Question

Problems that are best suited for the various methods of paternalistic, informative and shared decision making in leadership and management nursing

Answer 1

Paternalistic decision making:

Paternalist leaders are defined as the leaders who have a strong influence on employees, give them the opportunity to explain their own ideas, allow co-decision procedure and establish control on employees, and also encourage them to be innovative.

The most important characteristic of paternalism enables it to be perceived as a legitimate power.

It has been shown that authoritarianism has a negative impact on the behaviors of subordinates such as the satisfaction of staff about their leader, organizational commitment and organizational citizenship behavior.

Paternalistic leadership style can create a dependency on the clinicians Since the leader acts as the decision-maker, the staffs might feel less inclined to look for solutions or innovations.

Instead of making decisions on their own, subordinates start running for everything to the leader. This cannot just harm the staff’s ability to learn and develop new plans and actions, but also affect the overall patient health and wellbeing.

Since the staffs are not part of the decision-making process, the morale can drop if the staffs do not see the decisions as beneficial.

Although the leader should ideally try to make decisions based on what is best for the staffs or the patients, this is not always possible and different staffs might see a same decision differently.

Whilst subordinate input is not discouraged, the decisions are still in the hands of the leader or nurse manager. Placing power in the hands of a single individual can lead to problems.

If the leader doesn’t stay grounded and humble, the idea that he or she is the best person for deciding things can cause arrogance and lead to worse decisions. If there are no checks in place to question the leader’s decisions, then the organization might suffer. In short, paternalistic leadership could lead to complacency.

In addition, innovation has been shown by studies to grow when diverse opinions are allowed and encouraged. If the leader is always right, challenging can be difficult and thus innovation might stall. Thus  the staffs might become content in performing their daily routines. This can reduce their willingness to work hard for better patient care or look for new interventions.

Informative decision making:

Every person is an individual with different values and preferences. These values and preferences are important factors in making decisions in every aspect of life, including medical decisions. Informed decision-making is the two-way communication process between a patient and one or more health practitioners that is central to patient-centred health care.

Providers are not typically trained to facilitate informed decision-making in clinical practice.

System barriers include low compensation for time spent in decision-making compared with compensation for performing procedures and inadequate infrastructure to support decision-making, such as reminder systems, registries, or scheduling systems.

Patient-centered barriers to informed decision making are age, education, and illness.

Ethical medical care emphasizes respect for the decisions of autonomous patients, but medical care of patients who have never had autonomy, such as young children or those with mental developmental delay, relies on other ethical principles.

Process-centered barriers (such as content and readability of the consent form, timing of discussion, and amount of time allotted to the process) can affect an individual's ability to paticipate in informed decision making.

Shared decision making:

Attempts are being made to promote shared decision-making in which patients are given the opportunity to express their values and preferences and to participate in decisions about their care. There has been a paradigm shift away and a drive towards more patient-centred care, whereupon the patient is more empowered, informed, and autonomous – a move from a ‘paternalistic’ to a ‘mutualistic’ relationship

Most patients do not want to participate in decisions; that revealing the uncertainties inherent in medical care could be harmful.

Of course, there may always be the scenario where the patient does not engage in decision making, be it because they do not want to, do not feel equipped to, or lack the capacity.

It is not feasible to provide information about the potential risks and benefits of all treatment options; and that increasing patient involvement in decision-making will lead to greater demand for unnecessary, costly or harmful procedures which could undermine the equitable allocation of health care resources.

Patients want more information and greater involvement, although knowledge about the circumstances in which shared decision-making should be encouraged, and the effects of doing so, is sparse.