Clinical Decision Making : Clinical Judgment Essay

§ inappropriate treatment of people with infection and lack of information in the person’s personal care plan

Maria Niceforo, a 75-year-old woman receiving in-home nursing care, had died of infection due to numerous pressure wounds (Le May, 2016). She was admitted to the hospital presenting with a bleeding pressure wound across her back and legs that had penetrated through the bone (Le May, 2016). It was also observed that the wounds were soiled with urine and dried faeces (Le May, 2016). She was receiving in-home support from registered nurses, who according to her son, were not consistent nor reliable in their care of Mrs. Niceforo (Le May, 2016). Another contributing factor to her death was inadequate communication and documentation of her treatment (Menagh, 2016). For example, one of the nurses had reported not providing treatment to Mrs. Niceforo's bottom as she was not aware of it (Menagh, 2016). I was quite

On one of the placement on the ward, the student nurse was assigned to assist a patient. Alfred is a 65 years old man and was admitted with diarrhoea and generally unwell to the hospital. In the process of his admission he was isolated in a side room to prevent and reduce any risk of spreading infection. Alfred was a barrier nursed because he had clostridium difficile. He was isolated to lessen the hazard of spread of infections to other patients, visitors, and

Standing (2011), defines clinical decision-making as a complex process that involves observation, gathering information, critical thinking, evaluating evidence, applying necessary knowledge, reflection and problem-solving skills. Every day nurses make important clinical decisions and these decisions have important implications for patient outcomes and deserve serious consideration. Therefore, it is important for nurses to have a better insight of the decision-making process, be able to deliver holistic care and meet essential and complex physical and mental health needs of the patient.

The nurse practitioner in the case potentially violated fidelity to evidence-based practice. The most obvious dilemma was that she neglected her commitment to an evidence-based approach to managing a sore throat and potentially inappropriately prescribed an antibiotic despite a negative office rapid-strep test. This decision goes against the Code of Ethic for Nursing (provision eight) as it relates to a professional obligation to promote community health needs (American Nurses Association, 2015). Prescribing antibiotics inappropriately can contribute to resistant organisms in the community. In work by Hand (2013), "exposure to antibiotics in primary care is consistently associated with a subsequent twofold risk of antibiotic resistance" (p. 500).

Most decisions are made with analysis, but some are judgment calls not susceptible to analysis due to time or information constraints. Please write about a judgment call you’ve made recently that couldn’t be analyzed. It can be a big or small one, but should focus on a business issue. What was the situation, the alternatives you considered and evaluated, and your decision making process? Be sure to explain why you chose the alternative you did relative to others considered.

They are responsible for what seems like everyone and everything. However, nurses have all the tools they need to be effective and safe nurses early on. The standards of precautions are one of those tools nurses are taught that aids them in protecting every patient they care for, including him or herself. Regardless of the patient’s health status, the nurse should use their better judgment when implementing care. In order to prevent interruption in the chain of infection, nurses are to adhere to the standards of precautions by thinking critically when providing patient care. No matter how presumably capable or experience a colleague may be, evidence-based practice proves that standard precautions are greatly impacting the nursing field. Nurses need to stick to their guns and not compromise their beliefs for fear of being the odd man out. The more the nurse implements those practices in their everyday routine the more it will become second nature. By gaining knowledge of the importance of standard precautions, the nurse will in turn become more compliant and adherent, and be better suited to provide effective quality care to all

Evidence base practice is essential in nursing practice. It incorporates 3 key components which are clinical expertise, patient values, and best research evidence in order to provide the most effective and safe decision making for patient care. Neglecting a key component can affect the accuracy and efficiency of a research. Clinical expertise is based on a clinician’s experience, skill, education level and understanding in a certain area of nursing practice. Patient values can impact evidence base practice depending on their needs, preferences, expectations, values, understanding, and concerns. Best research evidence can be obtained from clinical research with supporting evidence base literature and sound methodologies. Each component will be discussed in further detail and how it links to clinical decision making by registered nurses in order to achieve the best evidence-based practice available.

As I was placed in an acute surgical ward in a hospital for my first semester placement, I have practiced this principle throughout my work by taking control and understanding a patient’s dignity and privacy. When admitting a patient in triage, one of the questions in the documentation of the process of admission is about the skin. This involves ensuring there is no broken skin or pressure sores for example. As elderly people and people in wheelchairs are more prone to getting pressure sores or skin breaks on their bottom, it is a nurse’s duty of care

Nurses are undoubtedly one of the most trusted professionals worldwide. Patients, family members, and doctors entrust nurses to provide the utmost quality care to sick individuals. Top priorities of all nurses are advocacy for their patients: including advocating for their physical health, holistic welfare, and utmost importantly, their safety. Patient safety will always be the top priority when providing patient care. The nurse’s responsibility during every patient encounter is to ensure that each patient under her care, receives no harm. As a direct result of the previous statement, it is crucial that every nurse knows their rights to refuse unsafe patient assignments, the process to refuse unsafe patient assignments, and the legal or ethical ramifications that could present themselves if proper judgement is not used. By understanding these rules, nurses not only achieve the responsibility of advocating for patient safety but also safeguard their careers and license.

so as not to be hauled to court. This refusal to treat patients has already

The first case scenario presented in this project reflect the significance of gaps between nursing programs and textbooks, organizations’ policies and procedures, published literature, and the actual practice. Some of the gaps refer to nursing programs and textbooks based on an ideal nursing profession, the autonomy of healthcare organizations to establish their specific policies and procedures, traditional policies and procedures unsupported by evidence-based practice (EBP), and the individual and organizational barriers that influence the breach between the published literature and the real-world. Literature review was used to demonstrate the negative personal and professional consequences triggered from these gaps when the nurse is employed in the healthcare system. In addition, the paper suggests how improving a “Culture of Safety”, preventing an unsafe environment, and promoting Continuous Quality Improvement activities enhance the overall health care quality and safety. The second case scenario provides guidelines to the ethical dilemma of the impaired nurse, signs and symptoms of impairment, ethical and legal obligations, common reasons for not reporting, and failing to report consequences.

“The definition of a health professional is a person who works to protect and improve people’s health by the diagnosis and treatment of illness to bring about a complete recovery from mental, physical and social perspectives, either directly or indirectly (Kurban, 2010, pg. 760).” Nurses in the community today have acquired an increasing responsibility to intervene with medical decisions. In the past, there were clear differences between nurses and doctors. It was more common for a nurse to be supervised directly under the physician. They are not just performing Doctor’s orders anymore. The nurse role in patient care has been widely expanded. Allegations against someone can be one of the most stressful moments of their careers. Negligence

The priority nursing diagnosis of hospital acquired infection is risk for any kind of infection. One of the main goals for each patient in the hospital is the patient will remain free of infection as evidence by absence of heat, pain, redness, or swelling in any area of the patient’s body during each nurse’s shift. (care plan book). Frequently hand washing is the best intervention for preventing infection. Hand washing reduces the risk of transmission of pathogens by inhibiting the growth of or killing the microorganisms. (cb)Proper sterile technique during urinary

Research shows that Surgical site infections are preventable. According to the CDC, hand hygiene is the simplest approach to preventing the spread of infections and needs to be incorporated into the culture of the organization. Ensuring the use of infection control prevention is an important component of nursing care. Infection control prevention policies must be communicated undoubtedly to all employees. Staffers who do not comply must be re-educated to ensure that all are complying. Speaking up and pointing out that a nurse forgot to wash his or her hands, or notifying the surgical team that surgical instruments were not adequately cleaned may seem like small issues; but at the same time, not acknowledging a break in a sterile technique could mean the difference between life and death for a patient. One hospital that was struggling with high levels of infection related to surgical procedures, implemented a pre-procedure huddle as a team. This innovate way decreased the spread of infection and was a great way to improve the quality of care for patients. As mandated by the Joint commission, infection prevention personnel should provide multidisciplinary education on SSI prevention, to all team members, including