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Critical thinking skills help nurses shape their actions. In other words, critical thinking is necessary to make good decisions. Everything that is done involves a decision, from titrating a potent intravenous medication, right down to choosing when to take a lunch break. Good decision-making requires a good foundation of scientific knowledge. The nurse must also be aware of standards that should be followed. Furthermore, a nurse must consider the ethical implications of each decision. Ethics involves doing what is “right” in a given situation,  and this is important when choosing between alternative actions. All decisions are ethical decisions, even the seemingly frivolous decision of when to take a lunch break. If a nurse goes to lunch before checking on a patient who just arrived from the post anesthesia care unit, an unethical decision has been made.

Types of Decisions

Decisions can be grouped into two main types, programmed and non-programmed. Most decisions are programmed, meaning they are anticipated and routine. There are likely guidelines, policies, or procedures that can be followed. Decisions such as how one should flush a central line catheter are programmed decisions.  Non-programmed decisions are unexpected, unique, and more complex. Issues regarding end of life care or the cultural needs of a specific client do not fit well into a policy manual. These types of decisions take more time and may require a group effort. Decisions that nurses make can also be grouped according to focus. Some decisions are related to patient care and are made frequently by staff nurses. Others are related to the work environment, and the final say is more likely had by a manager.

Decision-Making Process

The decision-making process is often broken down into a series of linear steps. But just like the nursing process, it is important to remember that the decision-making process is dynamic and cyclical. Often these so called “steps” occur all at once. But for the sake of discussion, the basic phases of the decision-making process are as follows:

  • Define the decision – Decision-making can only occur when there is a choice between actual alternatives. Decisions cannot be made on what one wishes could occur.
  • Gather information and deliberate – Data should be gathered about the alternative choices that are available. Potential consequences of each choice should be projected and considered.
  • Choose from among alternatives – Judgment about the merits of each alternative should lead to a preferred path.
  • Act – After a decision is made it must be implemented. This can be simple or complex, depending on the scope of the decision.
  • Evaluate – After taking a course of action, the results must be evaluated to determine if it was the best choice. This step is similar to the critical thinking skill of reflection.

Factors Affecting the Decision-Making Process

There are numerous factors that can influence the decision-making process. These can be grouped into internal and external factors.

  • Internal factors include characteristics of the person making the decision. Critical thinking ability is paramount to making good decisions. The person must be willing to think out of the box,  should not close the door too soon on potential alternatives, and should be willing to listen to others. Decisiveness, while sometimes thought of as a positive quality, can be a drawback if a person makes a decision before looking at all possible sides of an issue.
  • External factors relate to issues outside of the nurse that affect the decision. Some examples are the resources that are available to support alternative actions, the time that is allotted to make the decision, the outside people who are accessible to assist with the choice, and certainly, the wishes of any people the decision affects, especially clients.
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