The Development of Decision-Making in Nursing Nursing is a profession that has traditionally attracted individuals who have a desire to help others and have an interest in the health sciences (Ruesink, 2012). In the complex world of health care, good intentions only go so far in terms of client safety, quality of care, and achieving the best possible outcomes, and that is why critical thinking, decision making, and evidence based practice are crucial to the nursing profession when acting on the behalf of our clients (Fero, Witsberger, Wesmiller, Zullo, & Hoffman, 2009; Ruesink, 2012; Thompson, Aitken, Doran, & Dowding, 2013). In this paper I will discuss and explore three decision-making models that support nursing decision-making, how …show more content…
The College of Registered Nurses of British Columbia (CRNBC), defines Clinical decision-making as: A complex and dynamic process, occurring within a larger context and drawing from various dimensions of knowledge, in which nurses collect and organize information in order to form conclusions and choose actions, with the intent of creating the best outcomes for clients (2014, slide 19). The nursing profession demands a high standard of quality and safety, compelling nurses to act professionally, be accountable for their own actions, and embrace their Professional Standards (CRNBC, 2013). The CRNBC Professional Standards requires nurses to know where to access information to support their knowledge to deliver evidence-based, competent nursing care, as well as use decision-making tools to guide their assessments, diagnoses, and treatments (2013). For nurses to make clinical decisions that enhance a client’s health, promote realistic solutions, and reduce potential risks, decision making and critical thinking must happen in sync (Fero et al., 2009; Standing, 2005). To support critical thinking in nursing practice, and help novice nurses compensate for the lack of clinical experience, decision-making models have been constructed to help navigate the multi-dimensional complexities of the
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
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 differences in critical thinking skills can be applied to a clinical setting to compare the differences between an ADN, diploma and BSN education. One of the clinical setting scenarios that illustrate the differences in decision-making based on educational preparation is in the case of discharge planning. The clinical picture is that of an eighty-year old female being discharged after a fall that created a significant wound requiring complex wound care and a wound vacuum. Her spouse requires a walker and help with his activity of daily living (ADLs). They live together and up until this point the female drove for both of them. It is up to the RN to
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
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 ).
Within the practice of nursing, situations often arise where nurses are forced to make decisions regardless of their level of experience in the profession. Providing care and following the physician’s orders historically were the nurse’s sole responsibilities. However, social change, changes in health care finances, increasing international perspectives, and demographic population changes, have resulted in a significant evolution of the roles and responsibilities emplaced on today’s nurses (The National Association of Clinical Nurse Specialists (NACNS), 2007). Kelly and Crawford (2013) believe budget cuts, higher client acuity and clients with complex needs, mergers of hospital corporations as well as a general shortage of qualified nurses has made it necessary for nurses to play a role in decision making. Decision making is defined as “cognitive process leading to the selection of a course of action among alternatives” (Kelly & Crawford, 2013, p. 352).
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
Over the years there have been vast changes in healthcare that require nurses to go above and beyond in their level of expertise in technology and scientific knowledge (Palos, 2014). Nurses have to evolve with those changes, therefore they must utilize educational tools and develop skills to stay current with the advancements that hospitals require for practice (Palos, 2014). Palos (2014) also found that nurses have a responsibility to use their critical thinking skills, make sound clinical judgments, and apply evidence-based nursing
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.
As a nurse I will use my knowledge of critical thinking skills with in the nursing process: assessment, analysis, planning, implementation, and evaluation. Furthermore as a member of the nursing profession, I will assume accountability and responsibility for the quality of nursing care that I provide to clients, act as an advocate to promote quality health care for all clients, and take part in activities that promote the development and practice of professional nursing.
Critical thinking and clinical judgment are important skills that professional nurses use in every day clinical setting. In 2012, a mix method qualitative study by Dr. Jeanne Mann was done to evaluate the effectiveness of educational strategy to develop clinical judgment skills in nursing students. In this study, the population was identified as volunteered Level II baccalaureate nursing students from a Midwest nursing program. The variables identified in this article are the relation between critical thinking and clinical judgment. The title of the article clearly indicated the focus of the study and created an interest in reading the research due to nurses utilize their ability to critical think and
New graduates and seasoned nurses can occasionally suffer from poor reasoning skills which lead to failure and burnout. Van Graan and Williams (2017) also discuss meeting the demands of the clinical environment, nurses should think critically and innovatively; should be competent in reflection and self-critique; synthesize information; link concepts and become self-directed lifelong learners. (Van Graan & Williams, 2017, p. 277) D-I-K-W is a wonderful foundation on how to interpret data and the evolution of that data to wisdom. Reading the diagrams depicting D-I-K-W essentially draws us a map to the evolution of nursing judgement. Mastrian and McGonigle (2018) state that under to D-I-K-W paradigm that when we assess a patient to determine their nursing needs, we gather, and then analyze and interpret data to form a conclusion. (McGonigle & Garver Mastrian, 2018, p.
“Differences in Clinical Reasoning Among Nurses Working in Highly Specialised Paediatric Care,” an article published in the Journal Of Clinical Nursing, investigates the manner in which nurses with varying degrees of experience approach the clinical decision making process. As might be expected, Andersson, Klang, and Petersson concluded that strategies used for clinical reasoning differ between newly licensed nurses and those with greater clinical experience (2012). They found that nurses with less experience tended to take a superficial “task-and action-oriented approach,” were less likely to ask clarifying questions and “…seemed to identify each problem in the case separately without relating them to each other” (p. 873). This superficial
Critical thinking and clinical reasoning are terms often used interchangeably throughout the history of nursing. However, they are not the same, and distinguishing the difference amongst them is important. The purpose of this paper is to define critical thinking and clinical reasoning, discuss each concepts similarities and differences, as well as share this author’s perspective on how critical thinking and clinical reasoning have developed and evolved throughout my own career, guiding my clinical practice decisions.
As healthcare moves from the Industrial Age to the Information Age, a new role for nurses as knowledge workers comes in its wake (McGonigle & Mastrians, 2015). In his definition of a knowledge worker, O’Grady cited “that the knowledge worker is someone who synthesizes a broad array of information and knowledge from a wide variety of sources and brings that synthesis to bear on nursing work” (O’Grady & Malloch, 2003, para. 2). Thus, a knowledge worker is one who translates and integrates information that would eventually be applied in the context of patient care (O’Grady & Malloch, 2003). Nurses, as knowledge workers, therefore, have moved “from the process and function orientation to that of outcome and evidence-based direction” (O’Grady & Malloch, 2015, para. 1).