The aim of this study was to describe the relationship between negative affect (NA), decision-making style, time stress, and decision quality in health care.
Background
Health care providers must often make swift, high-stakes decisions. Influencing factors of the decision-making process in this context have been understudied.
Method
Within a sample of labor and delivery nurses, physicians, and allied personnel, we used self-report measures to examine the impact of trait factors, including NA, decision-making style, and perceived time stress, on decision quality in a situational judgment test (Study 1). In Study 2, we observed the influence of state NA, state decision-making style, state time stress, and their relationship with decision quality on real clinical decisions.
Results
In Study 1, we found that trait NA significantly predicted avoidant decision-making style. Furthermore, those who were higher on trait time stress and trait avoidant decision-making style exhibited poorer decisions. In Study 2, we observed associations between state NA with state avoidant and analytical decision-making styles. We also observed that these decision-making styles, when considered in tandem with time stress, were influential in predicting clinical decision quality.
Conclusion
NA predicts some decision-making styles, and decision-making style can affect decision quality under time stress. This is particularly true for state factors.
Application
Individual differences, such as affect and decision-making style, should be considered during selection. Training to reduce time stress perceptions should be provided.
AbramsonL. Y.AlloyL. B.HankinB. L.HaeffelG. J.MacCoonD. G.GibbB. E. (2002). Cognitive vulnerability-stress models of depression in a self regulatory and psychobiological context. In GotlibI. H.HammenC. L. (Eds.), Handbook of depression (pp. 268–294). New York, NY: Guilford Press.
2.
AikinsD. E.CraskeM. G. (2001). Cognitive theories of generalized anxiety disorder. Psychiatric Clinics of North America, 24, 57–71. doi:10.1016/S0193-953X%2805%2970206-9
3.
AlloyL. B.AbramsonL. Y.HoganM. E.WhitehouseW. G.RoseD. T., RobinsonLapkinR. S. (2000). The Temple-Wisconsin Cognitive Vulnerability to Depression project: Lifetime history of Axis I psychopathology in individuals at high and low cognitive risk for depression. Journal of Abnormal Psychology, 109, 403–418. doi:10.1037/0021-843X.109.3.403
4.
BaruchY.HoltomB. C. (2008). Survey response rate levels and trends in organizational research. Human Relations, 61, 1139–1160. doi:10.1177/0018726708094863
5.
BeachL. R.LipshitzR. (1993). Why classical decision theory is an inappropriate standard for evaluating and aiding most human decision-making. In KleinG. A.OrasanuJ.CalderwoodR.ZsambokC. E. (Eds.), Decision making in action: Models and methods (pp. 21–35). Westport, CT: Ablex.
6.
BerwickD. M.NolanT. W.WhittingtonJ. (2008). The triple aim: Care, health, and cost. Health Affairs, 27, 759–769. doi:10.1377/hlthaff.27.3.759
7.
BodenhausenG.SheppardL.KramerG. (1994). Negative affect and social judgment: The different impact of anger and sadness. European Journal of Social Psychology, 24, 45–62. doi:10.1002/ejsp.2420240104
8.
BorkovecT. D. (1994). The nature, functions, and origins of worry. In DaveyG.TallisF. (Eds.), Worrying: Perspectives on theory, assessment, and treatment (pp. 5–33). Sussex, UK: Wiley.
ButlerD.GeisF. L. (1990). Nonverbal affect responses to male and female leaders: Implications for leadership evaluations. Journal of Personality & Social Psychology, 58, 48–59. doi:10.1037/0022-3514.58.1.48
11.
Cannon-BowersJ. A.SalasE. (1998). Individual and team decision making under stress: Theoretical underpinnings. In Cannon-BowersJ. A.SalasE. (Eds.), Making decisions under stress: Implications for individual and team training (pp. 17–38). Washington, DC: American Psychological Association.
12.
ChaikenS.LibermanA.EaglyA. H. (1989). Heuristic and systematic information processing within and beyond the persuasion context. In UlemanJ. S.BarghJ. A. (Eds.), Unintended thought (pp. 212–252). New York, NY: Guilford Press.
13.
ChenG.GullyS. M.WhitemanJ. A.KilcullenR. N. (2000). Examination of relationships among trait-like individual differences, state-like individual differences, and learning performance. Journal of Applied Psychology, 85, 835–847.
14.
CloreG. L.StorbeckJ. (2006). Affect as information about liking, efficacy, and importance. In ForgasJ. P. (Ed.), Affect in social thinking and behavior (pp. 123–141). New York, NY: Psychology Press.
15.
CohenM. S.FreemanJ. T. (1997). Understanding and enhancing critical thinking in recognition-based decision making. In FlinR.MartinL. (Eds.), Decision making under stress: Emerging themes and applications (pp. 161–169). Aldershot, UK: Ashgate.
16.
CombsA. W.TaylorC. (1952). The effect of the perception of mild degrees of threat on performance. Journal of Abnormal and Social Psychology, 47, 420–424. doi:10.1037/h0057196
17.
CropanzanoR.WeissH. M.HaleJ. M.RebJ. (2003). The structure of affect: Reconsidering the relationship between negative and positive affectivity. Journal of Management, 29, 831–857. doi:10.1016/S0149-2063(03)00081-3
18.
DriskellJ. E.SalasE. (1991). Group decision making under stress. Journal of Applied Psychology, 76, 473–478. doi:10.1037/0021-9010.76.3.473
19.
DriverM. J. (1979). Individual decision making and creativity. In KerrS. (Ed.), Organizational behavior (pp. 59–94). Columbus, OH: Grid.
20.
EasterbrookJ. A. (1959). The effect of emotion on cue utilization and the organization of behavior. Psychological Review, 66, 183–201. doi:10.1037/h0047707
21.
FerrariJ. R.DovidioJ. F. (2000). Examining behavioral processes in indecision: Decisional procrastination and decision-making style. Journal of Research in Personality, 34, 127–137.
22.
FlinR.SlavenG.StewartK. (1996). Emergency decision making in the offshore oil and gas industry. Human Factors, 38, 262–277. doi:10.1177/001872089606380207
23.
FonteynM. E.RitterB. J. (2000). Clinical reasoning in nursing. In HiggsJ.JonesM. (Eds.), Clinical reasoning in the health professions (2nd ed.; pp. 107–116). Philadelphia, PA: Butterworth Heinemann.
24.
ForgasJ. P.GeorgeJ. M. (2001). Affective influences on judgments and behavior in organizations: An information processing perspective. Organizational Behavior and Human Decision Processes, 86, 3–34. doi:10.1006/obhd.2001.2971
25.
GotlibI. H.KaschK. L.TraillS.JoormannJ.ArnowB. A.JohnsonS. L. (2004). Coherence and specificity of information-processing biases in depression and social phobia. Journal of Abnormal Psychology, 113, 386–398. doi:10.1037/0021-843X.113.3.386
26.
GotlibI. H.YueD.JoormannJ. (2005). Selective attention in dysphoric individuals: The role of affective interference and inhibition. Cognitive Therapy & Research, 29, 417–432. doi:10.1007/s10608-005-5753-6
27.
HancockP. A.WarmJ. S. (1989). A dynamic model of stress and sustained attention. Human Factors, 31, 519–537.
28.
HarrenV. A. (1979). A model of career decision making for college students. Journal of Vocational Behavior, 14, 119–133. doi:10.1016/0001-8791(79)90065-4
29.
HarteJ. M.KoeleP. (1997). Methodological and psychometric aspects of process tracing research. In RanyardR.CrozierR.SvensonO. (Eds.), Decision making: Cognitive models and explanations (pp. 21–34). London, UK: Routledge.
30.
HinesS.LunaK.LofthusJ.MarquardtM.StelmokasD. (2008). Becoming a high reliability organization: Operational advice for hospital leaders (AHRQ Publication No. 08-0022). Rockville, MD: Agency for Health Research and Quality.
31.
HockeyG. R. J. (1986). A state control theory of adaptation and individual differences in stress management. In HockeyR. J.GaillardA. W.ColesM. G. (Eds.), Energetics and human information processing (pp. 285–298). Dordrecht, Netherlands: Springer.
32.
IsenA. M.MeansB. (1983). The influence of positive affect on decision-making strategy. Social Cognition, 2, 18–31.
33.
JanisI. L.MannL. (1977). Decision making: A psychological analysis of conflict, choice, and commitment. New York, NY: Free Press.
34.
KaempfG. L.WolfS.MillerT. E. (1993). Decision making in the AEGIS combat information center. In Proceedings of the Human Factors and Ergonomics Society 37th Annual Meeting (pp. 1107–1111). Santa Monica, CA: Human Factors and Ergonomics Society.
35.
KanferR. (1990). Motivation theory and industrial and organizational psychology. In DunnetteM. D.HoughL. M. (Eds.), Handbook of industrial and organizational psychology (Vol. 1, 2nd ed., pp. 75–170). Palo Alto, CA: Consulting Psychologists Press.
36.
KanferR. (1992). Work motivation: New directions in theory and research. In CooperC. L.RobertsonI. T. (Eds.), International review of industrial and organizational psychology (Vol. 7, pp. 1–53). New York, NY: Wiley.
37.
KeinanG.FriedlandN. (1987). Decision making under stress: Scanning of alternatives under controllable and uncontrollable threats. Journal of Personality and Social Psychology, 64, 219–228.
38.
KellyK. (1966). Clinical inference in nursing: I. A nurse’s viewpoint. Nursing Research, 15, 23–38. doi:00006199-196601510-00007
39.
KinickiA. J.VecchioR. P. (1994). Influences on the quality of supervisor-subordinate relations: The role of time-pressure, organizational commitment, and locus of control. Journal of Organizational Behavior, 15, 75–82. doi:10.2307/2488379
40.
KleinG. A. (1993). A recognition-primed decision (RPD) model of rapid decision making. In KleinG. A.OrasanuJ.CalderwoodR.ZsambokC. E. (Eds.), Decision making in action: Models and methods (pp. 138–147). Norwood, NJ: Ablex.
41.
KleinG. A. (1996). The effect of acute stressors on decision making. In DriskellJ. E.SalasE. (Eds.), Stress and human performance (pp. 49–88). Mahwah, NJ: Lawrence Erlbaum.
42.
Kowalski-TrakoflerK. M.VaughtC.ScharfT. (2003). Judgment and decision making under stress: An overview for emergency managers. International Journal of Emergency Management, 1, 278–289.
43.
LazarusR. S. (1999). Stress and emotion: A new synthesis. New York, NY: Springer.
44.
LazarusR. S.FolkmanS. (1984). Stress, appraisal, and coping. New York, NY: Springer.
45.
LehnerP.Seyed-SolorforoughM. M.O’ConnorM. F.SakS.MullinT. (1997). Cognitive biases and time stress in team decision making. IEEE Transactions on Systems, Man and Cybernetics, Part A: Systems and Humans, 27, 698–703. doi:10.1109/3468.618269
46.
LernerJ. S.KeltnerD. (2000). Beyond valence: Toward a model of emotion-specific influences on judgement and choice. Cognition and Emotion, 14, 473–493. doi:10.1080/026999300402763
47.
LernerJ. S.KeltnerD. (2001). Fear, anger, and risk. Journal of Personality and Social Psychology, 81, 146–159. doi:10.1037/0022-3514.81.1.146
48.
LernerJ. S.TiedensL. Z. (2006). Portrait of the angry decision maker: How appraisal tendencies shape anger’s influence on cognition. Journal of Behavioral Decision Making, 19, 115–137. doi:10.1002/bdm.515
49.
LipshitzR. (1993). Converging themes in the study of decision making in realistic settings. In KleinG. A.OrasanuJ.CalderwoodR.ZsambokC. E. (Eds.), Decision making in action: Models and methods (pp. 103–137). Norwood, NJ: Ablex.
50.
LipshitzR.KleinG.OrasanuJ.SalasE. (2001). Taking stock of naturalistic decision making. Journal of Behavioral Decision Making, 14, 331–352. doi:10.1002/bdm.381
51.
LoewensteinG.LernerJ. S. (2003). The role of affect in decision making. In DavidsonR. J.SchererK. R.GoldsmithH. (Eds.), Handbook of affective sciences (pp. 619–642). New York, NY: Oxford University Press.
52.
MattesonM. T.IvancevichJ. M. (1987). Controlling work stress: Effective human resource and management strategies. San Francisco, CA: Jossey-Bass.
53.
MatthewsG.FalconerS. (2000). Individual differences in task-induced stress in customer service personnel. Proceedings of the Human Factors and Ergonomics Society 44th Annual Meeting (pp. 145–148). doi:10.1177/154193120004401707
54.
McKenneyJ. L.KeenP. W. (1974). How managers’ minds work. Harvard Business Review, 52(3), 79–90.
55.
NygrenT. E. (1997). Framing of task performance strategies: Effects on performance in a multi-attribute dynamic decision making work environment. Human Factors, 39, 425–437.
56.
NygrenT. E. (2000, November). Development of a measure of decision making styles to predict performance in a dynamic J/DM task. Paper presented at the annual meeting of the Psychonomic Society, New Orleans, LA.
57.
NygrenT. E.WhiteR. J. (2002). Assessing individual differences in decision making styles: Analytical vs. intuitive. In Proceedings of the Human Factors and Ergonomics Society 46th Annual Meeting (pp. 953–957). doi:10.1177/154193120204601204
58.
NygrenT. E.WhiteR. J. (2005). Relating decision making styles to predicting self-efficacy and a generalized expectation of success and failure. In Proceedings of the Human Factors and Ergonomics Society 49th Annual Meeting (pp. 432–436). doi:10.1177/154193120504900346
59.
OrasanuJ.ConnollyT. (1993). The reinvention of decision making. In KleinG. A.OrasanuJ.CalderwoodR.ZsambokC. E. (Eds.), Decision making in action: Models and methods (pp. 3–20). Norwood, NJ: Ablex.
60.
PatelV. L.KaufmanD. R.ArochaJ. F. (2002). Emerging paradigms of cognition in medical decision-making. Journal of Biomedical Informatics, 35, 52–75. doi:10.1016/S1532-0464(02)00009-6
61.
PattersonJ.GardnerB.BurrB.HublerD.RobertsK. (2012). Nonverbal behavioral indicators of negative affect in couple interaction. Contemporary Family Therapy: An International Journal, 34, 11–28. doi:10.1007/s10591-011-9170-6
62.
PloyhartR. E.EhrhartM. G. (2003). Be careful what you ask for: Effects of response instructions on the construct validity and reliability of situational judgment tests. International Journal of Selection and Assessment, 11, 1–16. doi:10.1111/1468-2389.00222
63.
PrewettM. S.BrannickM. T.PecklerB. (2013). Training teamwork in medicine: An active approach using role play and feedback. Journal of Applied Social Psychology, 43, 316–328. doi:10.1111/j.1559-1816.2012.01001.x
64.
RevelleW.AmaralP.TurriffS. (1976). Introversion/extroversion, time stress, and caffeine: Effect on verbal performance. Science, 192, 149–150. doi:10.1126/science.1257762
65.
ReynaV. F.LloydF. J. (2006). Physician decision making and cardiac risk: Effects of knowledge, risk tolerance, and fuzzy processing. Journal of Experimental Psychology: Applied, 12, 179–195.
66.
RiazM.RiazM.BatoolN. (2012). Personality types as predictors of decision making styles. Journal of Behavioural Sciences, 22, 99–114.
67.
RockeC.BroseA. (2013). Intraindividual variability and stability of affect and well-being: Short-term and long-term change and stabilization processes. GeroPsych, 26, 185–199.
68.
RoemerL.OrsilloS. M. (2002). Expanding our conceptualization of and treatment for generalized anxiety disorder: Integrating mindfulness/acceptance-based approaches with existing cognitive-behavioral models. Clinical Psychology of Science and Practice, 9, 54–68. doi:10.1093/clipsy.9.1.54
69.
SalasE.DriskellJ. E.HughesS. (1996). Introduction: The study of stress and human performance. In DriskellJ. E.SalasE. (Eds.), Stress and human performance (pp. 1–45). Mahwah, NJ: Lawrence Erlbaum.
70.
SalasE.RosenM. A.DiazGranadosD. (2010). Expertise-based intuition and decision making in organizations. Journal of Management, 36, 941–973. doi:10.1177/0149206309350084
71.
SchwarzN. (1990). Feelings as information: Informational and motivational functions of affective states. In HigginsE.SorrentinoR. M. (Eds.), Handbook of motivation and cognition: Foundations of social behavior (Vol. 2; pp. 527–561). New York, NY: Guilford Press.
72.
ScottS. G.BruceR. A. (1995). Decision-making style: The development and assessment of a new measure. Educational and Psychological Measurement, 55, 818–831. doi:10.1177/0013164495055005017
73.
SimpsonP. A. (2001). Naturalistic decision making in aviation environments (Report No. DSTO-GD-0279). Victoria, Australia: DSTO.
74.
SzalmaJ. L. (2009). Individual differences in human–technology interaction: Incorporating variation in human characteristics into human factors and ergonomics research and design. Theoretical Issues in Ergonomics Science, 10, 381–397. doi:10.1080/14639220902893613
75.
TettR. P.BurnettD. D. (2003). A personality trait-based interactionist model of job performance. Journal of Applied Psychology, 88, 500–517.
76.
WardA.LyubomirskyS.SousaL.Nolen-HoeksemaS. (2003). Can’t quite commit: Rumination and uncertainty. Personality and Social Psychology Bulletin, 29, 96–107.
77.
WatsonD.ClarkL. A.TellegenA. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54, 1063–1070. doi:10.1037/0022-3514.54.6.1063
78.
WinkielmanP.KnutsonB.PaulusM.TrujilloJ L. (2007). Affective influence on judgments and decisions: Moving towards core mechanisms. Review of General Psychology, 11, 179–192. doi:10.1037/1089-2680.11.2.179
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