COGNITIVE PROCESSES USED BY NURSES' IN MAKING DECISIONS

Cognitive Processes used by Nurses' in Making Decisions

John M. Fedo

University of Connecticut

Cognitive Processes used by Nurses' in Making Decisions

Introduction

Decision making is an intrinsic part of nurses' clinical practice. Nurses make numerous decisions over the course of their workday. The decisions that are made have a direct impact on the patients' care, and thereby affect the patients' nursing care outcomes (Bakalis, 2006). Healthcare consumers, regulatory agencies, and insurers are demanding better patient outcomes, making healthcare workers more accountable for the decisions made (Bakalis & Watson, 2005; Thompson & Dowding, 2002). Nurses decide what data to collect, process the data, and evaluate the outcomes of the interventions (Bucknall, 2000). Furthermore, nurses often make decision in highly complex environments.

Statement of the Problem

Despite the fact that nurses make numerous decisions over the course of their workday, little is known about the types of cognitive processes they use to make decisions. Gaining an understanding of the types of cognitive processes nurses use would provide insight into the impact certain decisions may have on clinical outcomes. The two dominant perspectives of cognitive processes used to make decisions are analytical and intuitive. Analytical processes are defined by Hammond (1996) as “a step by step, conscious, logically defensible process” and intuition is defined as “a cognitive process that somehow produces and answer, solution, or idea without the use of a step by step, conscious, logically defensible process” (p. 60). Researchers have debated the merits and effectiveness of each cognitive process (Bakalis, 2006; Banning, 2007; Harbison, 1991). Analytical cognitive processes are set within a positivistic paradigm where a rational process is used to make a choice based on the best alternative. Analytical cognitive processes have been criticized for their lack of use in the real world (Bucknall, 2003; Crabtree, 2009; Hedberg & Larsson, 2003). Intuitive cognitive processes are viewed as a form of guessing and this type of process is inconsistent with rationalism and empiricism, which are the basis of Western medical epistemology (Rashotte & Carnevale, 2004).

Hammond's (1996) cognitive continuum theory provides a bridge between analytical and intuitive cognitive processes and suggests cognitive processes run along a continuum. One end of the continuum is anchored in analysis and the opposite end is anchored in intuition. In between each end are varying degrees of analytical and intuitive cognitive processes. Hammond refers these varying degrees of analytical and intuitive cognitive processes as quasirationality or common sense, and most decisions are made within the quasirational continuum.

Nurses' management patients' pain was chosen to examine the predominant type of cognitive process used when managing pain. There is a gap between pain management practices by nurses (Apfelbaum, Chen, Metha, & Tang, 2003; Manias, Aitken, & Dunning, 2004; Vallerand, Hasenau, & Templin, 2004), and the current pain management standards of the American Pain Society's (2008) Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain. Gaining an understanding of which cognitive process is predominantlyused by nurse's when managing pain would help close the gap ...