Decision types and clinical questions/choices expressed by acute and primary care nurses

Decision typeExample of clinical questions/choices
Intervention/effectiveness: decisions that involve choosing among interventions.Choosing a mattress for a frail elderly man who has been admitted with an acute bowel obstruction.
Targeting: a subcategory of intervention/effectiveness decisions outlined above, of the form “choosing which patient will benefit most from the intervention.”Deciding which patients should get antiembolic stockings.
Prevention: deciding which intervention is most likely to prevent occurrence of a particular health state or outcome.Choosing which management strategy is most likely to prevent recurrence of a healed leg ulcer.
Timing: choosing the best time to deploy the intervention.Choosing a time to begin asthma education for newly diagnosed patients with asthma.
Referral: choosing to whom a patient’s diagnosis or management should be referred.Choosing that a patient’s leg ulcer is arterial rather than venous and merits medical rather than nursing management in the community.
Communication: choosing ways of delivering information to and receiving information from patients, families, or colleagues. Sometimes these decisions are specifically related to the communication of risks and benefits of different interventions or prognostic categories.Choosing how to approach cardiac rehabilitation with an elderly patient who has had an acute myocardial infarction and lives alone, with her family nearby.
Service organisation, delivery, and management: these types of decisions concern the configuration or processes of service delivery.Choosing how to organise handover so that communication is most effective.
Assessment: deciding that an assessment is required and/or what mode of assessment to use.Deciding to use the Edinburgh Postnatal Depression screening tool.
Diagnosis: classifying signs and symptoms as a basis for a management or treatment strategy.Deciding whether thrush or another cause is the reason for a woman’s sore and cracked nipples.
Information seeking: the choice to seek (or not to seek) further information before making a further clinical decision.Deciding that a guideline for monitoring patients who have had their ACE inhibitor dosage adjusted may be of use, but choosing not to use it before asking a colleague.
Experiential, understanding, or hermeneutic: relates to the interpretation of cues in the process of care.Choosing how to reassure a patient who is worried about cardiac arrest after witnessing another patient arresting.