Patient Decision-Making

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

Decision-making in the workforce is a process of responsibilities used by upper management to implement, enforce rules, regulations, and maintain a successful environment. Decision-making implemented more effectively by making a plan, thinking it through, accepting more than one opinion and determining what is best. However, decision-making often utilized more effectively by opening doors of opportunities for a suggestion, question, discussion, and feedback. Although, more involvement helps improve understanding, utilize behavior skills and present opportunities for better communication. Everyday life consists of decision-making, the right decision may not always be applied, but ensure room for improvement and opportunity. Individuals approached decision-making in many different ways. As stated by (Jones, Graham, & Bateman, 2006) decision making is a procedure used to recognize a problem, weigh the alternatives and evaluate a solution in which, certain situations will require different approaches to become effective.

On March 20, 2010 President Barack Obama signed into law the Patient Protection and Affordable Care Act (ACA). With that signature, a new healthcare paradigm set into motion. Under Title III: Improving the Quality and Efficiency of Healthcare, Section 3506 requires establishment of programs that develop, test and disseminate “patient decision aids”. Tools that are designed to facilitate collaborative shared decision making between health care providers and patient beneficiaries. This provision outlines requirements to promote engagement of all stakeholders in informed decision making, mandates provision of up-to-date clinical evidence for all treatment options and promotes decision making that accounts for individual beliefs, preferences and circumstances.

The Patient Self-Determination Act is derived from the understanding that people should be given knowledge that will make them to give wishes for the extent of medical treatment they wish to receive if they incase become incapacitated. The Power of Attorney for Health Care is taken from the later to meet the wishes of the incapacitated in the state. The document power of attorney is legalized and therefore allows you to choose someone who can make decision for you in case your health condition has worsened and you are unable to decide anything by yourself concerning your health.

For policymaking, regulations and strategies, clinical decision support (CDS) provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care. CDS encompasses a variety of tools to enhance decision-making in the clinical workflow. These tools include computerized alerts and reminders to care providers and patients; clinical guidelines; condition-specific order sets; focused patient data reports and summaries; documentation templates; diagnostic support, and contextually relevant reference information, among other tools.

Clinical reasoning can be best described by the process of collecting indications, processing, understand the problem or situation, plan and implement interventions, asses outcomes and learn reflect on the whole process (del Bueno, 2005). Positive outcomes of this process can be determined by an individual’s preconceptions, attitude, perspective and willingness (mentally and physically) (McCarthy, 2003). In a report by the clinical excellence commission of NSW Health they conclude that there are three explanations for negative patient outcomes in which are failure to correctly diagnose, failure to adequately implement appropriate treatment and inability to manage complications. In this essay the author will outline a situation in which they were involved in explaining the background of the situation, factors which influenced a clinical decision to be made whilst describing the clinical decision making process.

Lastly, the article discusses the ability for shared decision making to reduce costs. The article found that “ consistently, as many as 20% of patients who participate in shared decision making choose less invasive surgical options and more conservation treatment than do patients who do not use decision aids” (Oshima Lee, Emily 2013). In 2008, the Lewin Group projected that implementing this model for 11 procedures would yield more than $9 billion in saving over 10 years. Group Health also conducted a study in 2012 that showed that providing patients with decision aids, whom were eligible for hip and knee replacement, reduced surgery rates and

The foundational knowledge within the situated clinical decision making model is the knowledge of nurses that informs their decisions. Gillespie and Paterson (2009) divides foundational knowledge into five ways of knowing; knowing the profession, knowing self, knowing the case, knowing the client and knowing the person.

a) Clinical decision support administers up-to-date data at the point of care, to enable information decisions about a patient’s care. Clinical decision support tools and systems enable clinical teams by being in charge of other duties and work. The purpose of CDS to administer up-to-date information to clinicians and patients. It reduces expenses, promote performance and decrease patient disturbance. It can efficiently promote patient outcomes and advance to better healthcare. Prevention of omissions and unfavorable results. It makes clinicians have attentive desirable matching tests a patient may be about to acquire.

How medical decision making aides the health care professional and the patient regarding the patient’s treatment, medical cost and autonomy.

According to Blumenthal-Barby, et al. (2013), patient decision aids are intended to assist the patients to make decisions about health care. These aids are designed to be neutral, non-directive, and unbiased. However, the authors argue that this should not always be the goal of such patient aids. They identify three specific areas where this balance may not be the best alternative. These situations include early stages of prostate cancer, deep vein thrombosis and colorectal cancer screening.

Different works found in the literature address research questions regarding the function of clinical decision support systems, its usage among healthcare providers, the role on improving care and reducing costs, the impact of design and usability interface, along with adoption of clinical practice guidelines in theses systems and the adherence of providers to the recommendations generated by them (Anderson & Willson, 2008; Bright et al., 2012; Piscotty & Kalisch, 2014). A systematic review by Bright and colleagues (2012) aimed at evaluating the effect of CDSSs on clinical outcomes, workload and efficiency, cost, provider use, implementation, patient

Although clinical decision-making and clinical judgements are closely linked, but the concepts are separate. Clinical judgement defined as “an assessment between alternatives” whilst clinical decision-making defined as “a choice between alternatives” (Dowie, cited by Thompson and Dowding 2009). To choose the best between two alternatives requires the rationale behind decisions which can obtain by asking questions to create information (Standing 2010). Furthermore, Levette et al’s (2010, p. 515-20) define clinical reasoning as “the process by which nurses collect clues, gather information, come to an understanding of a patient problem or situation, plan and implement interventions, evaluate outcomes and reflect on and learn from the process”.

Clinical decision-support systems (CDSS) apply best-known medical knowledge to patient data for the purpose of generating case-specific decision-support advice. CDSS forms the cornerstone of health informatics research and practice. It is an embedded concept in almost all major clinical information systems and plays an instrumental role in helping health care achieve its ultimate goal: providing high quality patient care while, at the same time, assuring patient safety and reducing costs. This computer based systems designed to impact clinician decision making about individual patients at the point in time that these decisions are made. If used properly, CDSS have the potential to change the way medicine has been taught and

Doctors, whether generalists or specialists, can no longer control the entire medical knowledge to recognize disease or determine the best therapeutic management. Thus, they often use external sources of information, traditionally colleagues, books, and Clinical Practice Guidelines, to find the information they lack. Nevertheless, despite the on-line diffusion of large volumes of easily accessible documentary resources, finding a solution to the problem posed by a given patient remains a difficult task. Early on, clinical decision support systems have been developed as potential solutions to this difficulty (Berner, 2007). The development of such systems appears even more crucial that many studies are published each year and who report frequent mistakes in the management of patients. Since the publication of "To Err is Human" (Kohn et al., 2000), CDSS are gaining an increased pop-ularity in various domains of health care.