The Pros And Cons Of Clinical Decision-Making

Nurses often have to make quick decisions, usually without adequate time to consider the entire situation. Have you ever wondered, how a person knew what to do, seemingly without ever thinking about it? Barbara Carper, was able to answer this question in detail with her “Ways of Knowing Concepts”, which she developed particularly for the nursing profession (Zander, 2011). A few of her concepts will be compared to a clinical situation, personal to this author. The above question will be explained in multiple ways so the reader will better understand Carper’s concepts and how they may apply to their own situation. This will be accomplished by: describing the clinical situation, observing applicable concepts and then relating them to the situation, visiting how an understanding of her concepts explains interventions and critical thinking, and how evidence affects critical thinking and knowing.

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).

This assignment will critically analyse and justify the decisions based around a fictitious patient using a clinical decision making framework highlighting its importance to nursing practice. The chosen model will demonstrate clinical decision making skills in the care planning process. The patient’s condition will be discussed in-depth explaining the pathophysiology, social, cultural and ethical issues where appropriate in the care planning and decision making process. Any vulnerability that the patient may experience will be discussed and dealt with in the care planning and decision making process. The supporting evidence based literature will be analysed 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.

Patients have the right to self-determination and individuals should have control over their own lives. With respect for human autonomy comes respect for patient rights. Apart of the nurses job is to promote, advocate and protect the rights, health, and safety of our patients. Patients have the right to determine their health needs, make informed decisions, and the right to information regarding their treatment and also the refusal of treatment. Nurses are obligated to know the rights of a patient and to make sure the patient understands their treatment plan. Supporting patient autonomy includes making decisions in the best interest of the patient, considering their values and recognizing differences between cultures. In the treatment

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.

Most of us have to make decisions from the time we wake up until the time we go to bed at night. Answering questions like what should I eat for breakfast, can I make that yellow light and should I go to the gym or go out for pizza all require us to make a choice or a decision (Robbins, S.P., Judge, T.A., 2009). At work I am challenged with collaborating with managers and other leaders to make decisions based on scenarios and events that occur in the hospital.

Evidence-based decision-making represents a process of conscientiously using the best available data and evidence when making managerial decisions. Step one is to identify the problem or opportunity. Step two is to gather internal data about the problem while step three is to gather external data. In step four, this information is integrated with an ethical implications are considered. Finally and stepfather, of the information is at the greeted and critically appraise to make a final decision. More effort to clear clearly identify the problems creating the well abnormalities may have helped the disaster. Instead of relying just on data, if the decision-makers a place more episodes of gathering external evidence in step three, they would have

Discernment which is defined in “Do you walk Ignation?” booklet as a “process for making choices when the option is not between good and evil, but between several possible courses of action all of which are potentially good” (Mooney, 2004, p. 6). This value is something nurses practice on a routine basis, as they are constantly forced to make decisions and these choices are not always black and white. They must consider then choose the correct path for the overall solution in the best interests of that patient and know when to involve the assistance of other healthcare professionals.

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

Clinical reasoning is “the process of applying knowledge and expertise to a clinical situation to develop a solution” (Carr, 2004 cited in Banning, 2008, p.177). Poor clinical reasoning skills can lead to a “failure to recue” (Aitken et al., 2003) the deteriorating patient. Additionally, studies by Hoffman et al. have compared the way in which the expert nurse and the novice nurse accurately collect cues from which they base their decisions. Effective clinical reasoning is therefore linked to “the ability to collect the right cues and take the right action for the right patient at the right time and for the right reason” (Levett-Jones et al., 2010). The ability to apply these “five rights of clinical reasoning” (Levett-Jones et al., 2010) will be discussed in more detail in Nursing Actions and Interventions: A Reflection.

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.

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.

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

Nursing practice requires both critical thinking and clinical reasoning. Critical thinking is the process of deliberate higher level thinking to define a patient’s problem, examine the evidence-based practice in caring for the patient’s, and make options in the delivery of optimal care. Critical thinking involves the demarcation of statements of fact, judgment, and opinion. The progression of critical thinking requires the nurse to think imaginatively, use reflection, and engage in logical thinking (Alfaro-LeFevre, 2013). Critical thinking is a vital skill needed for the recognition of patient’s