Measuring the quality of judgement and decision-making in nursing

Aim. This paper discusses measurement of the quality of judgement and decision-making in nursing research. It examines theoretical and research issues surrounding how to measure judgement accuracy as a component of evaluating decision-making in nursing practice. Discussion. Judgement accuracy is discussed with reference to different methods of measurement, including comparing judgements with independent criteria and inter-judge approaches. Existing research on how judgement accuracy has been measured in nursing practice is examined. Evaluation of decisions is then discussed, including consideration of the process of decision-making and evaluating decision outcomes. Finally, existing research on decision-making in nursing is assessed and the strengths and limitations of different types of measurement discussed. Conclusion. We suggests that researchers examining the quality of judgement and decision-making in nursing need to be aware of both the strengths and limitations of existing methods of measurement. We also suggest that researchers need to use a number of different methods, including normative approaches such as Bayes' Theorem and Subjective Expected Utility Theory

Individual differences in causal learning and decision making

This is an accepted author manuscript of an article subsequently published by Elsevier. The final published version can be found here: http://dx.doi.org/10.1016/j.actpsy.2005.04.003In judgment and decision making tasks, people tend to neglect the overall frequency of base-rates when they estimate the probability of an event; this is known as the base-rate fallacy. In causal learning, despite people s accuracy at judging causal strength according to one or other normative model (i.e., Power PC, DP), they tend to misperceive base-rate information (e.g., the cause density effect). The present study investigates the relationship between causal learning and decision making by asking whether people weight base-rate information in the same way when estimating causal strength and when making judgments or inferences about the likelihood of an event. The results suggest that people differ according to the weight they place on base-rate information, but the way individuals do this is consistent across causal and decision making tasks. We interpret the results as reflecting a tendency to differentially weight base-rate information which generalizes to a variety of tasks. Additionally, this study provides evidence that causal learning and decision making share some component processes

A conceptual treadmill: the need for ‘middle ground’ in clinical decision making theory in nursing

This paper explores the two predominant theoretical approaches to the process of nurse decision making prevalent within the nursing research literature: systematic-positivistic approaches as exemplifed by information processing theory, and the intuitive-humanistic approach of Patricia Benner. The two approaches' strengths and weaknesses are explored and as a result a third theoretical stance is proffered: the idea of a cognitive continuum. According to this approach the systematic and intuitive theoretical camps occupy polar positions at either end of a continuum as opposed to separate theoretical planes. The methodological and professional benefits of adopting such a stance are also briefly outlined

Mental Capacity and Decisional Autonomy: An Interdisciplinary Challenge

With the waves of reform occurring in mental health legislation in England and other jurisdictions, mental capacity is set to become a key medico-legal concept. The concept is central to the law of informed consent and is closely aligned to the philosophical concept of autonomy. It is also closely related to mental disorder. This paper explores the interdisciplinary terrain where mental capacity is located. Our aim is to identify core dilemmas and to suggest pathways for future interdisciplinary research. The terrain can be separated into three types of discussion: philosophical, legal and psychiatric. Each discussion approaches mental capacity and judgmental autonomy from a different perspective yet each discussion struggles over two key dilemmas: whether mental capacity and autonomy is/should be a moral or a psychological notion and whether rationality is the key constitutive factor. We suggest that further theoretical work will have to be interdisciplinary and that this work offers an opportunity for the law to enrich its interpretation of mental capacity, for psychiatry to clarify the normative elements latent in its concepts and for philosophy to advance understanding of autonomy through the study of decisional dysfunction. The new pressures on medical and legal practice to be more explicit about mental capacity make this work a priority

Certainty in Action

When is it permissible to rely on a proposition in practical reasoning? Standard answers to this question face serious challenges. This paper uses these challenges to motivate a certainty norm of practical reasoning. This norm holds that one is permitted to rely on p in practical reasoning if and only if p is epistemically certain. After developing and defending this norm, I consider its broader implications. Taking a certainty norm seriously calls into question traditional assumptions about the importance of belief and knowledge. In particular, it raises the possibility that many epistemological jobs that are usually assigned to belief and knowledge should be reallocated to two related but importantly different states: psychological and epistemic certainty

Decision-making capacity for treatment in psychiatric and medical in-patients: Cross-sectional, comparative study

BackgroundIs the nature of decision-making capacity (DMC) for treatment significantly different in medical and psychiatric patients?AimsTo compare the abilities relevant to DMC for treatment in medical and psychiatric patients who are able to communicate a treatment choice.MethodA secondary analysis of two cross-sectional studies of consecutive admissions: 125 to a psychiatric hospital and 164 to a medical hospital. The MacArthur Competence Assessment Tool – Treatment and a clinical interview were used to assess decision-making abilities (understanding, appreciating and reasoning) and judgements of DMC. We limited analysis to patients able to express a choice about treatment and stratified the analysis by low and high understanding ability.ResultsMost people scoring low on understanding were judged to lack DMC and there was no difference by hospital (P=0.14). In both hospitals there were patients who were able to understand yet lacked DMC (39% psychiatric v. 13% medical in-patients, P&lt;0.001). Appreciation was a better ‘test’ of DMC in the psychiatric hospital (where psychotic and severe affective disorders predominated) (P&lt;0.001), whereas reasoning was a better test of DMC in the medical hospital (where cognitive impairment was common) (P=0.02).ConclusionsAmong those with good understanding, the appreciation ability had more salience to DMC for treatment in a psychiatric setting and the reasoning ability had more salience in a medical setting.</jats:sec

Values based practice and authoritarianism

Values based practice (VBP) is a radical view of the place of values in medicine which develops from a philosophical analysis of values, illness and the role of ethical principles. It denies two attractive and traditional but misguided views of medicine: that diagnosis is a merely factual matter and that the values that should guide treatment and management can be codified in principles. But, in the work of KWM (Bill) Fulford, it goes further in the form of a radical liberal view: that the idea of an antecedently good outcome should be replaced by that of a right process. That however leads to a dilemma as to whether it can account for its own normative status. Given that difficulty, why might one adopt the radical version? I sketch a possible motive drawing on Rorty’s rejection of authoritarianism which replaces objectivity with solidarity as the aim of judgement. But I argue that, nevertheless, this does not justify the rejection of the more modest particularist version of VBP