Complete Guide to Making Decisions in Nursing
Developing the skill of clinical decision making is highly valuable for nurses aiming for a successful career. Allowing nurses the autonomy to make healthcare decisions based on evidence and established standards of practice brings advantages to both patients and society. Enhanced patient outcomes, increased nurse satisfaction, and reduced overall risk are positive outcomes of clinical decision making in nursing.
This article aims to assist healthcare practitioners in making sound clinical judgments and decisions, especially during challenging situations involving patient care. We will delve into what clinical decision-making entails and explore various theories related to this process.
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Understanding Clinical Decision-Making
To become a nurse, rigorous training and extensive experience are necessary. This equips nurses to gain insights into a patient’s condition even before they see a doctor. Nurses often serve as the first line of defense, detecting patient discomfort or deteriorating health early on. This highlights the importance of nurses possessing critical thinking skills and the ability to make informed decisions regarding patient care.
Clinical decision-making involves analyzing a patient’s condition and making treatment choices grounded in evidence. The best course of action is determined through collaboration among multiple medical professionals. Patients and their families play a role in this process, as they possess valuable insights into their medical conditions and preferences.
Successful clinical decision-making requires critical thinking, effective communication, teamwork, collaboration, and familiarity with quality standards. Nurses maintain open lines of communication with colleagues and patients, adhering to evidence-based practices when delivering healthcare services.
Four Key Steps in the Clinical Decision-Making Process
The process of decision-making in a healthcare setting is intricate and combines both art and science. While there’s no universal approach, reflecting on your strategy can help you adjust and provide optimal care to your patients. Follow these steps to ensure effective clinical judgments and decision making:
Assess Your Options
Consider the likelihood of a specific diagnosis based on the patient’s symptoms, medical history, and other factors. For example, if a patient exhibits a fever, productive cough, and loss of appetite, potential diagnoses could include pneumonia, bronchitis, or an upper respiratory infection.
Gather Additional Relevant Information through Patient Examination
Conduct a more detailed history-taking, assess vital signs, and perform a physical examination to confirm or dismiss your initial hypothesis.
Modify Your Probability Assessment Based on Acquired Information
Factor in the pre-test probability when considering any diagnostic tests you might order. Collect and interpret data from diagnostic testing, refining your differential diagnosis list.
Evaluate an Intervention to Determine if It Meets Treatment Threshold
A lower threshold indicates a greater potential benefit compared to risk. If uncertain about crossing the threshold, other options, like gathering more data or waiting, can be considered.
Models for Clinical Decision-Making
These concepts, tools, and templates can be adapted by teams to suit their specific population, personnel, and changing circumstances. We will continue to incorporate best practice examples and additional materials as they become available.
1. Warwick Model
The University of Warwick’s researchers developed this model based on the analysis of current protocols for deciding whether to escalate treatment or admit a patient to the intensive care unit. It incorporates the principle of reasonable accountability. The approach centers on gathering information to guide analysis and treatment planning.
It emphasizes patient involvement, communication, and ongoing review. After evaluating the model’s implementation, it was found effective in facilitating patient and family engagement, ensuring patient-centered decisions, documenting decision justifications, and maintaining transparency in the process. It aligns with the FICM sunset recommendations.
2. Moral Balance Model
Initially created for ICM students in NHS Blood and Transplant’s Deceased Donation Course, this model streamlines the application of the four tenets of medical ethics in patient care. Its applicability extends beyond ICM trainees, and it’s recommended in the FICM’s guidelines for end-of-life care. Over five years, more than 300 ICM trainees have embraced this paradigm.
Theories of Clinical Decision Making
Effective clinical decision-making involves input from various experts, incorporating perspectives from all those involved in a patient’s care plan. The following theories are frequently applied in clinical decision-making within nursing:
· Progressive Medication Decisions
In the NHS, patients, families, and doctors regularly grapple with challenging decisions about clinical care. Good medical practice, as defined by the GMC, involves decision-making in collaboration with patients and their families. The Mental Capacity Act mandates these conversations, particularly for determining a patient’s best interests when they lack decision-making capacity.
During the COVID-19 pandemic, a systematic approach is recommended to ensure equitable access to critical care. Some of the most ethically and emotionally demanding decisions concern life-sustaining treatment. Patient care decisions are not isolated but interdependent, and they must align with patient values and preferences. Balancing life-prolonging treatments and comfort care is complex, with multiple options to explore.
· Involvement of Others
This article assumes that the patient possesses the capacity to participate in decision-making. When patients lack decision-making capacity, clinicians should engage family and friends in best interest decisions. A healthcare power of attorney empowers someone to make healthcare choices on another’s behalf.
For significant best interest decisions (like ICU admission or discontinuing life-sustaining treatments), involving two senior practitioners is recommended. This might not be feasible under high clinical pressure, especially outside the ICU. Strategies for enabling such collaboration need to be developed.
· Enhancing Patient-Caregiver Interactions
The clinician-patient interaction occurs across diverse settings, including general care, telehealth, and inpatient treatment. Illness and isolation may leave patients without support or advocates for their wishes if their mental capacity diminishes. The need for remote communication must be balanced against patient privacy concerns, necessitating internal guidelines for telephone interactions within organizations.
Why Clinical Decision Making Matters in Nursing
Implementing clinical decision-making brings forth numerous positive outcomes for hospitals, patients, and nurses alike. This process is rooted in the scientific method, which involves forming hypotheses, testing them, and refining the approach. Instead of rigid steps, it empowers nurses to draw upon their vast experience in patient care.
Nurses possess the training and knowledge to make informed medical judgments. Embracing nursing professionals’ ability to exercise critical thinking and judgment leads to several advantages within healthcare institutions:
· Achieving Reliable Patient Outcomes
Clinical decision-making can notably improve patient outcomes, as showcased in the examples above. Nurses are involved in various aspects of patient evaluation, including collaboration, communication with patients and families, and assessment of healthcare needs. They can utilize evidence and research findings to inform their decisions.
Their critical thinking skills enable them to determine when adjustments to a patient’s treatment are necessary. Evidence suggests that clinical decision-making in nursing enhances care quality and patient satisfaction.
· Hospital and Service Benefits
In an evolving healthcare landscape, patient outcome metrics gain significance as the industry shifts from fee-for-service to value-based reimbursement. Soon, quality of care will hold more weight than the sheer number of procedures performed, affecting hospital revenue. Metrics like hospital-acquired infections, falls, and readmissions under Medicare incentivize hospitals to improve. Empowering nurses to make evidence-based independent decisions might positively impact healthcare facilities’ financial bottom line.
· Enhancing Job Satisfaction
The strain of the COVID-19 pandemic has exacerbated the existing nursing shortage. Granting nurses more autonomy contributes to job satisfaction and helps them feel valued. This could result in reduced burnout and higher retention rates. Employers that recognize their nurses’ clinical expertise are more likely to retain their nursing staff, a crucial factor given the ongoing nursing crisis and its impact on healthcare.
Examples of Clinical Decision-Making in Nursing
· Combating COVID-19
During the pandemic, skilled nurses utilized their experience and data analysis of prior COVID-19 cases to swiftly identify patients requiring urgent medical attention. Relying on their intuition and expertise allowed nurses to respond effectively to the evolving information and complex situations.
· Addressing Catheter-Related Infections
An investigation at Boston Medical Center found that Foley catheters contributed to 9% of hospital-acquired infections. A task force comprising hospital administrators, nurse educators, urologists, and others analyzed the data and launched awareness campaigns. By 2017, catheter-related infections dropped by 83% due to the efforts of this task force.
· Preventing Patient Falls
Patient falls are a major concern in hospital settings. A study published in the Journal of Medical Internet Research in 2021 examined the potential of a data analytics tool to reduce patient falls. Nurses using this tool exhibited greater awareness of risk factors, resulting in fewer falls.
Final Reflections
This article underscores the critical role of clinical decision-making in nursing, benefiting all healthcare practitioners striving for quality service delivery. At usanursingpapers.com, we are committed to providing students with the latest nursing concepts and information. Our expert nursing essay writers can guide you through theories of clinical decision-making and offer free samples of decision-making models to enhance your learning experience. Collaborate with us to further develop your nursing expertise and writing skills.
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