The use of clinical judgement and decision making in nursing is a cognitive process occurring frequently in clinical setting throughout the day (standing, 2008). It requires us to consider the reason why a decision is needed and the alternatives, before concluding what might the best action in the circumstances presented (Reading and Webster, 2014).
In addition to knowing why an intervention is needed and how to perform it competently, the nurse also has a professional responsibility and accountability to justify, explain and defend their judgment and decision (Dowding & Thompson 2002, cited in Standing 2008).
The focus of this essay will be on how a Newly Qualified Nurse NQN makes clinical decision that is deemed simple within a complex case.
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The NMC (2015) guidelines state that, nurses must practise autonomously, skilfully, safely, and use the best available evidence to inform their decision-making. O’Neil et al., (2005) agrees that, the complexity of clinical decision-making requires a broad knowledge base and access to reliable source of information. These mean the decision nurses make while performing nursing care will influence their effectiveness in clinical practice and make an impact on patient live and experience with health care regardless in what setting the nurse practice (Bjork and Hamilton, 2011). The development of clinical judgement and decision-making skills can, therefore, complement the mechanistic method of nursing process as described by Parse (1981) by encouraging the application of critical thinking from assessment to evaluation. This method of engaging clinical judgement, decision-making and nursing process will be crucial in the diagnosis, plan, implementation and evaluate of Mr Adams care (Standing, …show more content…
Mr Adams symptoms could indicate some cardiovascular compromise (Resus UK, 2015). However, not all heart attack will result in cardiac arrest. Visual observation must accompany some compromise physiological parameter which will indicate if cardiac arrest is imminent (Steele, 2008. Ruigomez et al., 2009). Mr Adams was later found in a state of collapse by a student nurse; an initial set of observation was performed, Mr Adams was tachycardic, hypoxic, hypertensive and slightly tachypnoea. When dealing with an emergency, there is a need for collaboration between multi-disciplinary team (Standing, 2010). The critical care outreach and medical emergency team were notified and they arrived in time to perform CPR on Mr Adams. The NQN must apply situational judgment and follows a good decision-making process that complies with all relevant legislations, including laws relating to capacity in the event of CPR (Resus UK,
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”.
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.
Critical thinking and knowledge are the foundation of nursing practice, and the most essential elements in providing quality nursing care. Nu...
Every nurse will be faced with a decision making dilemma at some point in his or her career. Being familiar with the nursing code of ethics, what is ethically and morally expected in society and how to approach the situations can help make dilemmas less of a nightmare. “The purpose of nursing ethics is to inspire questions and examine what would be the ethically right action in health care situations demanding a choice between at least two undesirable alternatives” (Toren & Wagner, 2010, p. 394). There are many different ways one can approach a situation to reach a resolution, finding a method that works best with the situation at hand is ideal.
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.
A nurse’s role in decision making is minimal depending on the place of work residence. Authors Shoni Davis, Vivian Schrader, and Marcia J. Belcheir’s opinion on Ethical decision making in nursing is “a process that involves making an ethical consideration of a patient care situation” (738-749). It seems like nurses can just cite immediately or take a hunch of what is wrong with a patient, but doctors are the ones that actually do the direct diagnosing. There have been many decision making processes and theories. Each has its own unique concepts and terminology, but all have similar components. It identifies good nur...
The healthcare system is very complex, and the nurses should be aware of all the policies, laws, ethics, and available sources to provide quality care to all patients. The following case study will explore some of the decision-making processes the nurses consider while caring for their patients to keep high standards of care.
Furthermore, in nursing, professional may have to decide on a course of action that is ethically, legally and morally correct or acceptable by their society.
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
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
I took it upon myself to advocate for her and asked if she would like an ativan, explaining that it would provide a calming effect. She agreed and I asked one of the nurses if I could administer the ativan since it was in my scope of practice to provide this nursing measure and have her be my co-signature after we both checked the physician’s orders. Rationale for Framework The CAEN Decision Making Model for Nursing Practice Framework was chosen for this analysis due to its incorporation of foundational knowledge, thinking processes, context and decision-making processes.... ... middle of paper ... ...
Nurses face various and exhaustive number of dilemmas and conflicts in their line of duty. Dilemma can come in various forms for a nurse, be it from family, colleagues and/or supervisors. To handle such situations, there have to be a framework of ethics and law that have to be considered before any decisions are made. According to (Hall, 1996, p.2), “Good nursing practice is good ethics is good law”. With this statement in mind, one can practice with confidence as what they do is within the guidelines of ethics and legal under the eyes of the law. An example of a dilemma in a clinical setting would be in the decision making process of a patient who is unconcious. Sometimes the physician would want the best for the patient but the family thinks otherwise or vice versa. This will be explored in the essay on the proper way to handle such dilemma faced by a nurse.
One of the many challenges in being a nurse is demonstrating the professional responsibilities of ones own practice in order to provide proper care to the patients and their families. It is crucial that nurses are in a healthy mental and physical state in order to provide adequate care for the patient. An example of Standard 1, professional responsibility and accountability, Indicator
Decision-making is the process requiring critical thinking and forecasting ability to assist a person in selecting a logical choice from the available number of options. (Tiffen, Corbridge & Slimmer, 2014). Studies show that nurses make a health care decision every 30 seconds so it becomes an involuntary process for nurses to make clinical decisions. From admission itself, the plan regarding the patient’s bed occupancy, care and treatment will be decided. In geriatric nursing along with many other clinical care decisions nurse need to make decisions on long term care plan like selection of end of life care (EOL) and discharge planning.
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.