Ambiguity

Ambiguity

Ambiguity Effect (Howard, 2019): when we consider decision makers like doctors, nurses, coaches, administrators, many avoid options when probability is unknown. Decision makers will choose a known probability over an unknown probability. In medicine, supporting individual needs of a client requires more than a prescriptive plan for a process (illness, disease). Even in medical planning, familiarity generates comfort. A provider with certainty based on experience, may not consider interventions that they are unfamiliar with. The intricate indecision and ambiguity can be associated with avoidance of the unknown outcomes. My role as a school nurse often calls out my ambiguity because youth are very literal and have not had as much life experience along with an underdeveloped frontal lobe.

Addressing ambiguity as a provider or a client

You cannot react to a claim unless you understand meanings. What is the reason? What is the meaning of the outcome? As a provider, what is critical? What are key terms that need to be understood by the client? What crucial words or phrases are being used to explain reasons and outcomes. Avoid abstract words. Use a reverse-role play to determine certain words or phrases that may impact understanding. A client cannot react with fidelity without understanding meaning of terms and phrases. Medical “lingo” can be confusing for clients based on knowledge base, culture, expectations, or educational background etc. As a client, or advocate for a client, address ‘Do I/you understand what this means?” Give the client opportunity to ask questions. Avoid the mind-reading and assumptions. Ask “What do you mean by that?”. Ok, wait, make one assumption; assume terms have more than one meaning. Question may be “could this have a different meaning?”. Requesting a client repeat understanding may help with this understanding. If an alternate meaning is shared does it come to the same outcome? Does changing the meaning make a difference in supporting the expected outcome?

Ability to Disagree

A client, through addressing any ambiguity in reasonings or outcomes, can make a reasonable foundation for disagreeing with the option. Giving opportunity for open dialog and intentional actions to support clarification in reasoning and outcomes for a decision, can assist in better compliance. It isn’t about “buy-in” for a plan, but understanding and context.

Critical-Thinking and Ambiguity

Nurses make numerous decisions throughout the day including ethical, clinical, and practical. Decisions made in nursing often take place in an atmosphere full of events and conflicts. These critical decisions have a direct impact on the outcome of a health care as well as client safety.

Ambiguity within nursing practice include:

(a) variations in cues/available information,

(b) multiple interpretations,

(c) novel/nonroutine presentations

(d) unpredictability

(McMahon, & Dluhy,2017).

Experiences in nursing include:

(a) a context-specific, clinical situation with ambiguous features requiring evaluation

(b) an individual to sense a knowledge gap.

(McMahon, & Dluhy,2017).

Consequences include ranges of:

(a) emotional

(b) behavioral

(c) cognitive clinician responses.

(McMahon, & Dluhy,2017).

Ambiguity recognized by a nurse likely influences judgment, decision making, and clinical interventions. Decision making in the nurse practice environment is a dynamic conceptual process that impacts patient outcomes. Nurses need meaningful ways to exercise discretion and should be self-reflective in order to evolve further in the professional arena.

References

Howard, Jonathan. (2019). Cognitive Errors and Diagnostic Mistakes: A Case-Based Guide to Critical Thinking in Medicine. 10.1007/978-3-319-93224-8.

McMahon, M. A., & Dluhy, N. M. (2017). Ambiguity Within Nursing Practice: An Evolutionary Concept Analysis. Research and theory for nursing practice, 31(1), 56–74. https://doi.org/10.1891/1541-6577.31.1.56