Clinical Decision Making Model

Clinical judgment is the clinical reasoning, which includes clinical decision-making, critical thinking, and a global grasp of the situation, coupled with nursing skills acquired through a process of integrating formal and informal experiential knowledge and evidence- based guidelines (AACN, n.d.). In the case of F.S., he was on isolation precautions due to his infection. The results from the cultures had yet to return, therefore the infection was not identified at that current moment. The registered nurse that was assigned to F.S. went into the room several times without wearing proper protective personal equipment. This nurse stated that if she wasn’t touching the site, she was not at risk. This was a bad clinical judgment. Unfortunately, this was not the first time this student nurse witnessed the lack of use of the personal protective equipment. What most nurses don’t seem to understand is that the risk of infection is not only towards the patient but towards the nurse as well as everyone the nurse encounters. Contact precautions were researched and found to be associated with activities likely to reduce transmission of resistant pathogens, such as fewer visits and better hand hygiene at the exit while exposing patients on contact precautions to less healthcare worker contact, less visitor contact, and potentially other unintended outcomes (Morgan et al, 2013). Although it can be depressive for the patient to become isolated due to an infection, this

The physician performs a problem focused history and physical examination with straightforward decision making 99201

The second step is the major diagnostic category determination in which the principal diagnosis is assigned to an encounter for one of the 25 MDCs (Casto & Forrestal, 2015). The 3rd step is the medical/surgical determination to determine whether a procedure was performed and can be assigned a surgical status (Casto & Forrestal, 2015). The MS-DRG Definitions Manual and many of ICD codebooks verifies which procedures are valid or not valid (Casto & Forrestal, 2015). For example, minor procedures and testing do not qualify (Casto & Forrestal, 2015). Also, when a qualifying procedure is not performed, the case is assigned a medical status (Casto & Forrestal, 2015). The fourth step involves using different refinement questions to figure out the correct MS-DRG assignment (Casto & Forrestal, 2015). Therefore, once the medical and surgical classification groups for an MDC are formed, each class of patients is evaluated to determine if complications, comorbidities, the patient’s age or discharge status consistently affected the use of hospital resources (Design and Development,” n.d.).

Step one, Pre-Major Diagnostic Category assignment (Pre-MDC), in this step the principal procedure is used to assign the MS-DRG. Step two, Major Diagnostic Category (MDC) Determination, in this step, the principal diagnosis is used to place the encounter into one of the MDCs. Step three, Medical/Surgical Determination, in this step, it is determined if the procedure performed qualifies, if it does then a surgical code is assigned, if not a medical code is assigned. Step four, Refinement, in this step questions are used to isolate the correct MS-DRG assignment allowing grouping of patients from similar clinical perspective, and like-resource

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.

Having the ability to optimize the quality of life for clients is essential function of a physical therapist. In order to transform society, physical therapists need to exercise the best practical standard across all aspects of the field. To fully understand the structure and functions of the human body, one must acquire the necessary problem solving, critical thinking, and clinical decision-making skills required to successfully prevent injury and alleviate impairments. Upon acceptance into this program, I anticipate being taught the highest standards of patient care and professional excellence. I would be provided with the necessary procedures for examining, evaluating, diagnosing, and creating interventions for clients. Through obtaining

Evidence – based practice can be defined in two ways as to being the approach to therapy emphasizing the pursuit of evidence on which the theory or techniques would be helpful for the clients to examine evidence before taking action (Pucci, 2005). Another way to identify evidence – based practice is by taking an approach to therapy which is supported by research findings or findings providing evidence that is accurate (Pucci, 2005). The purpose of evidence – based practice is to apply current mental health and addiction practices. As it may apply to individual clinicians, evidence – based practices should increase the efficacy, efficiency, and the applicability of services provided to individual patients (Norcross, Hogan, & Koocher, 2008).

You have raised a thought provoking question. This is the type of inquiry that we should be particularly keen when it comes to our profession. To reiterate my reply from yesterday’s discussion post addressed to Jinky as physical therapists we are expected to possess an excellent skills set on diagnostic process that involves the collection of important data, identifying signs and symptoms, mechanism of injury, and prognosis of the patient (“Today’s Physical Therapist: A Comprehensive Review of a 21st-Century Health Care Profession”, 2011). In addition, in our profession it is a widespread knowledge that physical therapists have a hand in identifying whether a patient needs a referral to another healthcare practitioner if necessary. I encountered

attention. To this end, sound clinical judgement is challenging (Tanner, 2006, p. 205) and as a future RN it is key to reflect on your actions and experiences to yield even greater clinical judgement in the future.

Skinner, S. B., & McVey, C. (2011). Clinical decision making for the physical therapist assistant. Sudbury, MA: Jones and Bartlett.

At the Bosque River Physical Therapy, I observed a physical therapist giving wide variety of treatments. In the outpatient clinic, I shadowed PT providing orthopedic care, sports medicine, workers componsatoin , rehabilitation, and other special program. Dr. Darren provide mainly manual therapy. While shadowing at the outpatient clinic, I have seen many types of patient such as patients with arthritis, low back pain, rotator cuff, hip, total knee replacement, shoulder, and ankle. For each patient, Dr. Darren start by evaluating patient with site of injury, surrounding area by the injury site, medical history, occupation, prior activity level, and cause of the injury. To evaluate the injury, Dr. Darren perform various test and measures to assess

The three key components of evaluation and management are history, physical exam, and medical decision-making. History is broke down into four blocks chief complaint, history of present illness, review of systems, and past medical, family, and social history. There are four levels of history problem focused, expanded problem focused, detailed, and comprehensive. Physical exam included the body and the organ system which is broke down into four blocks problem focused, expanded problem focused, detailed, and comprehensive. Medical decision making is the decision making that improves the patients’ health includes four blocks straightforward, low complexity, moderate complexity, and high complexity. New patient has to meet 3 out of 3 key components

This project illustrates a RAD approach for designing a patient decision support research platforms (web-based). This web-based research platform is designed with three components: an introduction of shared decision making, a patient decision aid (web-based), and items for decision process data collection. A feedback on paper drafts and online prototypes is also provided by this research platform (web-based). Consider a shared decision making (SDM) process that allows the health care providers and patients to make decisions collectively on the basis of an evidence-based scientific knowledge and the patient’s preferences. Consequently, this process provides both the provider’s practiced knowledge, and the patient’s right to be informed of all

Clinical Decision Rules (CDRs) are a set of criteria that have been developed to assist clinicians in determining if radiographs are necessary in the case of trauma for making diagnostic and prognostic assessments (McKinnis, 2014). Furthermore, these decision-making guidelines have undergone rigorous development that have predictive power, have been validated for accuracy, and analyzed in terms of patient outcomes and costs (McKinnis, 2014).

During the clinical reasoning process, physiotherapist have to keep in minds two important questions, What I will do? And Why am I doing it?. As a student or even more as a therapist, if we don’t know the reason to apply a technique to the patient and why we will do this technique then we have to stop and go back