Reflective Case Study : The Decision Making Process Essay

This discussion question is based on a case study. As in all case studies, review the facts of the case and consider the various steps of the nursing process in order to address the critical thinking questions.

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

The nursing practise has continually evolved and can be described as autonomous due to the significant involvement of nurses in patient care. This then necessitates critical reflection as a way to continually develop and improve the nursing practise. The Gibbs' model, one of the reflection models, assists nurses in complying to the codes and guidelines of nursing practice. For example, developing action plans, evaluating patient outcomes, and thinking critically. This essay will describe an event involving nurses and explain the feelings it evoked. It will also provide an evaluation of the positives and negatives, analysis and enhancement of learning, and an action plan.

I will use a reflective model to discuss how I have achieved the necessary level of competence in my nurse training programme. The reflective model I have chosen to use is Gibbs model (Gibbs 1988). Gibbs model of reflection incorporates the following: description, feelings, evaluation, analysis, conclusion and an action plan (Gibbs 1988). The model will be applied to the essay to facilitate critical thought, relating theory to practice where the model allows. Discussion will include the knowledge underpinning practice and the evidence base for the clinical skill. A conclusion to the essay will

The purpose of this paper is to conduct an in depth exploration of the nursing care considerations of patients in a specific clinical area. Through the synthesis of prior knowledge, clinical experiences and skills, evidence based best practices, and care of patients a comprehensive care and teaching plan will be composed. Integration of critical thinking and clinical reasoning skills, combined with evidence-based research will provide confirmation of nursing process comprehension. The inclusion of reviewed literature will further support knowledge and understanding.

As the nurses who participated in a study (Jones & Cheek, 2003) overwhelmingly advised, there is no such thing as a typical day for a nurse. Nurses face new situations everyday and it is important that they can adjust their knowledge and skills accordingly. Critical thinking and reflection are essential skills because they can enhance nurses’ ability to solve problems and make sound decisions. Critical thinking skills enable nurses to identify multiple possibilities in clinical situations and alternatives to interventions; weigh the consequences of alternate actions; and make sound judgement and decisions (Brunt, 2005). Through reflection, nurses can examine their practice, explore feelings and reactions and connect new meanings to past experience (Brunt). Reflection can enhance self-awareness, foster professional satisfaction and growth and increase the possibility for change and improvement in nursing practice and therapeutic relationships (Thorne & Hayes, 1997).

The co-operative nursing assignment has given me the opportunity to use my critical thinking, decision-making, leadership, and clinical nursing expertise learned throughout the RN-BSN program. “The fostering of critical thinking as one of the terminal learning goals of nursing education based on the idea that critical thinking is important not only in the nursing workplace, but also in nursing education” (Shin, Jung, Shin & Kim, 2006, p. 233). My

Critical thinking is a nursing process that includes reflective practice, problem solving and decision making which are connected to one another. The definition of critical thinking is transferring and applying knowledge and skills in a new situation. The critical thinking is needed in a lot of aspects of the nurses’ job such as when the nurses need to provide the precise identification in the specific problems had by the patients. They need to be in detail and also critical to themselves in every time in order to be able to provide identification precisely. When you have the profession in nursing, it is important to be critical thinker. The nurses have the high responsibilities and their responsibilities are increasing from time to time.

For the purpose of this essay, I have selected Gibbs (1988) Reflective Learning Cycle to reflect on an aspect of individual professional practice, which requires development in preparation for my role as a Registered Nurse. Gibbs (1988) Model of Reflection provides a clear description of a situation, analysis of feelings, evaluation of the experience, conclusion, and action plan to make sense of the experience to examine what you would do if the situation happens again.

Over the past 30 years nursing has evolved from a task-oriented to a logical and systematic approach to care, using theories and models to guide practice. According to Jasper (2007, p117) theories of decision making in medicine tend to favour logical, precise analytical models which are held to be testable, unambiguous and repeatable, therefore satisfying scientific principles. These represent important ideas of certainty and rationality that are intended to provide a sense of security and reliability. When used correctly a nursing model should give direction to nurses working in a particular area, as it should help them understand more fully the logic behind their actions. It should also act as a guide in decision-making and so reduce conflict within the team of nurses as a whole. This in turn should lead to continuity and consistency of the nursing care received by patients according to Pearson et al (1999,p ).

Underlying both the clinical decision-making process and the nursing process is the skill of critical thinking. Critical thinking has been described as the ability to gather and process data in such a way as to arrive at the best conclusion using the filters of prior knowledge, experience and external resources to overcome personal emotions, biases, and assumptions. (This description was developed during NUR/300 class, University of Phoenix, S. Colorado, March 16, 2006) Note that critical thinking is described as a

The aim of this essay is to demonstrate the assessment process of a patient using the Roper Logan and Tierney (RLT) model of nursing framework and to show how the nursing process works alongside this model. This will be shown by a holistic history of the patient being shown, followed by how the RLT model is applicable to this patient. This is then followed by one nursing intervention being discussed showing how the nursing process is applied to patient care. The patient will be referred to as Mr Frederick Valentine to protect the patient’s anonymity as stated in the Nursing and Midwifery Council Code of Conduct (2008) guidelines.

The national league for nurses defines critical thinking in the nursing process as “a discipline specific, reflective reasoning process that guides a nurse in generating, implementing, and evaluating approaches for dealing with client care and professional concerns” (Kozier, 2008). This definition is imperative to help a nursing student learn how to think in terms of nursing care. Nursing students must achieve a comprehensive understanding of critical thinking in order to understand the nursing process. The purpose for this paper is for nursing students to learn how to use the nursing process, how to properly document their findings and assessments, and correctly implement APA formatting in a formal paper.

The development of the nurse’s ability to clinically reason and take appropriate and timely action can, in time, become an instinctive and automatic process. Reflective practice by the nursing professional will highlight the areas in which further improvement is needed. Essentially, it is the responsibility of the individual nurse to identify the need to develop this ability, and the skill to effectively communicate the patient’s condition to the other members of the healthcare team to produce positive patient outcomes.

Clinical reasoning can be defined as, ‘the process by which nurses (and other clinicians) collect cues, process the information, come to an understanding of a patient’s problem or situation, plan and implement interventions, evaluate outcomes and reflect on and learn from the process’ (Levett-Jones & Hoffman 2013, p.4). It requires health professionals to be able to think critically and ensures better engagement and results for the patient (Tanner 2006, p.209). The Quality in Australian Healthcare Study (Wilson 1995, p.460) discovered that ‘cognitive failure’ resulted in approximately 57% of unfavourable clinical events involving the failure to produce and act correctly on clinical information. It also recognises that often nurse’s preconceptions and assumptions can greatly affect patient care and by going through such a process, one can take into account the holistic nature of the patient and provide the best, most appropriate care.