Problems in the decision making process: a review

Decision making is an integral part of the intensive care nurse's role, but many factors can disrupt this process. It is important that the nurse has an understanding of how defective decision making patterns can develop. Experience, the role of the nurse, uncertainty and conflict all exert major influences on the decision making process. The conditions that determine what type of decision making pattern emerges are; the seriousness of the risks as a result of the decision; if there is hope of finding a better solution; and how much time is available to search for the solution. The patterns that may emerge include vigilance, complacency, defensive avoidance and hypervigilance. Vigilance is said to be the optimum pattern, this is when all alternatives to the decision are analysed and interpreted in an unbiased manner. Defensive avoidance is the decision makers attempt to avoid or postpone the stress of the decision. It is manifested by procrastination, shifting of responsibility or rationalisation. Hypervigilance, or panic, represents a frantic search for a solution and a shifting back and forth between alternatives with a failure to see obvious faults in the possible solutions.