Decision making replies week 5

PatriciaMartinDecisionMakingreply.docx

Decision Making

Florida National University

11/27/2024

Psychological and Contextual Complexities and Constraints

There are multiple psychological and contextual complexities associated with this scenario that the ANP has to face. To begin with, the pressure of time is on because the patient wishes to minimize her stay in the ED so that she can reach home before midnight. This may hasten the process of decision-making. The anxiety of the patient regarding her travel plans carries an emotional burden associated with the situation and has a bearing on how the ANP prioritizes care. Coupled with a busy ED environment and an encroaching end of shift for the ANP, decision-making is further restricted as the ANP will have to offset other demands and ensure the patient receives timely and complete care in a limited time. According to Bijani et al. (2021), time management is a constraint that influences decision-making in a pre-existing emergency department.

Intuitive and Rational Analytic Decision-Making Models

For this scenario, both intuitive and rational types of decision-making models apply. Intuitive decision-making is driven by experience, pattern recognition, and gut feelings when presented with time pressure, as seen in the scenario (Mi et al., 2024). For example, the sudden interest in examining ANP's shoulder upon noticing stiffness is an intuitive response to subtle clinical cues. The rational decision-making style is the more formalized, logical step-by-step process: systematically examining the patient's wrist, reviewing X-rays, and formulating differential diagnoses. Here, the ANP should apply the two models: intuition to identify the swollen shoulder as an area of concern and rational analysis to suggest further imaging such as X-rays or MRI for pathological fracture. This is an occasion when both models apply, with intuition quickly recognizing problems and rational analysis guaranteeing thorough and evidence-based care.

Decision-Making Models Comparison

Although intuitive and rational decision-making models differ in approach, they complement each other in clinical practice. Intuitive models are faster and often spring from years of experience so that the ANP can quickly decide based on the subtle report from the top-left through the patient's demeanor or by employing visual appearance, for instance, ankle swelling in the scenario case above. While intuition alone, without the rigors of the rational model, may be inadequate in complex situations, the intuitive model serves as a guide for less complex situations. Where intuition granted instant insight, one could rely on rational decision-making as being slower but grounded in a structure through which all potential consequences are contemplated. In this case, intuition allowed the ANP to uncover a significant observation, such as shoulder swelling.

In contrast, rational thought enabled the establishment of a plan of care, such as additional imaging and potential consultation with an orthopedic specialist. The drawback of relying only on intuition is the possibility of bias, whereas over-reliance on rational analysis can be very time-consuming, especially in a busy ED. Furthermore, when over-relied on intuition, another set of drawbacks makes one overlook key decision-making strategies, leading to egregious errors (AlAmer, 2023).

Best Decision-Making Approach for Advanced Practice Nurses

The ideal strategy for ANPs would be a hybrid of intuitive and rational decision-making. In the hybrid model, intuition identifies urgent concerns, while rational analysis verifies and addresses the concerns comprehensively (Croskerry, 2020). This is an evidence-based practice because clinical decisions are timely yet research-based. It would be instinctive in this case for ANP to feel that something was wrong with the patient's shoulder swelling, but to order proper imaging and involve appropriate specialists would have come from rational analysis. This ensures completeness and centrality of the care to the patient.

Metacognition in Decision-Making

The term metacognition involves knowledge of and regulation of one's cognitive processes. This is vital for ANPs as this approach allows one to discriminate between correct and incorrect decisions (Wokke et al., 2020). It allows the practitioner to check over thought processes, question assumptions, and reflect on decisions made. In this case, it will help the ANP notice possible biases, such as anxiety from the patient, that may influence a rushed diagnosis. It fosters self-correction, where the ANP might change his strategy in the light of emerging information. The process of metacognition in encouraging critical thinking and reflection ensures that ANPs make thoughtful, adaptive, and evidence-based decisions that promote continued improvement in patient outcomes.

References

AlAmer, N. A. (2023). Decision-Making Styles and Managerial Creativity of Nursing Managers in Saudi Arabia: A Multi-Center Cross-Sectional Study. Healthcare, 11(12), 1719–1719. https://doi.org/10.3390/healthcare11121719

Bijani, M., Abedi, S., Karimi, S., & Tehranineshat, B. (2021). Major challenges and barriers in clinical decision-making as perceived by emergency medical services personnel: a qualitative content analysis. BMC Emergency Medicine, 21(1). https://doi.org/10.1186/s12873-021-00408-4

Croskerry, P. (2020). Becoming Less Wrong (and More Rational) in Clinical Decision Making. Annals of Emergency Medicine, 75(2), 218–220. https://doi.org/10.1016/j.annemergmed.2019.09.002

Mi, L., Prentice, C., Taskin, N., & Pauleen, D. (2024). Demystifying Intuitional and Rational Decision-Marking: Symmetrical and Asymmetrical Analysis. Australasian Marketing Journal. https://doi.org/10.1177/14413582241244811

Wokke, M. E., Achoui, D., & Cleeremans, A. (2020). Action information contributes to metacognitive decision-making. Scientific Reports, 10(1). https://doi.org/10.1038/s41598-020-60382-y

AshleyEvansDecisionmakingreply.docx

Ashley Evans

11/27/2024

Decision Making-DBX-DL01 Nora Hernandez-Pupo

Discussion Week 5

1. Describe some psychological and contextual complexities and constraints that may face the NP while making decisions in the above scenario

The ANP may face a sense of urgency in finding a diagnosis or treatment for the 69-year-old woman sense she was anxious in leaving to go home with family. Also, it may be some complexities and constraints with the root cause of her left non-dominant wrist which in the scenario was described as being grossly swollen and deformed, with bruising and swelling extending up the forearm and tenderness over the distal radius and ulna. The woman also stated she had problems with her left shoulder that appeared stiff. More investigation should be done.

2.Describe intuitive and rational analytic decision-making models (thinking) that would serve to guide the ANP's decision in this scenario (making sure to provide the decision the NP should make). Are both required, why or why not?

The intuitive analysis to guide with the decision making in this scenario will include the ANP prescribing diagnostic testing the definitively confirm the severity of the injuries the ED patient has suffered. In a recent article, "intuitive decision making is a valuable tool for managers, allowing them to make quick and accurate decisions even in complex or uncertain situations" (A.Bensla, 2023). This is very imperative for the ANP to use because of the uncertainty of when the injuries actually occurred. Contrary to intuitive analysis, rational analysis includes using visual and auditory detail from assessments and evidence-based practice to reach a decision on treatment for the 69-yr old patient. In this scenario both decision making models can be used to guide the ANP in deciding the best treatment for the patient since limited amount of clarity is given from the patient.

3.Compare and contrast the two decision-making models applied and discuss the benefits and consequences of using these decision-making methods in the above scenario.

Intuitive decisions have a numerous of advantages, they can be made quickly and without much effort. Especially in the case of minimal information like what has given in this scenario and under great uncertainty, few clear facts can be used anyway. On the contrary, rational decisions are usually made in a more structured, argumentatively comprehensible and controlled manner. Data and facts are collected in order to make a decision on this basis. Often, decisions are justified with arguments that were mainly made intuitively. But in this case, both models should be used in synchrony. In a recent article, it describes that "at the same time, it should be noted that intuitive components also flow into the rational decision-making process" (D.Seydel, 2023). For example, when evaluating information accordingly, it is often a mixture of intuition and analytically rational considerations.

4.What is the best decision-making approach/strategy for advanced practice nurses generally? Be sure to provide a well-supported response.

The best approach is the rational analytic decision-making model. This includes actuality with findings from assessments both objective and subjective. Examining the patient's arm will allow the ANP to make a decision if further diagnostic need to be done. The patient stated that swelling to upper arm and stiff left shoulder were both old injuries from a previous fall. Conclusively, the ANP did an x-ray to the left wrist and came back negative. Although, it is the patient's right to not be tested if they do not want to, refusing treatment can lead to further complications and the patient should be educated on the complications that may occur if the left arm injuries are not treated for. Such complications as DVT (Deep venous thrombosis), fracture which can lead to fat embolism should be educated.

5.What is metacognition and how does it help to guide decision-making for the APN?

"Metacognition comprises both the ability to be aware of one’s cognitive processes and to regulate them" (DS. Fleur, et al., 2021). The APN uses this metacognition along with rational and intuitive models to decide the best treatment possible for the patient. Metacognition can be used as the overall decision maker for the scenario. The APN will be able to determine if rational model over exceeds intuitive for this case scenario.

References

Bensla, A. (2023, November 9). The ultimate guide to intuitive decision making for managers. Risely. https://www.risely.me/intuitive-decision-making-pros-and-cons-and-4-models/.

Seydel, D. (2023, August 27). Rational vs. intuitive decision-making. Medium. https://medium.com/@decioo.com/rational-vs-intuitive-decision-making-e75c04885247.

Fleur DS, Bredeweg B, van den Bos W. Metacognition: ideas and insights from neuro- and educational sciences. NPJ Sci Learn. 2021 Jun 8;6(1):13. doi: 10.1038/s41539-021-00089-5. PMID: 34103531; PMCID: PMC8187395.