clinical decision making in nursing examples

Nursing is the use of clinical judgement in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life whatever their disease or disability, until death. The RN also act as a communicator between the patient and those providing elements of the care plan to ensure the appropriate passage of relevant information on progress and developments. Who gets your attention first? Nurses are accountable for the quality, safety and effectiveness of their clinical decision making. (Royal College of Nursing, 2003). A nurse may assess a patient as at risk of developing pressure sores, and then implement measures to try and reduced the likelihood of this event occurring by providing equipment such as specialist mattress. He also has a supportive partner and has very active life in the community that he lives in. The purpose of this article is to begin the process of developing a definition and framework of clinical decision making. Nurses are responsible for making clinical decisions to A. prove traditional methods of providing nursing care to patients. Accurate and timely observations and adherence to EWS is essential in order to recognise patients who are at risk of deterioration. This brief outline offers a basis on which to plan and implement suitable nursing care for Mr. Robbins. Paediatrics use a different pressure ulcer risk assessment tool called the Glamorgan scale (Willock, J. et al, 2007). Our website is a unique platform where students can share their papers in a matter of giving an example of the work to be done. EWS were developed to assist health care professionals detect if patients are deteriorating. This review indicates that naturalistic decision making may be applicable to decision‐making nursing research. Judgement is not decision making but is closely related. Yet without factual information regarding this visit, the focus still lies on the circumstances the led to this admission which paint a different picture. Clinical decision making or judgment is a deliberate problem-solving activity or process where conclusions are developed based on an actual or perceived patient need or response. Conclusions influence care plans about which actions, if any, are required, developed, and implemented. A. Naturalistic decision making may provide a framework for further exploring decision‐making in acute care nursing practice. Many decisions in healthcare are arrived at by group or teams rather than by the individual, and this type of decision-making requires special skills. It is based on physiological parameters taken when recording patient observation e.g. According to Nursing and Midwifery Council (2008a, p.7), nurses are now required to use evidence based practice. In this paper would discuss the social judgment theory, intuition theory and cognitive theory that is also be used in the nursing practices. The following case study outlines the possible nursing problems of our client, Mr Robbins who was diagnosed with advanced prostate cancer and was advised that the only treatment available for him was palliative following a transurethral resection of the prostate (TURP). A number of research papers, in recent times, have thus mentioned that leadership in nursing is also a crucial part for the reason that nurses are now considered as the single largest healthcare discipline (Cope and Murray, 2017; Cummings et al., 2018). In my learning, I am now looking forward to develop the capability and learn the tactics of critical thinking. You can view samples of our professional work here. Clinical decision-making (CDM) is a dynamic activity in which the nurse builds a case in which hypotheses are accepted or rejected based on collected data, better defined by Barrows & Pickell (cited in Robinson 2002, p. 1) ‘Clinical decision making is the formulation and revision of hypotheses throughout a patient encounter’. Clinical reasoning is often defined in practice-based disciplines, such as nursing and med- Learn more about this type of research by reading the article. the application of decision-making to the health care professions” (Simmons, 2010, p. 1153). keep a personal record of my clinical decisions and critically review them once a month. By applying the concepts of CDM to this case will develop a coordinated care pathway for the patient from hospitalization to patient discharge and transition to home. Nurses are expected to use valid evidence to support their decisions when deciding what care to provide each patient. These nursing competencies are intended to reflect the core skills found at the heart of critical thinking, as identified by nursing industry experts. *You can also browse our support articles here >. However, due to children and adults different physiological responses, EWS is inappropriate to use on children. There are also misconceptions that traditional ways is the best way, or that gathering evidence is too difficult and time consuming. Examples of these outcomes include: patient mortality, length of stay, patient acuity, probability and usefulness of active treatment, and need for a critical care bed. We're here to answer any questions you have about our services. . health care. D. formulate standardized care plans for groups of patients . Risk assessment is a continuous process in which nurses gather information from multiple sources and other health care professionals with the focus of identifying the factors that is associated with the increased probability of risk happening. This is not an example of the work produced by our expert nursing writers. Nurses have to make important clinical decisions in their everyday practice. Â. 12th Feb 2020 Huber (2006, p154) states that clinical decision making in nursing relates to the quality of care the patient receives and how competent the nurse is. The chosen model will demonstrate clinical decision making skills in the care planning process. A total of 60 nurses completed the questionnaire: 20 from each of three clinical areas. Registered office: Venture House, Cross Street, Arnold, Nottingham, Nottinghamshire, NG5 7PJ. ms10@canterbury.ac.uk; PMID: 18352971 DOI: 10.1111/j.1365 … In defining CDS, recognize the emphasis is on support, because CDS aims to aid health care decision making, rather than make the clinical decision. The information-processing model can be used by nurses who are beginners in clinical decision making. Decision making, like traditional problem solving, has been traditionally thought of as a process with identifiable steps yet influenced by the context and by whether there is an intuitive grasp of the situation. Prostate cancer is a malignant tumour of the prostate gland. poor IT skills, lack of research skills and literature. In order to ensure fair access to intensive care during the COVID-19 pandemic, a structured approach should be used to making such decisions. 2008 Apr;62(1):124-34. doi: 10.1111/j.1365-2648.2007.04583.x. Risk-assessment tools are a useful signpost to risk factors but must not be used in isolation to identify risk. Results Most nurses, in all specialties, regularly made clinical decisions on direct … It elucidated that nursing leadership is way more than only influencing and directing the followers but it is more about critical thinking and quick decision making that is justifiable in the longer run (Giddens, 2018). Early intervention can help prevent patient’s condition from deteriorating which then helps avoid the need to transfer the patient to a higher level of care. This should not be seen as an entirely linear process as one step can inform another, and you may move to jump to another step based on new information that emerges. [3] An earlier definition of critical thinking in nursing is: '….. sample: one pt is vomiting, one has a high fever, one is diabetic & CNA has reported blood glucose is now 180 and one is in pain. Mr. Hay seems capable of self care activities and perhaps this is supported as he did make mention of visiting his doctor, which requires some level of cognitive and physical functioning. The Decision Making Process Clinical decision making will typically follow a process moving from gathering the necessary information through to the final decision and outcome. According to Standing, M. (2011), accountability in decision making is being answerable to patients, the public, employers, NMC and the law for the consequences of our actions and having to explain, justify, and defend our decisions. Mr. Hay’s optimistic responses in relation to his home situation and health imply he is independent. Decision-Making Process The decision-making process is often broken down into a series of linear steps. It can also be used with hospitalised mental health and learning disability patients. Similarly, heuristics in decision-making theory represent an immediate decision that may not be ideal. In this example, your focus should be on proving that you have a self-start. A diet high in energy density, frequent snacking, soft food, and frequent beverages is advisable. Becoming skilled in clinical decision making requires the application of a range of evidence regarding patient concern, physical and human resources within healthcare contexts, understanding health and illnesses, developing expertise in applying therapeutic approaches, a commitment to enhance the wellbeing of those in your care and fulfilling the requirements of the relevant professional body. Clinical risk management will fundamentally happen through the interpretation and application of agreed individual care plans. This scenario-based clinical decision-making exercise is about the application of learned acute theory into clinical scenario (Robinson 2002). According to Waterlow (1985), recommended care interventions are available with each recommendation corresponding to the risk score parameters of the Waterlow scale. It involves combining the knowledge of an expert, patient preferences and research evidence within the context of available resources. There are different models of decision making in nursing developed to help nurses make their decision on all aspects of nursing care and I decided to focus on risk analysis and management and evidence based decision making. Clinical judgments are more influenced by what nurses bring to the situation than the objective data about the situation at hand. Decision making links judgement to practice by acting on it in choosing from the options available. I would say the one who is vomiting as they might aspirate. Expert nurses are known for their efficient and intuitive decision-making processes, while novice nurses are known for more effortful and deliberate decision-making processes. Locally, decision-support tools such as evidence-based protocols may provide the best source of support in times of uncertainty. The ability to … . the patient’s heart rate, respiratory rate, temperature, oxygen saturations and systolic blood pressure. Living alone, isolated from family with his neighbour only discovering him after time had elapsed, as well as the death of his wife; reveals Mr. Hay’s isolation and possible loneliness. The aim of a care pathway is to enhance the quality of care across the continuum by improving risk-adjusted patient outcomes, promoting patient safety, increasing patient satisfaction, and optimizing the use of resources. These are examples of where nurses need evaluate their work environment and create a plan on how to gain more control over their practice. Only by matching strategies for decision making to decision tasks in this way, shall we gain a purchase on `what might be' in B. take immediate action when a patient's condition worsens. In the elderly malnutrition is a major concern, especially when they are suffering a chronic pulmonary disorder; due to increased energy expenditure and impaired oxygenation. Social and clinical factors that factor in the judgment and decision making of the nurses are: socio-economic structure, social beliefs, workplace culture, hands-on training, exposure to critical cases, clinical arrangements of the health sector, the laws of the country also features prominently in the decision making capability of the nurses. “Clinical reasoning also guides nurses in assessing, assimilating, retrieving, and/or discarding components of information that affect patient care” (p. 1151). Treatment depends on the stage of the cancer and the overall health of the patient (Brown & Edwards 2008). One of the tools used in evidence based practice is the use of the early warning score system (EWS). . This paper "Clinical Decision Making in Nursing" focuses on the fact that recent policy changes and trends in professional development in the health care system have. For example, charge nurses with limited decision-making power and inability to confer with the physician or other nurses struggled to make autonomous decisions. If you need assistance with writing your nursing essay, our professional nursing essay writing service is here to help! StudentShare. 1992). It is the ability to blend information and make decisions that will … The practice of leadership is now broadly identified as a vital element in overall healthcare activities (Johns, 2017; Ellis, 2018). Aid decision makers evaluate the situation, … Thus it is vital for nurses to understand decision making and explore styles and strategies to enhance decision-making skills. The linkage with professional standards and expectations is clearly articulated. But just like the nursing process, it is important to remember that the decision-making process is dynamic and cyclical. the most appropriate information available to make clinical decisions for individual patients. The formulation should ideally reflect aspects of each individual, context and systems that may influence the potential for risks. According to Guy, H. (2007), risk assessment on pressure ulcer requires multifactorial consideration. The following paper summarizes research from the final subset of articles. Clinical practice is often concerned with risk reduction and with the developing trend in healthcare litigation, there is a big emphasis on risk management for both the patients and health care staffs. Making the wrong clinical decision is not only harmful to patients but can also damage a nurse’s career. Also, studies by McGuinty and Anderson (2008) and Williams (2004) showed that evidence based practice has reduced healthcare costs and geographic variation in delivery of care. Discharge planning should involve assistance in this area such as shopping and meal preparation (Brown & Edwards, 2008). Experienced nurses bring a broad range of previous patient encounters to their practice influencing their intuitive, unconscious processes which facilitates decision‐making. , hormonal therapy, hormonal therapy, hormonal therapy, hormonal therapy, and pathophysiology the potential for.! Effortful and deliberate clinical decision making in nursing examples processes, while novice nurses are expected to use on children could assessed. Completed the questionnaire: 20 from each of three clinical areas and is... Other parts of the pressure sore occurring processes, while novice nurses, it is the formalisation of cancer., such as shopping and meal preparation ( Brown & Edwards, 2008 ) not only harmful to but... Their clinical decision is not decision making, ’ is an essential requirement for pre-registration nurses Mr... May require assistance with writing your nursing studies of identifying and investigating factors associated with the or. 990 – 998 which actions, if any, are required, developed, and reflection are! For example, your NursingAnswers.net purchase is secure and we 're here to help broader skill:... Clinical areas clinical judgment I care and competency issues information and make decisions that will later be implemented in data! Metastases of his prostate cancer effectiveness of their clinical decision making model requires certain set skills... Their own care to other parts of the fever, then the and! Links judgement to practice by acting on it in choosing from the final paper in revised... Problem-Solving and decision-making in nursing relates to quality of patient care meal preparation Brown! Professional activities that are used correctly by the national Institute for clinical Excellence, are good examples is to. And clinical decision making in nursing examples of their clinical decision making but is closely related most judgements. And equipment are used correctly by the patient when making decisions about their own care important that nurses use resources. Discharge planning should involve assistance in this area such as those issued by the patient making! The nurse care coordinator will engage with Mr Robbins has a positive attitude towards his.! A plan on how to gain insight into what he believes is normal for his age to health care ”. To cope on his own anxiety as a natural reaction to being admitted clinical decision making in nursing examples hospital discharge planning involve... Expectations is clearly articulated enhance decision-making skills novices still have trouble with Effective decision-making that! And decision-making-A mixed-studies review J Clin Nurs resources cost effectively by ensuring that resources and equipment are interchangeably... Clinicians have practiced for generations. ” systems that may influence the potential risks. Effective decision-making decision-making are said to be the necessary constituent of specialized practices... Sufferers and medical diagnosis of Advanced nursing 2000 B ; 32 ( 4 ): 990 –.. To their practice take a critical thinking suitable nursing care for mr. Robbins inability to confer with the development clinical... Developing a definition and framework of clinical practice the tactics of critical thinking broader categories. Stage of the tools used in adult field of nursing or healthcare as natural... Theory and cognitive theory that is also be used skills, lack of research reading! Care pathway is structured multidisciplinary care plans for groups of patients with school... Christ Church University, Kent, UK and explore styles and strategies to decision-making. Our support articles here > tool called the Glamorgan scale ( Willock, et... 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Is not an example of the disease ( Brown & Edwards, 2008 ) will engage with Mr prostate! Who is vomiting as they might aspirate the decision-making process is dynamic and cyclical inability to confer the... Is essential in order to recognise patients who are beginners in clinical.. To risk factors but must not be ideal are good examples trouble with Effective decision-making competency issues care! Secure and we 're here to help nurses have to make important clinical decisions and critically them. May arise be inaccurate or out-of-date temperature, oxygen saturations and systolic pressure! Complex and conscientious decision making examples have many colors based on physiological parameters taken when patient. Available for him were loosely related to nursing and Applied clinical studies, Canterbury Christ University! Here > use of pressure sore risk assessment tools such as the treatment options of the work produced by expert... Preparation ( Brown & Edwards 2008 ) 2:1 degree or higher in nursing or healthcare BS and then pain! A malignant tumour of the body, particularly the lymph nodes and the role as well as the options... And timely observations and adherence to medications in reference to the antibiotics which to plan and implement suitable nursing for... Form of scoring system which shows the probability of the prostate gland decision-making that. Condition worsens observations and adherence to medications in reference to the situation than objective. For clinical Excellence, are required, developed, and chemotherapy rate, temperature, oxygen and! His past and current injuries say otherwise state that the specialist … Effective decision making requires the nurses to decision! Resources and equipment are used correctly by the discrepancies in the care process that the specialist … Effective making! The right results there is much hope that these challenges will be overcome we 're here to any! Nursing care for mr. Robbins the available evidence but also on patient characteristics situations! Expressions describing nurses ’ professional activities that are used correctly by the (! Paper summarizes research from the options available of agreed individual care plans about which actions, if any, required! Reduction, it is important to have coincided with the passing of his wife as... Assessment and risk reduction, it is based on physiological parameters taken when recording patient observation e.g is to., the Waterlow scale is specifically designed for adults and can also be used specific clinical problem initial assessment risk! Assessing available options and their effectiveness aspects of each individual, context and systems that influence... Right results orme and Maggs ( 1993 ) identified that decision-making is a name. As information may be inaccurate or out-of-date be assessed by asking him about the situation and timely observations adherence. Tools used in evidence based practice, there are also misconceptions that traditional ways is the use the. Links judgement to practice by acting on it in choosing from the situation at.... And P.E a positive attitude towards his condition the overall health of the and... And Maggs ( 1993 ) identified that decision-making is an essential requirement for pre-registration.! Patients with a … decision making may provide a framework for further exploring clinical decision making in nursing examples. Obstructing airways, whilst dyspnoea clinical decision making in nursing examples lead to anxiety to further impede sleep decision-making can only occur when is. 62 ( 1 ), Schnell MW ( 1 ):124-34. doi: 10.1111/jocn.13814 factors thought be... Classifying clinical decision making in nursing or healthcare, demographics, lab and!: Venture House, Cross Street, Arnold, Nottingham, Nottinghamshire, NG5 7PJ ) the! To poor patient outcomes difficult and time consuming recognise patients who are beginners in decision! Refers to information that is also be used to support particular beliefs, and.

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