Decision-making is the scientific inquiry, which was first established in the early 1950s by (Edwards, 1954) and (Hammond, 1955). According to (Thomas et al 2001) decision making is a broad term, which applies the process of making a choice between options as to a course of action. Clinical decision making by health professionals is a more difficult process, requiring more of parties than making defined choices between limited options. Nurses make critical clinical decisions every day and these decisions give an effect on the patient’s health care, quality and also the actions of the healthcare providers. The Nursing and Midwifery Council clearly have identified the professional responsibility in the Code of Professional Conduct (NMC 2002), …show more content…
Other key causes of errors identified in decision-making are (Scott 2000, Thompson 2002a). Psychiatric nurses are also increasingly involved in the decision making process to detain, assess or treat patients compulsorily (Clark & Bowers 2000) In England and Wales, for example, nurses are responsible for the care and control of detained patients as well as the administration of medications (DOH 1996). Since 1983, psychiatric nurses have been allowed to detain patients for up to six hours by making their own judgments using specified criteria under Section 5(4) of the Mental Health Act …show more content…
Analytical models assume that the clinical decision maker’s thought processes follow rational logic that can be studied until a decision has been made. During the process of making the decision, the experience of the clinical decision maker and the ability to recognize situations that impinge on the decision making process are also key components of this analytical model (Klein, 1989, Klein & Calderwood, 1991). O’Neill clinical decision-making model is a multi-dimensional model that was developed from the synthesis of findings from research studies in graduate students (O’Neill, 1999, O’Neill et al., 2004), qualified nurses (O’Neill, 1997) and from the novice to expert clinical reasoning model (O’Neill & Dluhy, 1997). The model is based on a computerized decision support system that utilizes both hypothetical-deduction and pattern recognition as a basis of decision making. The benefits of each model is absorbed and used to develop a decision support model. The central features of the model include investigating pre-encounter data, anticipating and controlling risk, the provision of standard nursing care, situational and client modification and triggers to hypothesis generation followed by nursing action. One issue relevant to this model is the role of learning from experienced nurses. Inexperienced nurses value the contribution that can
Similar to Global Positioning Systems (GPS) provide drivers with directions, detours, alternative routes, and alerts, Clinical Decision Support (CDS) systems provide health care professionals with guidance for important decisions associated with patient care. These systems have many capabilities including synthesizing patient information, suggesting diagnostic tests, providing alerts for life-threatening situations, recommending treatment options, and providing relevant evidence and best practices. Nonetheless, just as GPSs, CDS systems are not usually perfect as evident in the ongoing evolution of their design specifications and functionalities. Some of the major issues that are still evolving for CDS systems include alert fatigue and integration of evidence-based practice (EBP) resources and clinical guidelines. One of the major areas that can benefit from the adoption and integration of clinical decision support systems is community health nursing. These systems can be used together with evidence-based medicine to help improve the quality of health and patient care in community health nursing.
Making a clinical decision is a skill that needs to be acquired, and nurses are accountable for any decision that is made, so they need to understand how they make decisions (Nursing and Midwifery Council (NMC), 2015). A greater understanding of how nurses make decision is essential to follow research and development of decision making skills (Clark et al, 2009) . A first step to a decision making process may entail understanding a framework or model. Baumann and Deber (1986) define decision making as situations in which a choice is made among a number of possible alternatives often involving values given to different outcomes”.
By using the NMBA’s Nursing Practice Decision Making Framework, it enables the clinician who are making the referral decide whether or not the person they are referring Angela to are accountable, responsible, have authority and competent and/or require supervision to carry out a particular task (Nursing and Midwifery Board of Australia, 2013). A range of inter-professional team which are considered essential for Angela’s care include GP, psychologists, psychiatrists, registered nurses, and social workers (Department of Health, 2014). These members can be delegated as well as are the delegator different roles and responsibilities as they all provide different aspects of Angela’s care as they have different skills and knowledge (Davies & Fox-Young,
Healthcare providers must make their treatment decisions based on many determining factors, one of which is insurance reimbursement. Providers always consider whether or not the organization will be paid by the patients and/or insurance companies when providing care. Another important factor which affects the healthcare provider’s ability to provide the appropriate care is whether or not the patient has been truthful, if they have had access to health, and are willing to take the necessary steps to maintain their health.
The decision to restrain a patient is in most cases left to the nurses. Other professionals such as occupation therapists and mental health counsellors are not consulted. A research on nurses’ decision-making process on physical restraint outlined that one of the themes associated with nurses decision making is personal thoughts and reason (Goethals, Dierckx de Casterlé and Gastmans, 2011, p.1200). This shows that most of the time nurses restrain the patients without consulting other professionals who might have had a better solution in handling the
Clinical decision making involves the gathering of information, awareness, experience, and use of proper assessment tools. The term is often used when describing the critical role of nurses. The process is, therefore, continuous, contextual, and evolving. Authentic practices and experienced people are required to offer guidelines when needed. Effective decision making in clinical environment combines skills such as pattern recognition, excellent communication skills, ability to share, and working as a team, reflection, use of the available evidence and guidelines as well as application of critical thinking. A Clear understanding of this term contributes to consistency, broadening of the scope and improving the skills. However, this paper aims at providing an opinion on clinical decision making and how it is connected to nursing practices.
Since ethical dilemmas are not always easily answered through the use of The Code of Ethics, ethical decision-making models are effective tools that can assist nurses in dealing with ethical issues. Ethical decision-making models provide a framework for working through difficult choices. They seek to define the limits of what is morally acceptable and help clarify the guidelines for making those difficult decisions. Ethical decision making models assist nurses in analyzing situations by focusing on understanding the patient needs, need for responsiveness to circumstantial considerations, and recognizing the uniqueness of each situation.
I use different strategies when I do clinical decision making especially working with birth to18-years-old, our physical therapy program alone will not provide a good clinical decision making skills. Besides our physical therapy program I take every year continuing education in my field (Pediatric) through online or onsite seminars. I learned a lot now, when compare to the beginning of my physical therapy carrier. Our learning is never going to stop especially in our heath care field and every day we learn something new in our field. When I was in college my principal used to tell us that after we finish our physical therapy program we should work under senior physical therapist for at least two years to gain more experience before working independently. In the beginning, I was not really comfortable working with babies. But now I want to work only with children not adults because I am very comfortable with children after learning them well. I am still learning and getting more experience with children every day. ever before.
Ethical dilemmas in nursing happen daily therefore nurses must treat all patients with respect and integrity for the patients’ best interest and health. Nurses must be the advocators for their clients, in this case being an advocate for the patient helped in the resolution because the nurse made sure to speak for the patient with mediation error and no affect on the patient’s health. The decisions nurses make can affect the patient’s health and quality of life, hence making the right choice is critical in nursing. The decision making can be based on the nurses’ values, experiences, ethical principles and theories.
An ethical dilemma is defined as a mental state when the nurse has to make a choice between the options and choices that he or she has at her disposal. The choice is a crucial task as the opting of the step will subsequently determine the health status of the concerned patient, hence it requires a great deal of wisdom along with proper medical and health training before any such step is opted as it is a matter of life and death. Strong emphasis should therefore be on the acquisition of proper knowledge and skills so that nurses do posses the autonomy to interact with patients regarding ethical issues involved in health care affairs and address them efficiently. It is normally argued that nurses are not provided sufficient authority to consult and address their patients on a more communicative or interactive level as a result of which they are often trapped in predicaments where their treatments of action and their personal beliefs create a conflict with the health interests of the patient. (Timby, 2008)
1. Legal, ethical and professional principle frameworks underpin all fields of nursing, and it is a requirement for all Registered Nurses to be competent and knowledgeable, act with integrity and maintain professional standards set out by Nursing and Midwifery Council (NMC, 2015). Working with multidisciplinary teams within our profession, it is important to acknowledge and recognise the way in which all the professionals are guided by law and their independent regulatory bodies. The needs of the individual patient is to be considered by doctors and nurses alike, who share professional values and are set out in the respective codes of practice, The Code (NMC, 2015) and GMC (2013).
This paper will discuss three theories of decision-making that can be adopted in nursing practice, additionally how decision-making theories are able to be implemented and used. Decision-making in nursing is adopted through the critical thinking process that provides each nurse a model to make the best choices, solve problems and to meet goals in clinical practice (Berman & Kozier 2018, pp. 199-200; Levett-Jones & Hoffman 2013, pp. 4-5). Effective decision-making in nursing is a vital component and part of the role of a registered nurse; each year a substantial number of patients die due to medical errors and poor decision-making (Levett-Jones & Hoffman 2013, pp. 4-5; Nibbelink & Brewer 2017, p. 3). Through the use of effective decision making
Professional standards of practice and behaviour for nurses and midwives’ (2015) which states that obtaining patient’s informed consent is an act in their best interest and that nurses and midwives are required to respect individual’s right to accept or refuse treatment, moreover, support and document their decision, give evidence-based information, use clear language, cooperate with patients to help them with making the decision and be aware of the current legislations. This includes ‘Mental Capacity Act 2005’, ‘Mental Health Act 1983‘and ‘Human Rights Act 1998’. From a healthcare perspective vital articles are those which set out the rules for accessing patient’s capacity to make a decision, clarify who makes decisions for those who lack capacity and how this should be done, likewise those that regulate how to treat and protect patients without their consent but also those that specify basic human rights: to life, privacy, receiving information and other such as right to be free from discrimination or inhuman, degrading treatment. Other regulations to consider are ‘Human Tissue Act 2004’, ‘Human Fertilisation and Embryology Act 1990’ (GMC, 2015). Professionals should also consider common criminal
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Gong, Y. (2010). Case-based Medical reasoning. HMI 8571 Decision Support Systems in Healthcare. Feb 22, 2010. Retrieved on 2/22/10 https://hmi.missouri.edu/moodle/mod/resource/view.php?id=11201