. 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. Clinical judgment and decision-making is a required component of professional nursing. Any opinions, findings, conclusions, or recommendations expressed in this essay are those of the author and do not necessarily reflect the views of NursingAnswers.net. Pearson (2013) clarifies “clinical decision making is essential to every aspect of care delivered to a patient” (p. 214). 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’. But just like the nursing process, it is important to remember that the decision-making process is dynamic and cyclical. Study for free with our range of nursing lectures! DATA USE IN CLINICAL AND ADMINISTRATIVE DECISION MAKING IN NURSING HEALTH CARE By Presented to in partial fulfillment of the requirements for the degree of [degree name] [university name] [university location] [date] ABSTRACT The application of IT technology in nursing sector still holds many challenges. 1992). Decision making by nurses is now ®rmly established on practice, policy and educational agendas. It applies judgement regarding our reasons for doing or not doing things. The Nursing and Midwifery Council (NMC, 2008) states that nurses are personally accountable for their actions during practice and therefore they must be able to justify their decisions at all time. Do you have a 2:1 degree or higher in nursing or healthcare? Until the time occurs when nurses make judgments based on tacit knowledge, they generally use analytical thinking to make sense of the situation and decide upon a course of action ( Tanner, 2006 ). Begin by considering your clinical decision-making in your nursing The information-processing model can be used by nurses who are beginners in clinical decision making. Decision-making A free flow of ideas is essential to problem-solving and decision-making because it helps prevent preconceived ideas from controlling the process. It is the foundation on which decisions are made and risks plans are then formulated through available national and local policies and procedures (Morgan, S.,1998). His prior injuries all seem to have coincided with the passing of his wife, as he sustained a #NOF and P.E. . Free resources to assist you with your nursing studies! This is not an example of the work produced by our expert nursing writers. Relevance to clinical practice. He also has a supportive partner and has very active life in the community that he lives in. The development of a comprehensive and individualised care plan will relate to the broad range of effective treatment, rehabilitation and support services provided at the current level of clinical knowledge (Morgan, S., 1998). Company Registration No: 4964706. The grief experienced by the remaining spouse due to the loss of closeness in sexual intimacy and overall companionship can manifest into serious health implications. These are examples of where nurses need evaluate their work environment and create a plan on how to gain more control over their practice. Prostate cancer is usually slow growing. 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. 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. 32 Nevertheless, one of the most beneficial issues of data mining, compared with clinical decision making, is the feedback system, emphasized in every model. Risk assessment is a process of identifying and investigating factors associated with the increased probability of specified risk occurring. It is important to carry out a care plan once the patient is identified to be at risk of developing a pressure sore so that occurrence of pressure damage can be prevented. • Identify contextual factors that influenced the way the decision(s) unfolded. B. take immediate action when a patient's condition worsens. Clinical reasoning is the process by which nurses make their judgments (e.g., the decision-making process of selecting the most appropriate option) (Tanner, 2006, p. 204): 1. Clinical decision making can be defined as, the collection of relevant patient information and accurate assessment, which results in an action being taken in the delivery of nursing care to the patient (Clark 1996). Introduction Decision-making (DM) in healthcare can be understood as an interactive process addressing decision makers' reasoning as well as their visible behaviour after the decision is made. Evidence-based decision making is a prescriptive approach to making choices based on ideas of how research and theory can be used to improve decision making in regards to delivery and quality of patient care. arrange with a school of nursing or clinical nursing education department to periodically take a critical thinking test . keep a personal record of my clinical decisions and critically review them once a month. For example, if a patient scores 15 or over on the Waterlow scale, the individual may be considered at risk of developing pressure sores and therefore the nurses will have to maintain a pressure ulcer prevention (PUP) bundle in order to keep track of the patient’s condition. [2] Clinical decision making requires good quality judgment including critical thinking. The nurse coordinator also monitor the progress of the care plan by collating information from agencies and individuals who provide particular elements of a care plan. To export a reference to this article please select a referencing stye below: If you are the original writer of this essay and no longer wish to have your work published on the UKDiss.com website then please: Our academic writing and marking services can help you! A nursing case study is a detailed study of an individual patient, which allows you to gain more information about the symptoms and the medical history of a patient and provide the proper diagnoses of the patient’s illness based on the symptoms he or she experienced and other affecting factors. The chosen model will demonstrate clinical decision making skills in the care planning process. 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. *You can also browse our support articles here >. In the department of the nursing, there are said to be many of the decision-making theories that can be used. An assessment should be conducted to gain insight into what he believes is normal for his age. Participants’ key perception was that the unique contribution of CDSS technology to clinical decision making is its ability to predict or forecast patient outcomes prior to actual decision making. Clinical decision making in nursing relates to quality of care and competency issues. Extrinsic factors such as the hospital environment can amplify sleep disturbances, as Mr. Hay may have to share a room with strangers and endure a noisy ward when he is accustomed to sleeping alone in his home. Making difficult decisions is not a new problem, it is a daily experience for patients, families and doctors every day in the NHS. Clinical intuition in the nursing process and decision-making-A mixed-studies review J Clin Nurs. 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. As nurses, we use different information sources to support our judgement and decision making. Nurses are accountable for the quality, safety and effectiveness of their clinical decision making. It recognises that health care is individualised and ever changing and involves uncertainties and probabilities. Clinical decision-making is considered synonymous with clinical judgement (Manetti, 2019).Clinical reasoning and decision-making are the thinking processes and strategies we use to understand data and choose between alternatives with regard to identifying patient problems in preparation for making nursing diagnoses and selecting nursing outcomes and interventions. Please take the time to complete this description as this scenario will be the focus of many of the subsequent learning activities in the workbook. In my learning, I am now looking forward to develop the capability and learn the tactics of critical thinking. Alternatively, Paediatric Early Warning Scores (PEWS) is use for children, to record observations and is use to assess the child’s condition i.e. Nurses are accountable for their decisions, therefore it is crucial that they are aware of how they make these decisions Muir (2004). These nursing competencies are intended to reflect the core skills found at the heart of critical thinking, as identified by nursing industry experts. Nursing opinion and decision-making are said to be the necessary constituent of specialized nursing practices and very complex. The RN will also organize the care and services identified in the care plan across social care and other agencies and he/she will also liaise with the other healthcare professionals in regards to implementation of Mr Robbins care plan. The Waterlow scale is mostly used in adult field of nursing. Clinical decision making can be defined as choosing between alternatives, a skill that improves as nurses gain experience, both as a nurse and in a specific specialty. 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. 12th Feb 2020 Nursing Essay He had several falls but did not suffer any fractures. Other symptoms can potentially develop during later stages of the disease (Brown & Edwards 2008). C. apply clear textbook solutions to patients' problems. 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. The following paper summarizes research from the final subset of articles. Mr. Hay appears to understand how to manage his health as he sought medical attention for his cough, and believes he copes at home despite no mention of services in place. Therefore, he may require assistance with self care activities and ambulation whilst admitted. 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. He takes Bisphosphonate medication for his bones and believes that his medication has his cancer under control. Examples: Problem list, medication list, medication allergy list, demographics, lab tests and value results, vital signs B. . This may incorporate questions regarding his dietary and fluid intake; utilizing a dietician or nutritionist if necessary. Copyright © 2003 - 2020 - NursingAnswers.net is a trading name of All Answers Ltd, a company registered in England and Wales. He should also be asked if frequency or pain is experienced with defecating or urinating, if laxatives or enemas are used, results should also be noted. Aim: This paper is a report of an evaluation of cognitive continuum theory and identification of revisions required for application to clinical judgement and decision-making in nursing. Experienced nurses bring a broad range of previous patient encounters to their practice influencing their intuitive, unconscious processes which facilitates decision‐making. Evidence-based decision making is a prescriptive approach to making choices based on ideas of how research and theory can be used to improve decision making in regards to delivery and quality of patient care. Therefore maintenance of an acceptable and stable weight is important. We find that intuition plays a key role in more or less all of the steps in the nursing process as a base for decision‐making that supports safe patient care, and is a validated component of nursing clinical care expertise. These nursing competencies are intended to reflect the core skills found at the heart of critical thinking, as identified by nursing industry experts. Classifying clinical decision making: interpreting nursing intuition, heuristics and medical diagnosis. Utilizing the ethical principles of autonomy, beneficence, nonmaleficence, fidelity, justice, and paternalism as outlined by the American Nurses Association (ANA) provides us with a firm foundation for ethical decision making. the application of decision-making to the health care professions” (Simmons, 2010, p. 1153). The NC (2004) state that the capacity to exhibit ‘sound clinical-decision making,’ is an essential requirement for pre-registration nurses. Reference this, Clinical decision making in nursing involves applying critical thinking skills to select the best available evidence based option to control risks and address patients’ needs in the provision of high quality care that nurses are accountable for. The process of clinical decision making in this framework can be fit with simple or complex decisions, which may potentiate being able to reproduce and evaluate the framework as well as optimize or standardize decisions making. 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. Not to mention his own anxiety as a natural reaction to being admitted to hospital. In this example, your focus should be on proving that you have a self-start. the most appropriate information available to make clinical decisions for individual patients. Â. Although hypoxia and fever could affect his mental state, as alluded to by the discrepancies in the data. Examples of clinical reasoning and decision-making 'I will' statements: . Mechanical and gas exchange alterations in the lungs that occur in normal aging, in conjunction with his respiratory complications and possible angina, would most likely reduce Mr. Hay’s ability to tolerate exercise (McCance & Huether 2006). Prostate cancer is a malignant tumour of the prostate gland. Whilst the pyrexia could affect sleep as he may be experiencing night sweats or feeling too hot to sleep. It is an examination of the context and details of past risk incidents in the light of current circumstances. Accurate and timely observations and adherence to EWS is essential in order to recognise patients who are at risk of deterioration. Any opinions, findings, conclusions, or recommendations expressed in this essay are those of the author and do not necessarily reflect the views of NursingAnswers.net. McKibbon (1998) recognises the importance of the patient when making decisions about their own care. *You can also browse our support articles here >. Nursing judgment and decision making contribute significantly to the quality of patient care. This is the final paper in a series of four discussing judgement and decision-making in nursing. Paediatrics use a different pressure ulcer risk assessment tool called the Glamorgan scale (Willock, J. et al, 2007). EWS were developed to assist health care professionals detect if patients are deteriorating. They are grouped into five broader skill categories: problem recognition, clinical decision making, prioritization, clinical implementation, and reflection. When considering risk assessment and risk reduction, it is important that the initial assessment of risk is accurate. “Integrating research evidence into decision making involves forming a focused clinical question in response to a recognised information need, searching for the most appropriate evidence to meet that need, critically appraising the retrieved evidence, incorporating the evidence into a strategy for action, and evaluating the effects of any decisions and actions taken.” – Thompson et al (2004). Increasingly, however, they are being cast in the role of active decision makers in healthcare by policy makers and other members of the healthcare team. The EWS is designed for adults and can also be use with mental health and learning disability patients. 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. A cross-sectional survey was carried out with 2095 nurses in four hospitals in Norway. Nurses have to make important clinical decisions in their everyday practice. It is the ability to blend information and make decisions that will … It could be taken at face value that Mr. Hay drinks a nightly scotch, yet alcohol consumption is linked with ineffective coping mechanisms, especially in men (Cooper et al. It can also be used with hospitalised mental health and learning disability patients. Laying down results in sputum obstructing airways, whilst dyspnoea may lead to anxiety to further impede sleep. In this paper would discuss the decision-making theories in the nursing practices for the preparation of PEP. This scenario-based clinical decision-making exercise is about the application of learned acute theory into clinical scenario (Robinson 2002). Mr Robbins has a positive attitude towards his condition. the patient’s heart rate, respiratory rate, temperature, oxygen saturations and systolic blood pressure. The nurse care coordinator will engage with Mr Robbins, and support him through the duration of his care plan. INTRODUCTION ound clinical reasoning and clinical decision-making is largely considered a “hallmark” of expert nursing (Simmons, Lanuza, Fonteyn, Hicks, & Holm, 2003). His past #NOF may also be impairing mobility. There are also misconceptions that traditional ways is the best way, or that gathering evidence is too difficult and time consuming. It is usually asymptomatic in the early stages but eventually the patients may have symptoms such as difficulty in urinating and erectile dysfunction. In order to ensure fair access to intensive care during the COVID-19 pandemic, a structured approach should be used to making such decisions. While decision‐making research in acute care nursing is prevalent, errors in decision‐making continue to lead to poor patient outcomes. Ultimately, Evidence base practice is the formalisation of the care process that the best clinicians have practiced for generations.”. Orme and Maggs (1993) identified that decision-making is an essential and integral aspect of clinical practice. Banning described three clinical decision making models: information-processing model that uses a scientific hypothetic-deductive, quantitative approach, the intuitive-humanistic model that focuses on intuition and how the knowledge gained from nursing experience enriches the clinical decision making … Learning about developing and applying effective clinical decision making skills is vital for the wellbeing of patients and nurses’ capacity to demonstrate that decisions are justified. A diet high in energy density, frequent snacking, soft food, and frequent beverages is advisable. Learn more about this type of research by reading the article. Resources are only one fac… 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 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. – Standing, M. (2011). This subset of articles produced about 200 articles that had strong relevance to clinical decision-making and were subjected to a more detailed and thorough review. Conclusions influence care plans about which actions, if any, are required, developed, and implemented. Method A clinical decision-making questionnaire (CDMQ) consisting of 15 statements was developed. 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. The opening chapter defines and discusses clinical decision-making from a cultural context, professional identity, decision theory and a matrix that brings together perceptions with conceptual understandings of nursing. It is also important that nurses use their resources cost effectively by ensuring that resources and equipment are used correctly by the patient. A total of 60 nurses completed the questionnaire: 20 from each of three clinical areas. His elimination pattern could be assessed by asking him about the frequency of bowel and bladder activity and seeking a description. All work is written to order. This essay should not be treated as an authoritative source of information when forming medical opinions as information may be inaccurate or out-of-date. Reflection. Over the past 30 years nursing has evolved from a task-oriented to a logical and systematic approach to care, using theories and models to guide practice. Risk-assessment tools are a useful signpost to risk factors but must not be used in isolation to identify risk. 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. • Define the decision – Decision-making can only occur when there is a choice between actual alternatives. Reference this. Aid decision makers evaluate the situation, … The use of early warning score (EWS) is the best practice for clinical observations (Department of Health, 2000), and this is backed up by NCEPOD (2005) who emphasised that every in-patient should have a EWS recorded. According to Tanner (2006), decision making in the clinical arena is called clinical judgment . In the UK, for example, the Chief Nursing Officer recently outlined 10 key tasks for nurses as part of the National Health Services modernisation agenda and the breaking down of artificia… To further clarify the concept of clinical decision support, consider a non-clinical but popular health related scenario involving the decision to purchase and smoke a pack of cigarettes. These are two of several expressions describing nurses’ professional activities that are used interchangeably. Sackett el al (1996) defines evidence base practice as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient by incorporating individual clinical expertise with the best available external clinical evidence from a systematic research.” This means that one solution will not be the same for all clinical scenarios and it is the nurse’s role to identify the research that best fits the clinical situation. It is important to define the terms clinical decision-making and clinical judgement. ms10@canterbury.ac.uk; PMID: 18352971 DOI: 10.1111/j.1365 … His major concern is his osteoporosis and fracture incidence due to bone metastases of his prostate cancer. Journal of Advanced Nursing 2000 b; 32 (4) : 990 – 998 . Yet without factual information regarding this visit, the focus still lies on the circumstances the led to this admission which paint a different picture. . Method A clinical decision-making questionnaire (CDMQ) consisting of 15 statements was developed. The primary aim of pressure ulcer risk assessment tool is to help nurses identify individuals at risk of pressure ulcers and determine the degree of risk (Shakespeare 1994).Formal pressure ulcer risk assessment involves the use of a tool that assists in identifying those patients likely to develop a pressure ulcer. 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. For example, charge nurses with limited decision-making power and inability to confer with the physician or other nurses struggled to make autonomous decisions. 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. 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. The process of decision making with patients and families, is a part of Good Medical Practice as defined by the GMC, and is an integral part of determination of best interests as outlined in the Mental Capacity Act. Evidence based practice values, enhances and builds on clinical expertise, knowledge of disease mechanisms, and pathophysiology. It provides novice nurses with a … Nurses are expected to use valid evidence to support their decisions when deciding what care to provide each patient. Mr. Hay is able to express himself clearly as evidenced by his complaints of chest pain, and he is also able to recall past events by stating this had happened previously. These care plans can be developed based on didactic knowledge, previous clinical encounters, collaboration with the healthcare team, intuition, weighing options, or other reasoning processes (Tanner, 2006). poor IT skills, lack of research skills and literature. The multidisciplinary approach of the decision making requires the nurses to multitask. 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. Relevance to clinical practice: We find that intuition plays a key role in more or less all of the steps in the nursing process as a base for decision-making that supports safe patient care, and is a validated component of nursing clinical care expertise. One of the tools used in evidence based practice is the use of the early warning score system (EWS). We are accountable to the patients, clients and service users to whom we owe a duty of care. It involves combining the knowledge of an expert, patient preferences and research evidence within the context of available resources. Dunger C(1), Schnell MW(1), Bausewein C(2). “Evidence based practice is an approach to health care wherein health professionals use the best evidence possible, i.e. Risk is integral to nursing and the assessment of risk is one of the most common judgements nurses make. The purpose of this article is to begin the process of developing a definition and framework of clinical decision making. The majority of tumours occur in the outer aspect of the prostate gland. Pearson (2013) clarifies “clinical decision making is essential to every aspect of care delivered to a patient” (p. 214). No plagiarism, guaranteed! Disclaimer: This work has been submitted by a student. Making the wrong clinical decision is not only harmful to patients but can also damage a nurse’s career. 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