Clinical Decision Making Essay

Clinical judgment is the clinical reasoning, which includes clinical decision-making, critical thinking, and a global grasp of the situation, coupled with nursing skills acquired through a process of integrating formal and informal experiential knowledge and evidence- based guidelines (AACN, n.d.). In the case of F.S., he was on isolation precautions due to his infection. The results from the cultures had yet to return, therefore the infection was not identified at that current moment. The registered nurse that was assigned to F.S. went into the room several times without wearing proper protective personal equipment. This nurse stated that if she wasn’t touching the site, she was not at risk. This was a bad clinical judgment. Unfortunately, this was not the first time this student nurse witnessed the lack of use of the personal protective equipment. What most nurses don’t seem to understand is that the risk of infection is not only towards the patient but towards the nurse as well as everyone the nurse encounters. Contact precautions were researched and found to be associated with activities likely to reduce transmission of resistant pathogens, such as fewer visits and better hand hygiene at the exit while exposing patients on contact precautions to less healthcare worker contact, less visitor contact, and potentially other unintended outcomes (Morgan et al, 2013). Although it can be depressive for the patient to become isolated due to an infection, this

Within the practice of nursing, situations often arise where nurses are forced to make decisions regardless of their level of experience in the profession. Providing care and following the physician’s orders historically were the nurse’s sole responsibilities. However, social change, changes in health care finances, increasing international perspectives, and demographic population changes, have resulted in a significant evolution of the roles and responsibilities emplaced on today’s nurses (The National Association of Clinical Nurse Specialists (NACNS), 2007). Kelly and Crawford (2013) believe budget cuts, higher client acuity and clients with complex needs, mergers of hospital corporations as well as a general shortage of qualified nurses has made it necessary for nurses to play a role in decision making. Decision making is defined as “cognitive process leading to the selection of a course of action among alternatives” (Kelly & Crawford, 2013, p. 352).

A survey of the nursing literature shows that supporting medical nurse staffing guarantees quality nursing watch over patients and has been a progressing test for attendant directors and executives. Inability to guarantee adequate numbers and empathetic medical attendant staff has been shown to adversely affect tolerant fulfillment and results. The medical nurse staffing issue is not restricted just to guarantee sufficient quantities of staff that are being lost in the intense consideration settings because of workaholic behavior, burnout, sympathy exhaustion and wounds; the attendant staffing issue additionally incorporates the effect to patient consideration and to the nursing work power when empathy and caring

Once all data collected, a clinical data report will be generated and presented to the quality improvement committee in PED with appropriate recommendations on pain management improvement within PED. The possible recommendations of my clinical audit will be as below:

Nurses use clinical judgement each day when caring for patients. It is essential that nurses have an understanding of the problems associated with each patient’s disorder and possess the knowledge and skill to make concise decisions that will help to deliver better quality care. According to Bussard, (2015) clinical judgement is defined as, “an interpretation or conclusion about patient’s needs, concerns, or health problems, and/or the decision to take action (or not), use to modify standard approaches, or improvise new ones as deemed appropriate by the patient’s response” (p. 451). The writer chose clinical judgement in the care for patients with pressure ulcers because

Although clinical decision-making and clinical judgements are closely linked, but the concepts are separate. Clinical judgement defined as “an assessment between alternatives” whilst clinical decision-making defined as “a choice between alternatives” (Dowie, cited by Thompson and Dowding 2009). To choose the best between two alternatives requires the rationale behind decisions which can obtain by asking questions to create information (Standing 2010). Furthermore, Levette et al’s (2010, p. 515-20) define clinical reasoning as “the process by which nurses collect clues, gather information, come to an understanding of a patient problem or situation, plan and implement interventions, evaluate outcomes and reflect on and learn from the process”.

Kayla, I like how you talked about how nurses tend to use their own experiences when take making decision for patients. I read in an article that with the dramatic changes in healthcare and the growth of integrated delivery systems have intensified practitioners’ efforts to access new information about more efficacious approaches that enhance discipline-specific contributions to patient outcomes (Rosswurm & Larrabee, 1999). Now that we have been exposed to these new models, it will interesting to see which model we will lean toward as start to slowing build on our own experiences.

Clinical Decision Support is an important tool for clinicians, staff, patients and other persons because it provides these individuals with knowledge and information with the aim of enhancing health and healthcare. It encompasses various elements that make the decision making process more effective within the clinical workflow. They include computerized alerts to care givers and patients, focused data report on patient status, clinical guidelines, documentation templates, and contextual relevant reference. This essay will critically analyze strategy that can be employed to enhance the integration of various aspects of patients with the CDS and means through which efforts can be prioritized in a team. This will include CDS intervention meeting meaningful use requirements and other areas of institutional priorities where clinical improvement can be achieved.

Lauri and Salantera (2002) have identified three decision-making models that are utilized by nurses to make clinical judgments based off of information processing and intuitive-humanistic theories (Parker, 2014). The first model is the analytical decision making, which involves the collection of data, forming a hypothesis and continuing to collect data until a decision has been reached (Parker, 2014). Secondly, the intuitive decision-making is “understanding without rationale” (Parker, 2014). The third model is a combination of the analytical and intuitive decision-making. The registered nurses (RN) who participated in this study were from an acute care unit who had activated the RRT at least once in the past 12 months. The RN’s were between the ages of 24-57, 91% were female, 63% of them held a baccalaureate or master’s degree in nursing and the average time working as an RN was 10 years (Parker, 2014).

The questionnaire that will be used to measure the clinical decision making skills of the nurses if the Nurse Decision Making Instrument by Lauri & Salantera (2002). It was originally developed as a 56-item scale based on Hammond’s (1996) Cognitive Continuum Theory and designed to investigate whether nurses make more analytic or intuitive decisions in practice. The instrument is used to determine in general terms how nurses’ decision making occurs on the continuum from analytical to intuitive. The instrument was originally structured to include four main stages of decision making: collecting information to define a patient’s condition; processing information to define nursing problems; planning and implementing; monitoring and evaluating nursing

In a study conducted by La Martina & Ward (2014) cite that nurses are required to possess skills and attribute necessary for complex decision –making. A measure instrument that was developing to facilitated the ability to make decision of cognitive behavior

Decision making is the cognitive process leading to the selection of a course of action among alternatives (Kelly &Crawford). Nurses’ decision, particularly focuses on clinical scenarios. Clinical Decision making is by deciding what information to gather, which tests to order, how to interpret and integrate this information to draw diagnostic conclusions, and which treatments to give (Douglas L, 2015). The nurse’s decision is judgments as to whether it will be helpful to the client/patient or it will harm. I noticed that the patient’s life or health are placed in our care which before we make the conclusion of our decision, nurses must access or weigh the positives and negative impact and other considerable alternatives before we conclude our

Clinical decision making is a contextual, continuous, and evolving process, where data are gathered, interpreted, and evaluated in order to select an evidence-based choice of action. An Effective Practitioner is tasked with making clinical decisions with patients and clients many times during their health and care journey. Factors that affect decision making There are many factors involved in clinical decision making and each of the core skills has the potential to impact effective decision making. 1.Knowing the evidence – Any clinical decision maker should rely on a knowledge base which contains a wide array of literature review. Thanks to the digital advancements and technology, we can embed a wide variety of information in the form of E-books, articles, journals, reference materials related to the current practice, so that we as a clinical decision makers can rely on them for decision making process or even patients if they want information about the disease or treatment protocols, can utilise to research the evidence base, many of the physicians as well are simply referring them a bunch of latest treatment articles or their website link in their portals to justify their

As a student nurse, the rationale for choosing this case scenario in the decision-making process is to develop the knowledge and skills of decision-making theory as this situation might come across in the near future while working in the hospital. Decision making is one of the Nursing Midwifery Council (NMC) (2010) standards for pre- registration education under “ The competency framework Domain 3: Nursing Practice and Decision Making” that all the pre- registration must achieve before qualifying as a nurse.

Critical thinking and clinical reasoning are essential skills to develop a sound clinical judgement. Nurses use critical thinking models and processes to support and organize the interventions that they perform in the clinical setting. In the scenario of Mr. Patient requesting for a “Do Not Resuscitate” order, I used the nursing process to serve as the framework of the patient care and the Lasater’s Clinical Judgment Rubric by Kathie Lasater (2007) to guide my reflection. In this paper, I will describe the skills that were used in relation to the nursing process, provide analysis of the model and application of learning in terms of CNO competencies, and evaluate my clinical decision-making in terms of patient outcomes. While, the nursing process, served as a guide to organize my thought process in relation to the overall picture of the patient, I also incorporated thinking structures such as ABC and Maslow’s Hierarchy Of Needs to determine the prioritization in each activity. Furthermore, I utilized the Structured Prebriefing Worksheet by Karin Page-Cutrara (2015) to make inferences from the data before engaging in the scenario.