such as collaborative care or person-centered strategies. Therefore, the nurse-patient relationship, the state of the patient conditions, the org anizational structure, and experience of the nurses among other factors are essential for the contingency theory as they have both direct and indirect influences on decision-making towards healthcare. On the other hand, contingency theory when applied in making a decision in the clinical setting as it has its advantages and disadvantages. Daviter (2014) denotes that the effectiveness of the decision made will depend on the balance of the importance of the decision made. It is also based in how complete the decision-makers are informed on the subject and the likelihood of reception or acceptance of the decision made. Contingency theory hence requires effective communication between the nurse and the patient so that awareness can be made on any unpopular decision to increase the chances of positive results at the end of the decision-making process. Cognitive Continuum Theory According to Campbell (2015), all processes of decision-making often involve at some point various forms of comparisons that principally include comparisons between decision situations, between alternatives, as well as between possible attributes of the different alternatives. Cognitive continuum theory of decision-making is identified as one of the recent theories not only in clinical setting but used even in other industries. According to the theory, many clinical judgments are often present information that tends to induce an oscillation between intuitive and analytical cognition (Dowding 2010, P. 78). The theory also suggests that judgments and decision-making processes are often joint functions of cognitive properties and task properties. In other words, the theory suggests that different tasks of decisions should be done by adopting different but relevant cognitive processes. In a strategic analysis of the study, Lauri and Salantera, (2011) denote that a decision-making task involving various uncertainties tends to be difficult when it should be broken down into different components. In such a case, it is more advisable adopting a more intuitive approach other than a decision task is properly structured with few but more recognizable cues. According to Hamers et al. (2013), cognitive continuum theory has been tested in other non-clinical settings and is accepted as an alternative way of nursing decision-making conceptualization. The theory is hence adopted in many nursing organizations as a tool or instrument of exploring the perception of nurses on decision-making as it influences the method through which nurses arrive at effective decisions in the practical clinical situations in the process of healthcare provision. The theory is hence mainly used in the examination of the cognitive processes often adopted by nurses in making healthcare decisions while correlating them with contextual and demographic factors an aspect that is considered as an advantage to both the nurses and the organization. Choose one that you will apply to your nursing practice with a clear rationale In his study, Muir (2014) points out those nurses often make a range of decisions in their daily practices. There are also different perspectives or stances aimed at explaining decision-making that differs in the account of influence as well as the extent at which the decision made is intuitive depending on the model adopted by the nurses. Campbell (2015) also denotes that clinical decision-making is considered an integral aspect of the role of nurses especially in times of decision-making complexities. Information processing decision-making theory will be the most effective for use in any clinical setting as its solutions are reached based on the evidence of the patient's information.The theory often involves situational variables and identified clinical experiences as major influencers of decision-making in relation to the cues retrieved from the long- and short-term memory of an individual. In a systematic review, Tscharaktschiew (2016) denotes that professional experience, nursing knowledge and skills, and evidence-based perspective often supports effective decision-making models. These factors hence determine the informed values of the patient, the available professional resources, as well as research knowledge on the conceptual nursing issue that calls for the decisions. Information processing theory is hence more advantageous as compared to contingency and cognitive continuum theory. Complexities and contradictions of the theories and provide one counter-agreement According to Kydonaki et al. (2016), the development and adoption of descriptive theories in the clinical model have been very dynamic. Despite the development of information processing theory, contingency theory, and cognitive continuum theory many authors have come up with frameworks with the primary aim of a better understanding and comparison of the descriptive theories. Daviter (2014) proposed that the process of human development involves at least one of the three modes of decision-making; matching, reassessment, and consequential choice. The same study denotes that the three modes often form an argument-driven as well as an interactive framework where actions towards decision making are categorized by discussion and argument rather than the choice of forward-looking. Irrespective of the theory adopted in the clinical setting, it is essential that nurses should be very objective and focus much on the decision itself based on the factors surrounding the decision. These factors can be internal or external but have a direct influence on the kind of decision to be made by the nurse as pointed out by Santos (2016, p. 416). The same study denotes that many people have often compromised good decisions as a result of self-interests, fear, and feeling from other people hence resulting into negative eventualities. However, adoption of contingency theory often comes with challenges as decisions are at times made on the personal ground and self-interest while neglecting the most effective alternative for the best result. In a clinical setting, the results of a bad decision can be destructive or can lead to an adverse negative effect on the decision-maker, the receiver, the organization, as well as the community at large. In his studies, Campbell (2015) denote that some of the effects of decision-making models in the clinical settings include lessons being learned in a hard way, loss of property and jobs, time wastage, wrong diagnosis and medication, economic losses, misplaced priorities in terms of both individual and organizational objectives and goals, and in worst cases, loss of life. Despite the challenges facing the adoption of the theories in a practical clinical decision-making process, Muir (2014) presents a counter argument with the idea that the use of every theory often based on the factors affecting the decision-making process as well as the complexities involved. However, every theory is often practiced at different levels depending on the objective of decision-making. Depending on the situation, all the theories are effective since they are evidence-based. According to Kydonaki et al. (2016), an effective decision-making theory should be predictive and explanatory since quality in decision-making is essential other than focusing on evaluating every factor involved while missing the objective of the decision-making process. However, information processing theory is preferred by many nurses as it ideally encompasses prior theories and relevant data rather than contradictory evidence by different authors as pointed out by Campbell (2015, p. 6). Conclusion Decision-making in any industrial setting is an essential aspect for nurses and other medical practitioners. The more experience one acquires in making a decision, the more one gets familiar with the processes and tools that can lead to effective and sustainable decision-making. Proper decision-making is not only essential to an individual and the receiver of the decision as well as the organization. As a result, it is essential for a professional to learn the theories, models, and tools of effective decision-making in their respective organizational responsibilities and that can aid in making good decisions. With the analysis of the various theories that can be adopted in effective decision-making in a clinical setting, it is essential that every nurse understands the effect and implication of every theory adopted. The process of making effective decisions in nursing practice environment is a very complex process but very integral to the nursing profession. In this report, the proce ss of decision-making is a very dynamic conceptual process that can easily affect not only the nurses but even the outcome of the patients who receives healthcare. Depending on the theories, decision-making is also affected by the size of the clinical setting or healthcare organization, differences between the nurses and the leadership, operational management styles, government regulations, technologies, socioeconomic conditions, attitudes between patients and nurses, and the corporate cultures. In other words, nurses are called upon to be very evaluative to understand the aim and effective ways of making sound decisions with a self-reflection idea in developing the process further within their professional environment. Gaining an insight into the process adopted by nurses in making decisions should also be visible to the management and the healthcare team as they can as well help in making effective decisions depending on the complexity of the situation. List of references Campbell, S 2015, Cognitive Continuum Theory in nursing decision-making, Journal of Advanced Nursing,49(4):397-405, Academic Search Premier, EBSCOhost, viewed 24 April 2017 Daviter, F 2014, 'An information processing perspective on decision making in the european union',Public Administration, 92, 2, pp. 324-339, Business Source Premier, EBSCOhost, viewed 24 April 2017. Dowding, J, 2010, Commentary on Banning M (2008) A review of clinical decision making: models and current researchJournal of Clinical Nursing, vol. 18, no. 2, pp. 309311, 2009. Hamers, H. Huijer A, Saad, R, Halfens, G, 2013, Diagnostic process and decision making in nursing: a literature review,Journal of Professional Nursing, vol. 10, no. 3, pp. 154163, 1994. Kydonaki, K, Huby, G, Tocher, J, Aitken, L 2016, 'Understanding nurses' decision-making when managing weaning from mechanical ventilation: a study of novice and experienced critical care nurses in Scotland and Greece',Journal Of Clinical Nursing, 25, 3/4, pp. 434-444, Academic Search Premier, EBSCOhost, viewed 24 April 2017. Lauri, K S. Salantera, 2011, Developing an instrument to measure and describe clinical decision making in different nursing fields,Journal of Professional Nursing, vol. 18, no. 2, pp. 93100, 2002. Muir N, 2014, Clinical decision-making: theory and practice. Nursing Standard. 18, 36, 47-52. Date of acceptance: January 9 2016. Reyna, V, F2012, Theories of Medical Decision Making and Health: An Evidence-Based ApproachMedical Decision Making?: An International Journal of the Society for Medical Decision Making,28(6), 829833. https://doi.org/10.1177/0272989X08327069 Santos, I 2016, 'Decision-making in Healthcare: Item and factor analytic procedures for model appraisal',Psychological Assessment, 28, 4, pp. 416-428, PsycARTICLES, EBSCOhost, viewed 24 April 2017. Tscharaktschiew, N 2016, 'The who and whom of help giving: An attributional model integrating the help giver and the help recipient',European Journal Of Social Psychology, 46, 1, pp. 90-109, Academic Search Premier, EBSCOhost, viewed 24 April 2017

The New Fuss About Summer Pre-college Essay Samples

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How Does a Research Paper Start Using Culture?

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The collapse of Enron free essay sample

The collapse of Enron seems to be rooted in a combination of the failure of top leadership, a corporate culture that supported unethical behavior, and the complicity of the investment banking community. In the aftermath of Enron’s bankruptcy filing, numerous Enron executives were charged with criminal acts, including fraud, money laundering, and insider trading. Ben Glisan, Enron’s former treasurer, was charged with two-dozen counts of money laundering, fraud, and conspiracy. During the plea negotiations, Glisan described Enron as a â€Å"house of cards. † Andrew Fastow, Jeff Skilling, and Ken Lay are among the most notable top-level executives implicated in the collapse of Enron’s â€Å"house of cards. † Andrew Fastow, former Enron chief financial officer (CFO), faced 98 counts of money laundering, fraud, and conspiracy in connection with the improper partnerships he ran, which included a Brazilian power plant project and a Nigerian power plant project that was aided by Merrill Lynch, an investment banking firm. We will write a custom essay sample on The collapse of Enron or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page 2. How did the top leadership at Enron undermine the foundation values of the Enron Code of Ethics? Enron’s ethics code was based on respect, integrity, communication, and excellence. Kenneth Lay, former chairman and (CEO) of Enron Corp. , once quoted as saying: â€Å"I was fully exposed to not only legal behavior but moral and ethical behavior and what that means from the standpoint of leading organizations and people. † In an introductory statement to the revised Enron Code of Ethics issued in July 2000, Lay wrote: â€Å"As officers and employees of Enron Corp. Its subsidiaries, and its affiliated companies, we are responsible for conducting the business affairs of the companies in accordance with all applicable laws and in a moral and honest manner. † Lay went on to indicate that the 64-page Enron Code of Ethics reflected policies approved by the company’s board of directors and that the company, which enjoyed a reputation for being fair and honest, was highly respected. Enron’s ethics code also specified that â€Å"An employee shall not conduct himself or herself in a manner which directly or indirectly would be detrimental to the best interests of the Company or in a manner which would  bring to the employee financial gain separately derived as a direct consequence of his or her employment with the Company. † 3. How did Enron’s corporate culture promote unethical decisions and actions? Enron has been described as having a culture of arrogance that led people to believe that they could handle increasingly greater risk without encountering any danger. According to Sherron Watkins, â€Å"Enron’s unspoken message was, ‘Make the numbers, make the numbers, make the numbers—if you steal, if you cheat, just don’t get caught. If you do, beg for a second chance, and you’ll get one. ’† Enron’s corporate culture did little to promote the values of respect and integrity. These values were undermined through the company’s emphasis on decentralization, its employee performance appraisals, and its compensation program. Each Enron division and business unit was kept separate from the others, and as a result very few people in the organization had a â€Å"big picture† perspective of the company’s operations. Accompanying this emphasis on decentralization were insufficient operational and financial controls as well as â€Å"a distracted, hands-off chairman, a compliant board of directors, and an impotent staff of accountants, auditors, and lawyers. † Jeff Skilling implemented a very rigorous and threatening performance evaluation process for all Enron employees. Known as â€Å"rank and yank,† the annual process utilized peer evaluations, and each of the company’s divisions was arbitrarily forced to fire the lowest ranking one-fifth of its employees. Employees frequently ranked their peers lower in order to enhance their own positions in the company. Enron’s compensation plan â€Å"seemed oriented toward enriching executives rather than generating profits for shareholders† and encouraged people to break rules and inflate the value of contracts even though no actual cash was generated. Enron’s bonus program encouraged the use of non-standard accounting practices and the inflated valuation of deals on the company’s books. Indeed, deal inflation became widespread within the company as partnerships were created solely to hide losses and avoid the consequences of owning up to problems. (p29-31) Weiss, Joseph W. (2009). Business Ethics: A Stakeholders Issues Management Approach

Overview of the Sans-culottes

Overview of the Sans-culottes The Sans-culottes were urban workers, artisans, minor landholders, and associated Parisians who took part in mass public displays during the French Revolution. They were frequently more radical than the deputies who formed the National Assembly, and their often violent demonstrations and attacks threatened and cajoled revolutionary leaders down new paths at key moments. They were named after an article of clothing ​and the fact that they didn’t wear it. Origins of the Sans-culottes In 1789, a financial crisis caused the king to call a gathering of the ‘three estates’ which led to a revolution, the declaration of a new government, and a sweeping away of the old order. But the French Revolution wasn’t simply the rich and the noble versus a unified body of middle and lower class citizens. The revolution was driven by factions across all levels and classes. One group who formed and played a massive role in the revolution, at times directing it, were the Sans-culottes. These were lower-middle-class people, craftsmen and apprentices, shopkeepers, clerks, and associated workers, who were often led by the true middle class. They were the strongest and most important group in Paris, but they appeared in provincial cities too. The French Revolution saw a remarkable amount of political education and street agitation, and this group was aware, active and willing to commit violence. In short, they were a powerful and often overwhelming street army. Meaning of the Term Sans-culottes So why ‘Sans-culottes?’ The name literally means ‘without culottes’, a culotte being a form of knee-high clothing that only the wealthier members of French society wore. By identifying themselves as ‘without culottes’ they were stressing their differences from the upper classes of French society. Together with the Bonnet Rouge and the triple colored cockade, the power of the Sans-culottes was such that this became a quasi-uniform of revolution. Wearing culottes could get you into trouble if you ran into the wrong people during the revolution; as a result, even upper-class French people sported the sans-culottes clothing to avoid potential confrontations. What Role Did the Sans-culottes Play in the French Revolution? Over the early years the Sans-culottes program, loose as it was, demanded price fixing, jobs, and crucially provided support for the implementation of the Terror (the revolutionary tribunal that condemned thousands of aristocrats to death). While the Sans-culottes agenda was originally focused on justice and equality, they quickly became pawns in the hands of experienced politicians. In the long run, the Sans-culottes became a force for violence and terror;Â  the people at the top were only ever loosely in charge. End of the Sans-culottes Robespierre, one of the leaders of the revolution, attempted to guide and control the Parisian Sans-culottes. Leaders, however, found that it was impossible to unify and direct the Parisian masses. In the long run, Robespierre being arrested and guillotined, and the Terror stopped. What they had instituted began to destroy them, and from them on the National Guard were able to defeat the Sans-culottes in contests of will and force. By the end of 1795 the Sans-culottes were broken and gone, and it is perhaps no accident France was able to bring in a form of government which managed change with far less brutality.