Ethical Decision-Making in Nursing: Strategies and Principles
Decision-Making Strategies in Nursing
Various Strategies for Effective Decision-Making
Several strategies are employed in nursing for effective decision-making. Some of these include:
- Trial and Error: This intuitive approach, based on hunches, is generally considered less effective for problem-solving.
- Pilot Project: Similar to research methodology, this strategy involves testing a decision in a limited area to assess its effectiveness.
- Issue Review: This involves two or more individuals critically examining a problem to identify facts and potential solutions.
- Creativity Techniques: Brainstorming, Delphi analysis, and nominal group techniques are employed to address problems with unclear or inadequate solutions.
- Decision Tree: This graphical model, often used in healthcare, visually represents the therapeutic course and expected outcomes for patients. It helps illustrate the relationships between interventions and diagnostics.
- Group Problem Solving and Decision Making: This participatory approach involves the leader and team working together to identify the problem, explore alternatives, and make decisions.
- Cost-Benefit Analysis: This strategy helps allocate scarce resources by evaluating the positive and negative aspects of different alternatives.
- Worst-Case Scenario: This involves determining the worst possible outcome for each alternative, aiding in risk assessment and damage limitation.
Advancements in computer systems have facilitated the use of probability calculations and statistical forecasts based on decision tree models in healthcare organizations.
Ethical Considerations in Nursing
Ethical dilemmas frequently encountered by nurses include:
- Inadequate staffing allocation
- Prolongation of life with extraordinary measures
- Insufficient resources
- Inadequate patient care
- Irresponsible activities of peers
Ethical Decision-Making Framework in Nursing
Guiding Principles
Key ethical concepts guide decision-making in nursing, especially when faced with challenging choices. These principles, as outlined by Aiken (1994), include:
- Autonomy: Respecting the patient’s right to self-determination and decision-making.
- Beneficence: Acting in the patient’s best interest by offering benefits that outweigh risks.
- Fidelity: Maintaining loyalty and commitment to professional responsibilities.
- Justice: Ensuring equitable treatment and fair distribution of benefits, costs, and risks.
- Non-Maleficence: Adhering to the principle of ‘do no harm’.
- Truthfulness: Being honest and transparent with patients, avoiding deception.
Application in Nursing Management
These ethical principles also apply to decision-making in nursing leadership:
- Autonomy: Promoting decentralization and shared governance, empowering nurses in patient care and practice decisions.
- Beneficence: Providing training and support to enhance nurses’ competence and control.
- Fidelity: Offering adequate support services to nursing staff and administration.
- Justice: Implementing fair promotion and remuneration systems.
- Non-Maleficence: Implementing universal precautions to protect patients and staff from bloodborne pathogens.
- Truthfulness: Encouraging open discussion of challenges and weaknesses to promote awareness and improvement.
Organizational Decision-Making
As defined by Kerrigan (1991), organizational decision-making involves selecting options to solve problems and achieve organizational goals.
Decision-Making Under Different Conditions
Nurses make decisions under various conditions:
- Certainty: Decisions guided by scientific evidence.
- Uncertainty: Decisions made with limited knowledge or in complex situations.
- Risk: Decisions involving potential harm to the patient, such as medication management, crisis intervention, infection control, invasive procedures, or technology use.
Uncertainty and complexity are common in nursing care administration.
Elements of Effective Decisions
La Monica and Finch (1977) identified three key elements contributing to effective decisions:
Quality x Acceptance x Time = Effectiveness
These elements should be considered in conjunction with the specific situation to ensure optimal outcomes.