Decision Making in Clinical Practices
Introduction
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.
The Nursing Process
This is a practice that provides a thinking framework through the provision of nursing skills to an organization. It is a useful, flexible tool in nursing practices that allows one to think and develop more creativity. Nursing process involves five phases in which when combined
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There are several differences in competencies between an ADN and a BSN. These include, but are not limited to decision-making skills, the depth of knowledge base, as well as critical thinking abilities. As the nursing is role is becoming more complicated; strong skills are necessary for providing excellence in patient care (American Association of Colleges of Nursing, n.d.a., pp. 1,3). More than ever patients that are being admitted to hospitals have multiple commodities. When caring for a post-surgical open heart patient, it takes multiple types of critical thinking skills to recognize when a patient is becoming hemodynamically unstable. Quick, crucial, and significant decisions need to be made quickly to turn a grave situation around.
Tanner (2006) made a clinical judgment model thinking like a nurse in which research of literature of the topic clinical judgment was reviewed and used to develop
In conclusion, Mr. Devi journey discussed throughout the essay, focusing on the role of the nurse in clinical decision-making. This essay looks at the Tanner (2006) model that begins with gathering relevant information about the patient and assembling that information to identify the problems. To assess and comprehend his condition Mr. Devi physical, mental and social information gathered from a nursing perspective. Based on Mr. Devi background, current condition and assessment, his risk factors for stroke were identified. Further, in response to his problem a nursing care plan formulated in partnership with patient and nurse considering his values, customs and spiritual belief. Nursing interventions and actions were placed based on best available
A diagnosis is the expert and clinical judgment of the patient 's present or potential medical issue. During the 1970s and 1980s, a controversy about nurses using the term “diagnosis” began. Up until then, only physicians held the ability to diagnose a patient. But the nursing diagnosis is completely different than a medical diagnosis. In other words, a nursing diagnosis is a judgment based on a comprehensive nursing assessment (NANDA, 2013). Nursing diagnoses must be promoted by data or signs and symptoms.
Reasoning is one of the characteristics to be a qualified nurse. What renders a nurse’s thinking dissimilar from another professional? It is how nurses view the patients and the kinds of problems that the nurses manage in practice while they engage in patient care. To reason critically like a professional nurse necessitates that nurses learn nursing content; the notions, theories and concepts of nursing, plus develop their intellectual skills and capacities so that they become self-directed and disciplined critical thinkers. In the nursing practice, critical thinking for medical decision-formulating is the capacity to contemplate in a logical and systematic way with readiness to question plus reflect upon the thinking process utilized to guarantee safe practice of nursing plus quality patient care. (Facione, Facione & Sanchez, 2010).
According to Bandman & Bandman (1995), critical thinking is defined as the rational examination of ideas, inferences, assumptions, principles, arguments, conclusions, issues, statements, beliefs and actions. In this subject ‘Critical Thinking in Nursing’ has emphasized critical thinking as an essential nursing skill and its definition of critical thinking have evolved over the years. In short, the general definition of critical thinking is self-directed, self-disciplined, self-monitored and self-corrective thinking. Every nurses must cultivate rigorous standards for critical thinking, however they cannot avoid completely the situatedness and structures of the clinical traditions and practices. They must make decisions and act quickly according to
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.
Clinical reasoning is the process that clinicians and nurses use to consider patient situation, collect cues, process information, then to make plans and implement interventions, finally to evaluate outcomes and reflect on learning from this process (Hoffman, 2007). The framework that is used in clinical reasoning is the clinical reasoning cycle. This case study will discuss, clinical care provided to Julie Kenny, a 27 year old female, admitted to emergency department after an exacerbation of asthma using the clinical reasoning cycle as a framework using objective and subjective data (Please refer to Appendix 1) that has been provided following a comprehensive nursing assessment. Asthma, a condition of the airways, is associated with hyper
Sampaio, C., & Guedes, M. (2012). Nursing process as a strategy in the development of
Pearson (2013) clarifies “clinical decision making is essential to every aspect of care delivered to a patient” (p. 214). It is the ability to blend information and make decisions that will later be implemented in the situation. Evidence-based decision making involves choosing from a variety of possibilities and combining the knowledge through research and the scientific evaluation of one’s practice. The purpose of this paper is to analyze my decision of administering ativan by advocating for the patient and anticipating her change prior to confirming signs; which provided a therapeutic response.
Looking back at my first year of being a physical therapist and comparing it to today, I can definitely say that my strategies for clinical decision-making have evolved. I can attribute it to my past experiences in the field and the wealth of knowledge that I gained from working with other members of the healthcare team as well as the numerous CE classes that I have attended in the past. When I first started with geriatric home care (after leaving the SNF setting), my initial evaluation would take forever to finish. It only made sense because everything was new - from the patient’s environment, the information needed to be gathered, and of course, the patients themselves. I was trying to get all available information to allow me to reach
One of the most essential aspects of doing a job well, no matter what job it is, is the ability to think critically about a situation. Finn (2011) defines critical thinking as “the ability and willingness to assess claims and make objective judgments on the basis of well-supported reasons and evidence rather than emotion or anecdote”. The difference between assessing a certain situation critically and assessing it without any evidence to corroborate your claims is that when you look at something critically, you are using your ability to “come up with the alternative explanations for events, think of research findings and apply new knowledge to social and personal problems” (Finn, 2011). When you can come up with other explanations using evidence, you can also create an alternative way of enhancing the situation. Critical thinking skills are especially important to nurses in a fast-paced setting. Nursing is a very demanding and rewarding field to enter into; it becomes enjoyable when you are good at it. In order to be good at their jobs, nurses need to learn the skills required to think critically and also, relate those skills to their everyday routines. This is known as evidence-based practice. Evidence-based practice is defined as “using the best scientific evidence available to guide clinical decisions and interventions with the goals of fostering self-management skills and improving health outcomes” (Miller, 2011). This paper examines the skills required for critical thinking, how to learn these skills, and how to apply them in clinical settings. (Miller, 2011; Finn, 2011; Noonan, 2011; Lunney, 2010; Wangensteen, Johansson, Bjorkstrom & Nordstrom, 2010; Chitty & Black, 2011).
In EOL decisions for aged, nurses who have previously developed a trusting relationship with the family gain a unique perspective that allows them to become aware of a clinical deterioration and this places nurses in a position to facilitate EOL decision-making (Adams, Bailey & Anderson,2011). Thou the individual competence, employer policies standards and conditions may vary the registered nurse’s scope of practice allows her to commence an EOL decision when a plan is already in place but restricts her to make a decision for the patient in the first place, she give the information and directions so that family or patient itself reaches the right decision (Leditshke, Crispin & Bestic, 2015; Tiffen, Corbridge & Slimmer,
It is an essential part of the nursing care plan. The Deliberative Nursing Process consists of five stages: assessment, diagnosis, planning, implementation, and evaluation. These stages focus on creating patient improvement or positive outcomes for patients (Wayne, 2014). The entire process is cyclical, individualized, and flexible, as you can determine whether to continue or modify the plan of care, or terminate the plan of care if the goals were achieved. All five steps are interrelated and depend on the accuracy of each of the preceding steps. The stages are collaborative as well. The nurse is required to communicate with the patient, their family, and other members of the healthcare team to provide quality, patient-centered care. In addition, the nurse uses critical thinking skills throughout the process. Research by Butts and Rich (2015) support Orlando’s theory is considered a middle
In the healthcare setting, a systematic process to ensure maximum care and maximum recovery in patients is needed, which is called the nursing process. This process consists of four steps: assessment, diagnosis, planning, implementation, and evaluation (Walton, 2016). The nursing process is important to ensure quality care and to get the preferred outcome. In the nursing process, critical thinking is used to recognize the issue and come up with a logical solution to solving it. One important aspect of the nursing process is that the plan is not set in stone; it is meant to be manipulated in order to better suit the patient. Nurses must be able to think critically in order to recognize the issue, develop a way to correct it, and be able to communicate the issue to others. Throughout the nursing process, critical thinking is used to determine the best plan of care for a patient based on their diagnosis.