Decision making process
Taking a decision you have been involved in with regard to the care and/or treatment of a
client/patient, critically analyse that decision making process paying particular attention to
team working, leadership, legal, ethical and professional issues.
Taking a decision to pursue medical health nursing was a wonderful choice in my life.
Despite knowing the challenges that come with handling mental health patients, I took the bold
step and decided to pursue a career in mental health nursing focusing on mental health patients in
the community, acute units, care homes and rehabilitation.
Quality health care delivery and confidentiality for patients has always been my goal as a
mental health nurse. I value working with mental health patients and would never compromise
their privacy for anything. Conduct for nurses according to the nursing profession stipulate that
nurses should treat patient information with utmost confidentiality and privacy. This is in
conjunction to the national privacy principles guidelines of 2001 supporting the privacy act of
- Many jurisdictions have legislation and policies regarding nursing and privacy of patient’s
health especially when dealing with mental health patients. The conditions of mental health
patients are not only serious but very private as well. The societies stigmatize mental health
patients and the last thing that a patient wants needs is having her private health information
Scenarios to be analyzed
The key points to be analyzed in this essay are why I ventured into mental health nursing
and how the I have succeeded in my decision through the support of my members, leaders and
following the nursing code of conduct. The journey to my nursing career started many years after
watching my aunt die from mental health related complications. It was a sad experience for me
especially because we grew up close and she was my not only my best but also only aunt. Losing
her to a mental related condition was a great loss for our family and me. The children she left
behind were young and could not understand why their mother used to act the way she used to.
When she died, relatives adopted the children. My aunt mental condition was schizophrenia,
which she had lived with on and off episodes for almost three years before finally succumbing to
it. Her experience was a revelation of how critical mental health can be and why nurses need to
take care of mental health patients effectively. Despite being so young, my interest to take care
of mentally ill patients and assist them started growing from here. As I graduated from high
school into college, I had fully decided that mental health nursing was the professional field I
wanted to pursue.
The decision making process
The nursing profession is a demanding and dynamic field that requires care and patience
especially when dealing with mentally challenged patients. Nursing practice should be flexible
enough to respond to the patient’s immediate needs and give them utmost care. My decision to
pursue this profession was directed by several theories.
Turpin and Marais (2004) argue that naturalistic decision-making is concerned with
making a decision in the natural context. The decision to pursue mental health nursing was from
seeing a close relative go through the medical condition and succumb to it. It was thus not hard
for me to imagine what could have happened. The experience came in a natural context
significantly improving my ability to decide. Theorists argue that the naturalistic model of
decision-making differs from other descriptive model as a situation similar to one’s previous
experience. To come up with the decision effectively one has to establish appropriate goals,
important cues and know what to expect. Making the decision to pursue mental health nursing
profession came easily but having visited my aunt in the hospital made me appreciate that caring
for a mentally ill patient is a great challenge. As I decided to go into that career, I prepared my
mind and emotions to embrace any challenge that would come my way. I knew that there would
be instance where I would be less motivated but the desire to see patients recover would always
be my goal. To make this decision, I took actions needed to succeed. The naturalistic decision
making theory argues that the key aspects of good decision-making is having prior experience. I
have always found this view to be true in my profession and I am certain that if I had not
experienced what it feels like to live with a mentally ill person, I would have never pursued the
mental health-nursing career.
Multiple perspective approach
Multiple perspective approach is a decision making process that involves sweeping in
decisions. Based on the unbounded systems thinking concept, this theory assumes that a problem
is like any other challenge. Multiple perspective approach classifies perspectives as technical,
organizational or personal in nature. Attempts of collecting information to help one understand
the problem can be termed as technical perspectives while coming up with different projects and
technical views can be termed as organizational. Individual perspectives include role players and
individual decisions that people make. Each of these perspectives relate and interconnect to one
another as a way of coming up with the right decision. Considering how effective a decision
should be based on the individual mostly although the technical and organizational perspectives
will come in at some point (Turpin and Marais, 2004,p.147).
Rational comprehensive model
In this theory, reasoning is a major element as it assumes that the decision maker can
identify the problem, their goals, values and objectives according to their rank of priorities and
importance. Once they have identified those factors, alternative ways of approaching the issues
can be done to maximize attainment of their goals and objectives or values. Though problems are
not always defined, an individual has the ability to make the choice they feel will be appropriate
for them. As one decides, they should be aware of the future consequences that underlie in the
decisions they make and be willing to deal with conflicting values. The rational model is almost
similar to the naturalistic model of decision-making, as the individual making decisions remains
a target for decision-making. Both theories assume that only one unitary decision-maker exists to
benefit others. A nurse for example decides to pursue her nursing career alone, but ends up
helping patients, hospitals, homes and health centers.
This theory attempts to correct the rational theory arguing that decision making is not individual
focused but intertwined through various factors. Incremental approach gives alternatives to
decision makers who chose from existing policies. It thus can be described as non-individual.
Besides those decision making theories, the scope of nursing practice decision making
has been directing me to make many decisions with mental patients. Below is a chart of how i
Define the activity/ task (mental health care)
Review if the activity is permitted by the nursing practice act No STOP
Review if the task is precluded in any other law/policy No STOP
See if the activity is consistent with national nursing standards
Nurse competed special education needed
Document evidence and competency skills
Doing the act as a reasonable and prudent nurse
Nurse prepared to accept consequences of action
Nurse allowed performing tasks according to acceptable and prevailing nursing safety
and care (ASBN, p.16)
Team working leadership
The nursing profession cannot be successful without working with a team and under a
strong leadership. Teamwork and commitment to leadership are crucial aspects for nursing to be
effective. Teamwork and leadership influence nursing actions especially in mental health greatly.
Nursing profession in a health team greatly define what roles/practices are carried out daily in a
health institution and the theoretical benchmark that underlies the model of mental healthcare.
Nurses need each other for their practice to be complete. Working as a team is critical to
effective management within nursing and making the workload easier for nurses. Nursing is a
complex role that cannot be managed alone. A nurse needs the help of another to carry out
medical examinations, record the patient’s history and offer quality health care to patients
generally. When dealing with mental health, nurses need each other to deliver quality healthcare.
Mental health patients unlike other patients suffering from physical ailments require special
attention to come up with appropriate treatment. They need to receive proper medical attention.
Severely ill mental patients require more than one nurse to sedate them and make them feel
better. Working as a team makes the workload easier and motivates people to function
effectively. According to NMC, nurses must work together as a team. They work together
towards common goals thus creating a sense of unity in their job.
Nursing is a humanistic approach for nurses that require achieving full competency for
the best health care. Nursing practice can only achieve its five stages through working as a team.
Those five main stages are assessing, planning, diagnosing and intervention, which are crucial
for ensuring that nurses function as a team. During the collection of information from patients, it
is important that the nursing staff work in unison to correctly record the information gathered.
Nurses working in unison do the process of recording the information and writing or storing
patient data. This way patients are cared for in an effective way and have their needs met
adequately and in a fast way. If nurses fail to cooperate and work together in unity, the process of
mental health care cannot be complete. For instance, no records would mean that nurses have no
information on the patient and thus cannot treat the patient effectively. Recording patient
information ensures that nurses record and store patient information safely thus facilitating the
treatment procedure. Assessment is another procedure that requires multidisciplinary teamwork.
Assessment involves consultation with teams and is important for quality assessment to
take place. During patient assessment, various skills are distributed to team members with regard
to their proficiency. Some nurses perform the roles in their area of specialty as others use
particular skills to come up with diagnosis for certain conditions. Mental health nursing for
example is a field that requires knowledge in diverse fields. While some nurses specialize in
depression, others specialize in schizophrenia or bipolar disorder. Each nurse specifies in their
field and can perform exceptionally well in their assessment role. For assessment to be
successful nurses, must be willing to share information obtained and give feedback on their
patients condition as an essential part of assessment phase. Sharing that information ensures that
the team is accountable for nursing care that patients receive and has a chance to suggest another
suitable method of management that they had not thought of.
Understanding is key element in nursing and teamwork. The leaders should understand
their team members and work towards supporting them attain their goals while team members
ought to understand each other for proper communication to take place in health care. Mental
health care nursing requires strong leadership for quality delivery of services. Leaders act as role
models for other nurses. They make quick decisions and responses to ensure that patients are
treated and do not lack anything. Their effective leadership roles are reflected on nurses and
teams that they lead. Good leaders make great followers and teams. According to the trait theory,
good leaders are assertive, value honesty and integrity, are SMART, good decision makers, have
empathy, have knowledge and prowess in their field of medicine, have self-confidence, and have
emotional control. Leadership in mental health is crucial for the team members and patients.
With good leadership teams can improve their work performance and improve mental health care
for mentally ill patients.
Communication is another crucial aspect for leadership and team members. Leaders and
team members in mental health care should be able to communicate with each other for effective
health care delivery. Through communication, leaders and team members are able to develop
good listening skills, talk to each other, and participate in dialogue and clear misunderstandings.
Communications helps in the achievement of similar goals as team members can let each other
know what is expected of them. Lack of communication makes things wrong and creates many
misunderstandings in the delivery of health care. Effective delivery of health relies on the team
members and prowess of leadership in the healthcare.
Legal and ethical professional issues
Legal implications of nursing are tied to state and federal law licenses given by the state.
The scope of practice for nurses and public expectation should adhere to professional standards.
A nurse who wishes to pursue the field of medical health nursing should have qualified nursing
education, licenses and use nursing standards that provide a framework by which nurses practice
nursing, When a nurse’ s qualifications falls below the acceptable nursing standards they become
exposed to litigation. The basis for litigation is similar to negligence, poor health care delivery,
nursing malpractice, and professional negligence and neglect for professional roles (NCCHC,
2015). Nurses are expected to uphold high standards for quality treatment of patients especially
when dealing with mental health care. Failing to follow the nursing code and acts can lead to
serious legal challenges for the nurse. Ethical concerns for nurses are in six ethical principles
namely (autonomy and being self determined) respect for persons
Doing good (Benevolence)
Non-maleficence (avoid harm)
Fairness, truthfulness and equitability (Just0
Veracity and integrity (being truthful)
Fidelity (faithfulness to commitment) NCCHC (2015)
The above principles guide ethical decision making for nurses. Ethical concerns for nurses
handling special patients or patients in a custody environment must maintain attitude and
compassion at the same time.
Mental illness accounts for thousands of deaths every year. National alliance on mental
health reported that every year mental illness affects 61.5 million of Americans. One in every 17
people lives with the mental illness like bipolar disorder, depression and schizophrenia, which
leads to death if not treated. 20% of teenagers from 13-18 experience serious mental disorders
while 1.1% of American adults live with schizophrenia (about 2.4million people) (National
alliance on mental illness). The impact of mental health in the world is hospitalization for youths
and adults thus leading to great health costs. Patients living with mental ailments are also more
vulnerable to other chronic and physical conditions. Mental patients are estimated to die two
decades earlier than other people and have extremely higher suicide rates. Canada mental health
association (2014) reported that suicide is committed every forty seconds. Suicide is a result of
severe depression, which is one of the major mental health diseases. The young generation is
vulnerable to suicides and death related to mental ailments as compared to people aged above 50
years. The loss of young lives is a deprivation of the productive years of a country and a terrible
setback for growth. As a result, taking care of mentally ill patients is a role that nurses should
play actively to reduce the number of deaths and help mental patients recover.
ASBN, Position statement 98-6, Decision making model,
Canadian mental health association 2014, Fast facts about mental illness, who is affected?
National alliance on mental illness (NAMI), Numbers of Americans affected by mental illness,
Mental illness facts and numbers, Arlington, VA
National Commission correctional health care 2015, Ethical and legal issuesl
Turpin, S and Marais, M, 2004, “Decision making: Theory and practice,” Orion, Vol. 20(2), p.