Importance Of Information Processing Theory
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Answer:
Clinical decision making is a complex process that involves the interaction between the knowledge about pre existing pathological conditions, information present explicitly for the patient, learning acquired through experience and nursing care plan (Standing 2017; Johansen and O’Brien 2016). Various models can be utilized in clinical decision making, such as information processing theory, expected utility theory, social judgment theory, intuition theory and cognitive continuum theory (Shaban 2015; McEwen and Wills 2017; Wiltshire et al. 2014)
The aim of this essay is to discuss the importance of Information Processing Theory in clinical decision making in nursing practice. In this essay, information processing theory will be compared with social judgment theory and expected utility, with the three theories being outlined. Through the comparison of these three theories the pros and cons of each of their theories will be discussed to understand their merits and demerits in their use in clinical practice in nursing. From such an understanding, the reasons for selecting information processing theory in clinical decision making will be identified and how that can be useful in nursing practice for making clinical decisions. Also, examples of how the theory can be used in the nursing practice will be explained to elucidate the potential applications of the theory in practice. This will be used to connect theory to practice in order to outline a thought provoking work, which exhibits the advantages and aspects of the selected theory in nursing practice. Additionally, to have a better understanding of the theories, the various complexities, contradictions and inconsistencies between these theories will also be discussed while comparing them, in order to identify limitations and how they can be overcome. The essay will also try to identify possible counter arguments to the limitations identified for each of the three theories.
The three theories that would be discussed in this essay are: Information Processing Theory, Expected Utility Theory and Social Judgment Theory. Each of these theories have utilizes in the clinical decision making process, and can be applicable in the nursing practice. Discussed below are the outlines of each of these three theories:
Information Processing Theory explains how information is received, processed, stored and retrieved inside the brain, and it utilizes the model of information processing seen in computers to develop the human model of information processing. The model helps to understand how sensory information (or input) that is perceived from the environment is processed to develop a response (or output), as seen in case of a computer. The information can also take several paths based on the attention, encoding or storage (Rao 2016). The theory mainly assumes that information is processed in steps or stages, there are limits to the amounts of information that can be processed in each of these stages, and the system of processing the data is highly interactive. The main components of the model include the sensory register, the short term memory, the long term memory and the control processes, whose interactions while processing the environmental stimuli creates the response of output (Rains and Tukachinsky 2015).
Expected Utility Theory proposes that the decision maker can choose between uncertain or risky prospects by comparing their expected utility outcomes which is the weighed sum that is obtained by adding the utility values of outcomes by their respective probabilities. The theory assumes that when risky outcomes are present, the decision maker will not always choose the option that has more expected value of investment. This theory focuses on the analysis of situations in which an individual is required to make a decision without prior knowledge of the outcome that can occur due to the decision, and thus the decision is made under an uncertain condition. The choice and action of the decision maker is generally aimed to maximize the expected utility of the outcome and is also dependant on the extent of risk aversion of the decision maker and the utility of the agent (Shaban 2015; Farmer 2015).
Social Judgment Theory provides a framework for understanding human decision making process. The theory focuses on cognitive perspectives which studies how an individual perceive situations. The theory assumes that a contrasting effect occurs on an individual’s judgment when the stimulus is far from the anchor, while an assimilating effect occurs when the stimulus is close to the anchor. The theory generalizes the principles of psychosocial decision making processes to apply on social decision making, in which the preferred position of the decision maker is considered as the anchor of the judgment. The theory mainly focuses on the internal processes that are involved in the internal decision making in the context of the message being communicated. It helps to explain how persuasive messages can be better succeed and how attitude change is the fundamental objective of a persuasive message (Wiltshire et al. 2014; Shaban 2015; Unsworth et al. 2015).
For information processing theory the main strengths are i) Helps to process a large amount of information into a value that is meaningful. ii) It helps to focus on the dynamic mental processes that are involved in decision making which has helped to revolutionize developmental psychology. iii) It helps to understand the different types of thinking processes at different stages of information processing (Kriegeskorte 2015). The weaknesses of information processing theory include: i) It fails to explain the behavior of an individual in a complete or wholesome manner. ii) It also cannot explain complex cognitive functions of an individual as well as the perceptual and emotional dimensions involved in human development. iii) This model abandons emotions and behaviors in favor of the approach towards cognitive information processing (Indiveri and Liu 2015).
Expected Utility Theory: The main advantages are: i) It helps to understand decisions that are made under an uncertain circumstance. ii) It helps to understand how risk aversion influences clinical decision making. iii) It helps to understand decisions that are made without the prior knowledge of the outcomes of the decision based on their expected utilities and probabilities. iv). This theory is based on the implicit economic cognition hypothesis which provides a more comprehensive description of human decision making behavior (Greco et al. 2016). The disadvantages: i) An inability to reflect upon how agents interact in the real world to make decisions. ii) Real world behavior of the agents also can contradict some of the axioms of the theory that is not all decisions are based the probabilities of their expected outcomes. iii) The theory assumes that only the distribution of the probability over the final outcomes matter (Ramos et al. 2014; Greco et al. 2016).
Social Judgment Theory: The strengths of this theory include: i) It helps to explain how persuasion can be affected by the perception of a message. Ii) It helps in the prediction of the attitudes of an individual based on the position held by the person in regards to the views of the person. iii) It can provide an effective tool for healthcare professionals to invoke changes in attitudes. Iv) It helps to explain how involvement can greatly increase persuasiveness of the message (Bandura 2014). The disadvantages of this theory include: i). The theory does not consider the involvement of ego in the decision making process. ii) It does not upon how the latitudes of a person can affect the general persuasiveness of an individual. iii) It ignores message variables and contents such as argument quality or evidences. iv) It does not consider that individuals might be more open towards persuasion about things they have limited knowledge about. v). It does not deal much with people with less involvement apart from identifying them as having high latitude of non-commitment (Hall and Oppenheimer 2015).
From the three theories on decision making that are outlined above, I have selected the Information Processing Theory to be applicable in my nursing practice. This theory helps to understand how healthcare practitioners actually think and make clinical decisions, instead of focusing on how they should make the decisions, and helps to understand as well as explain behavior of the decision maker rather than predicting and controlling it (Ford 2017). Moreover, the model explains how an input of information in the form of environmental stimuli can be incorporated into the long term memory through the interaction with sensory registers, short term memory and control processes to create a response or output in the form of a clinical decision (Lachman et al. 2015). Such aspects can be used to design the learning outcomes in the training of nurses and how information can be transferred more efficiently into the long term memory (Hasson et al. 2015).
In the Information Processing theory model, concepts of cognitive science is utilized and focuses on the memory capacity (which is important to understand how much information can be memorized by an individual), chunking or clustering the complex information into patterns that can be recognized, evaluating alternate options and identify paths to solutions (Libby 2017). The model explains how information is gathered from the long term memory and converted into chunks that can be manipulated cognitively within the short term memory. A key assumption of this theory is that only a limited amount of information can be processed at time, and effective problem solving is adapted to such a limit (Dodge 2014). Within the profession of registered nursing, the use of information processing theory was utilized with a protocol of study usually known as verbal or ‘thinking aloud’ for making clinical decisions. Moreover, due to the addition of contextual variables, heuristics, task complexities of various degrees, and differing uncertainty levels, the information processing models are no longer mechanistic and linear (Anderson and Hinton 2014). Due to such advantages, information processing theory is considered to provide the best fit model for making clinical decisions in healthcare and nursing professions which has dynamic environments which requires certain levels of ambiguity in clinical practice (Lachman et al. 2015).
An example of using information processing theory in professional nursing practice can be found in the structured approach of identification of treatment options (for a patient) and their possible outcomes, assigning values to each of the identified outcomes, and also identify the possible relations between the identified options and their probable outcomes. This system can be used to systematize the process of clinical decision making through formal or informal models and incorporating frameworks such as decision trees, grids or flow diagrams. These factors have been found to be very useful in the evaluation of medical treatment options as well as analysis of treatment costs, treatment sensitivity and making decisions on policies or for the improvement of quality (Choi et al. 2016).
The technique of information processing can be easily used in nursing practice to support continuous practice, best practices and professional development. This can provide a suitable tool for identify errors in the decision making process and thus is also an effective tool for teaching (Aesaert et al. 2014). Using this approach uncertainty of the outcomes can be limited by outlining the scopes of the possible inferences. The hypothesis is generated from the information in the complaint form filed by the patient (such as what illness the patient is suffering from or whether it is the condition A, B or C that the patient is afflicted with. Specific cues are focused on, that can help to infer the correct diagnosis. The knowledge that is utilized in the decision making is categorized into 4 types: identification knowledge (which helps in the identification of the illness), elaboration knowledge (helping to understand how the illness is associated with the symptoms), planning knowledge (to develop a care plan or treatment plan) and execution knowledge (the act of providing treatment to the patient) (Shaban 2015).
Utilization of the information processing theory can be outlined through specific case scenarios, highlighting the decision making process involved, that supports the information processing theory. Discussed below is a case scenario related to the diagnosis and treatment/referral for Pelvic inflammatory disease (Brunham et al. 2015):
After the presentation of the case, a focused questioning can be started that will help to learn the history of discharge (such as the type, color, smell and onset) which will be followed by the examination of the patient, and further clinical information is either sought for or shared with the patient. This can involve sharing photographs or palpating the lower abdomen for signs of tenderness. These steps can be considered the acquisition of the cues and is the component 1 of the decision making process. Next the hypothesis is generated in which the presence of any acute problem is identified. This is the component 2 of the decision making process. From the identification of the acute condition, the cue can then be interpreted and any scopes of uncertainty are identified. This is the component 3 of decision making. Based on the interpretation of cue the hypothesis is evaluated which forms the component 4 of decision making. After evaluation of the hypothesis, the acute problems are analyzed to reach towards a diagnosis, which is the component 5 of decision making. Based on the diagnosis, the treatment plan or referral options are identified which the components 6 and 8 of the decision are making process) (El Hentour et al 2018).
Critical Analysis: The information processing theory has been criticized by authors as the studies supporting the theory were mostly based on simulated cases rather than real life scenarios, and each leading the dissimilar possibilities of outcomes. The reasons for the dissimilarities between the outcomes of simulated cases from real life scenarios are mainly due to the controlled amount of information that is available to the participants of the study, the information are serially presented to them and it is presumed that the goals and motivations of each of the participants 9of the study) are simple and singular. However a counter argument to such a view can be understood through the consideration as to whether it is the best practice to ‘think aloud’ every procedure during a real life clinical procedure. Such views can be rejected in clinical practice since in real life, most patients provide information in both serial as well as a controlled manner, especially if they are inarticulate. The ability to collect relevant information from the patient is the responsibility of the healthcare professionals. Also through the process of ‘thinking aloud’ the goals and motivations of the participants can be made explicit and understood (Lachman et al. 2015).
The Expected Utility Theory in turn sharply contradicts with the information processing theory, as it focuses on the expected utility of the outcomes and the possible risks in the decision making process. Authors have highlighted that expected utility theory is based on certain incorrect assumptions (Briggs 2014). So the process actually focuses on the possibilities of outcomes of a process. This makes the decisions subjective to the expected outcomes or probability distributions, and therefore in my opinion is not the best decision making tool in the arsenal of a healthcare professional. However, a significant counter argument that supports this model for clinical decision making is the possibility to incorporate loss aversion, which can prevent adverse effects of wrong treatment in case of an uncertain treatment plan. This counter argument however is only applicable only in when there is a significant uncertainty in the clinical decisions (Levy 2016).
The complexities and contradictions of the social judgment theory with the other two theories are based on the fact that the theory focuses on the perceptions of the message instead of how the message is encoded or the expected utility of the message. The main assumptions of the social judgment theory can be critiqued on the bases of how internal representation, understanding and outcomes of a message can affect the decisions. The theory mainly is based upon the persuasiveness of a message which is used to explain how memories are retained by individuals and decisions are made based on it. However, such assumptions can be criticized in cases of clinical decisions whose outcomes are not clear, and hence does not provide a scope for being persuasive (Murphy 2017).
Form the essay it can be summarized that information processing theory uses the model of decision making and information processing as used in computers, where data is divided into chunks of information with a meaningful pattern and the model outlines how data is processed in the brain. The expected utility theory however is applicable in situations with uncertain outcomes, where the probability distribution of an event is used for reaching a decision. In case of the social judgment theory, the message is seen in terms of its persuasiveness, helping to understand how some message are better retained than others.
Clinical decision making is a vital component of healthcare practice which requires both a prior knowledge of clinical conditions and their effects and a process of continuous learning though experiences and development of treatments and care plans. Different models can be used by healthcare professionals to make clinical decisions such as information processing theory, expected utility theory, social judgment theory, intuition theory and cognitive continuum theory. In this essay, the information processing theory was compared to social judgment theory and expected utility theory to understand the merits and demerits of each and how information processing theory is the best fit model for making clinical decisions. The process of involving the information processing theory in real life practice has also been discussed as a case scenario, and the complexities and contradictions of each of these theories have also being outlined to gain a better insight into these theories.
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