Clinical Decision Making In Nursing

In this assignment I will be exploring the issues around communication and assessment in relation to the care given to the patient. I will look at how care was delivered and how successful it was. The NMC (2008) states that healthcare professionals must respect a person’s right to confidentiality; to ensure this I will be using pseudonyms for the service users mentioned in this assignment. I will be referring to the patient as ‘John’ and his wife as ‘Brenda’. I have gained consent from Brenda to talk about her husband’s situation in this assignment, as he did not have capacity to grant consent himself due to dementia.

Equally important the nurse indicated that she was in a hurry and unable to sit down, choosing rather to stand while she talks to the patient. What the nurse did not realise was that she had assumed a power stance and had failed to create an environment that was holistic, conducive and

The primary issues presented in this case are related to the cultural as well as the religious factors affecting the medical decision making as well as disease management. This involves Rivka Cohen, who is a six-year-old girl diagnosed with cystic fibrosis (CF). Rivka and her family live in a tight knit Hasidic Jewish community where daily life is built on ancient laws and religious devotion. The Cohen family have acknowledged that their daughter requires treatment for her medical condition, but are struggling to find a compromise between their religious and cultural beliefs and the cf treatment team’s recommendations. The Cohen’s medical decision making and disease management is heavy influenced by their cultural and religious beliefs in conjunction with input from their rabbi. At the present time, the CF treatment team has established a treatment plan, but the Cohens are having a difficult time adhering to this plan due to several factor that will be discussed.

The Health Care field in the United States is rapidly expanding due to medical advances and a growing population. While new the advances can lead to major medical breakthroughs, it can also cause confusion to the everyday consumer. According to Johnson "Navigating health care systems and treatment options has become increasingly complicated and demanding for patients facing health care challenges" (2011). Providing countless health services and insurance plans does provide options, but it can also increase consumer confusion. Obamacare was introduced in 2010, by President Obama, the purpose of Obamacare was to provided healthcare insurance to the uninsured. The ACT requires United States residents who are not currently covered to obtain insurance

The worker contacted Delois Stevenson who is the aunt of Johnne Leake. The worker asked Mrs. Stevenson if she had any safety concerns for Ms. Leake or her boyfriend Jamel Bowen when their newborn child Jayce. Mrs. Stevenson stated “I’ve never had any cause for concern when it comes to Johnee’s decision making abilities. I do not have any safety concerns for either parent, I just saw Jayce yesterday (1/4/17) and the baby seemed healthy, happy, and clean. Jayce is bonding well to Johnee and Johnee is motherly to the baby. Jamel wasn’t there yesterday when I was visiting. Mrs. Stevenson stated “I don’t know Jamel very well but from my time around him he hasn’t shown me any cause for any safety concerns being around Johnee or Jayce. Jamel and Johnee

Discuss how you interpret each way of knowing. How do you use way of Knowing in your Nursing practice?

The most powerful example of an unsuccessful communication in this book surrounded Catherine’s original diagnosis. Nicola described the doctor as “impersonal and imposing” and he had, “no welcoming smile, no expressions at all” (Schaefer, 1999, p. 5). He did nothing to build rapport with Nicola or Catherine. He said nothing to reassure Nicola as he launched into an only negative account of what he believed Catherine’s prognosis to be. At the end of the appointment he told her, “I suggest you go home, put this baby in an institution and then have another” (p. 6). Although this doctor is not completely to blame because he is a product of his training and the time period, sending children with severe and multiple disabilities to an institution was typical at this time, I was still completely appalled at how this appointment went. He didn’t follow any part of therapeutic communication: speaking clearly, being fully present, listening or developing trust (Davis, 2006). Even if his recommendation of sending Catherine to an institution remained the same, he could have communicated this in a much more compassionate and understanding way in his conversation with Nicola. Receiving a diagnosis is never easy, but there are ways to do it that are respectful, caring and client-centered.

Clinical decision support (CSS) systems are clinical resource tools embedded in EMR (electronic medical record) applications that provide actionable intelligence specific to an individual patient thus enhance clinical decision making. These tools provide tailored feedback, which directs clinical decisions and interventions in the clinical workflow. According to The Stage 2 Meaningful Use Final Rule, the fundamental components and characteristics of a successful decision support system should allow clinicians to reduce errors and adverse events, improve efficiency, enhance outcomes, and ultimately lower costs. Furthermore, the federal government has defined the Five Rights of CDS as follows: the right information, to the right people, through

Today’s nursing has its foundation in evidenced based practice guiding our nursing skills and interventions. Empirical knowledge provides us with the best possible researched evidence to support and build on a nurse’s clinical judgement, for a population. However, it is not the only source and there are limitations in its application and at times questions concerning its legitimacy. For example, in 2015, Kaplan’s research exposed published peer reviewed research as having falsified peer review credentials. One can only guess at the reason and the extent of its influences across the scientific community. How many other studies based their research on one of these falsified publications? At minimum, it is unsettling but is it that surprising in a field of study where prestige and money are so closely associated with results. In addition, Prasad et.al. 2013, researched legitimate peer reviewed published applied research and demonstrated a significant percentage were overturned or reversed. The practice of nursing needs to be based on solid evidence derived through scientific processes and approved through peer review but to apply it then have it overturned years later? Can we trust current research or is it produced to quickly? When does it become reliable? As a side note, Dawkins video The Enemies of Reason and The Vaccine Wars, both present some disdain towards the population that does not accept all the science “evidence” of today. Perhaps falsified peer reviews

Clinical judgment is an essential skill for nurses. The professionals have to be able to make decisions that are in the best interests of the patients at critical stages. Thus, it is a concern when studies have shown that a large number of graduate nurses do not possess adequate levels of this skill (Raymond-Seniuk & Profetto-McGrath, 2011). This means that the methods used in teaching baccalaureate courses are not effective. Mann (2012) examined the issue and found that the teaching strategies are not designed to help the students understand and apply clinical judgment in a healthcare situation. The author expresses her ideas on the topic clearly and helps to shed more light into an issue that is critical to nursing practice.

Wisdom is the interpretation and application of gained knowledge, knowledge is obtained through data and information. Data-information-knowledge-wisdom create the D-I-K-W paradigm that was discussed this week. Wisdom is very similar to nursing judgement, it appears after the data and information has been collected, analyzing it with knowledge. Interpreting that knowledge and implementing it into practice is when nursing judgement is used, similarly the same with wisdom. Ronquillo, Currie & Rodney (2016) state that all knowledge and wisdom ultimately stem from objective, value-free, and “pure” data. (Ronquillo, Currie, & Rodney, 2016, p. E9) Van Graan and Williams (2017) describe nursing judgment as following a process of observation, reflection, and analysis, weighing evidence, using intuition, and recognizing patterns to make clinical decisions. (Van Graan & Williams, 2017, p. 278)

When assessing how to develop an effective yet efficient care plan for Suzan, it was decided that the health system and the services that it offers must be incorporated so that her goals could be met and her health improved. One way in which the health system was integrated into Suzan’s care was through the implementation of inter-disciplinary care. Both the Canadian and Rwandan perspectives suggested that inter-disciplinary care be implemented so that her goal of improving her mental health and wellbeing could be met. This inter-disciplinary care would involve the integration of a few health professionals into Suzan’s care, in addition to her nurse. These professionals would each be from

Nurses use clinical judgement each day when caring for patients. It is essential that nurses have an understanding of the problems associated with each patient’s disorder and possess the knowledge and skill to make concise decisions that will help to deliver better quality care. According to Bussard, (2015) clinical judgement is defined as, “an interpretation or conclusion about patient’s needs, concerns, or health problems, and/or the decision to take action (or not), use to modify standard approaches, or improvise new ones as deemed appropriate by the patient’s response” (p. 451). The writer chose clinical judgement in the care for patients with pressure ulcers because

One of these norms that helped to guide care was the development of the therapeutic nurse-client relationship. Creating this relationship would have allowed for the establishment of trust and respect between the nurse, Jacqueline, and Jack, thereby fostering care and the improvement of personal health. Despite this nursing norm being implemented within the assessment as well as the care plans of both Canadian and Rwandan perspectives, there were also aspects that varied between the practices and norms implemented by the two perspectives. One norm in particular that was apparent in the Canadian, but not the Rwandan perspective was the utilization of community supports. Community supports can help to improve the health of individual(s) by employing various resources that can assist in reaching of the most desirable outcome(s) for said individual(s). As nursing in Canada is thought to be a practice that involves large amounts of collaboration, community supports are a common resource that many nurses rely on and incorporate into care. Moreover, although the Rwandan perspective did not suggest the use of community supports in Jack and Jacqueline’s care, this viewpoint still worked to address their goals, but in a way that solely involved the nurse providing

Clinical reasoning is another most important thing to consider when being a leader (Benner, Hughes, & Sutphen, 2008). Clinical reasoning is used interchangeably in the process which the nurse collects cues, processes the information and can come to an understanding of a patient problem (Benner, Hughes, & Sutphen, 2008). They can plan and implement interventions and can elevate the outcome. They can also reflect and can also learn from the process (Benner, Hughes, & Sutphen, 2008).