Decision making the explicit evidence-based way: comparing benefits, harms and costs.

Decisions that nurses make in clinical practice are a significant contributor to effectiveness and cost effectiveness of health care. This paper explores the relationship between evidence, decision tools, and the effectiveness of the nursing contribution to health services. Whereas research evidence, to varying extent, has been used to inform decision making in nursing for some time, explicit evidence-based decision-making, or 'balance sheet' decision-making, is less familiar. A continuum of decision-making will be explored within the international trend of the Effectiveness Movement, drawing on international literature and local experience. Included in this discussion will be the concept of explicit evidence-based decision making, the guideline development movement as exemplified through the New Zealand Guidelines Group, information technology in decision-support, and some of the challenges of an evidential approach to nursing.