Using a case example analyse a decision made by a nurse in the practice setting - Essay Example

?Introduction Decision making in a nursing profession plays a critical role. It evaluates the ability of a nurse to identify and collect critical information in an emergency situation, analyze on them, identify appropriate decisions and more importantly, implement those decisions in such precarious situations. According to the case presented, the decision of the nurse is to respect the choice of the patient and go with the method of treatment, as chosen by the patient. (Adair 1999) This decision-making process plays an integral part in establishing the most complex of all relationships in health care – between a patient and the nurse. The health care services have improved so much that patients have become more cautious about the approach taken for their treatment. (Benner 2004) Many of the services are customized in such a way that the patient’s approval of the process taken for their treatment has become a must. So, with the growing trend, people have started to understand about the different options available for a particular treatment and know about the consequences of each of the methods. (Benner 2001) These steps of improvement towards health care clearly show that decision-making has gained high priority among the patients. The changing trends have made sure that nurses are given full freedom to excise their duties and make appropriate decision. Such autonomy has also provided them with prime responsibility. Any decision that could have severe impact directly affects the growth of their career. (Department of Health Nursing and Midwifery Council 2002) It also acts as one of the means of measuring a nurse’s contribution towards improvement of health care. The clinical importance of decision-making process is directly attributed towards the improvement of patient care. Their critical thinking skills in a clinical field allow them to be actively responsive to grasping even semblance of opportunities that could help in improving care. (Chapman 1994) In this case study, the patient is a 26 year old female working as an assistant in a shop. The patient as got a cut in the proximal phalange on the dorsal aspect of the middle finger. The patient is extremely tentative towards the concept of needles and sutures and in every possibility is in favor of avoiding such methods to treat her. The nurse handling the case, being an experienced practitioner in nursing gave the opportunity for the patient to decide between suture and gluing. The nurse practitioner did not fail to mention about the advantages and consequences of choosing each method. Given the stress that the patient incurs about suture and needles, the patient’s choice for gluing method to treat her was respected and followed. The first priority of the nurse practitioner while deciding on the method of treatment was to respect the choice of the patient. Since the patient was given the details of both the procedures and after having decided that the nature of the wound to be a minor one, the patient was given the responsibility of self-management. Secondly, the guidelines of the gluing procedure were easily satisfied by the wound’s state and hence, the nurse had an easy approach while deciding on the treatment. (Tschudin 1994) Several systems like the Clinical Decision Support Systems are used to support practitioners while making decisions. (DOH 2007) Such systems are categorized as knowledge based and non-knowledge based. These systems work on the basis of the information collected and also on the past history of the patient to guide the practitioners to take a final decision. Ultimately, these systems only help in guiding the practitioners to make a decision and they do not finalize any decision. (DOH 2009) The theories of rational approach towards clinical decision-making suggest that, decisions should be made on a long term basis, taking in details of the numerical data, the probabilities of different decisions and others facts. These systems help in collecting those empirical data and allow for making a decision that is well thought out and rational. (Farion et. al 2009) Policies that are aimed at impacting patient care at a national level are bound to impact nursing practice at every level. Though designing policy frameworks lies entirely with government, there are areas where nurses should become politically active to voice their needs. Policies that decide on the best practices of nursing should be enhanced to include guidelines and probabilities on improving health care. (Banks 2004) The current policy frameworks have the responsibility of defining to the society what nursing as a profession is and how a nurse practitioner should be treated among other physicians in health care environment. (Benner & Tanner 1997) Decision making process involves a series of steps that are fulfilled in order to arrive at a decision. Decision is made only after considering the situation and the options that are available. In the field of medicine, decision-making plays an important role, as each of these decisions involves a person’s life. (Buckingham & Adams 2000) Decision-making is generally a process about which the people involved are already intimated. It is considered to be efficient only if it is implemented in a proper manner. (Burman et. al 2002)The situation is equally important in the decision-making process. The selection and implementation of steps purely depend on the type of problem and the people involved in it. The skills and experience of the people involved play a major role in the decision-making process. In the nursing profession, the decision-making process, if not handled well, can turn out to be very problematic. (Cioffi 2001) The nurse must be capable enough to analyze the problem, decide on the treatment, inform the patient and then implement the method selected by the patient. Decision-making process involves a series of steps like problem definition, requirement determination, alternative identification, selection of a proposed method and implementation. (Cioffi1997) Problem Definition The initial step in the decision-making process is to define the problem. The problem is clearly defined to the people who are involved in this process. (Dowding & Thompson. 2004) In this case, the 26 year old female patient is well informed about the wound and the problem with it. The nurse practitioner clearly explains the problem about the wound and the possible ways to deal with it. The patient also has the equal right to decide on the type of treatment. As the nurse explains the situation in a proper manner, the patient can select a method that is feasible for her. Requirement Determination The nurse must determine the requirements of each of the treatment. In case of suture, the nurse must make necessary arrangements for the equipment needed to implement this procedure. As the initial step of deciding on the type of treatment is left to the patient, the patient has selected gluing. Gluing requires certain equipment like glue, the dressing pack, wound cleanser and other medical equipment. The nurse must determine the things needed to treat the wound. Once this is accomplished, the nurse can be sure of treating it without any problem. Since the equipment and medical options are considered to be important, they are determined well in advance. (Dowding & Thompson. 2003) Alternative Identification A problem has several solutions depending on its severity and importance. When considering this case, the nurse explains the two available methods that deal with the wound. The patient is given due importance in deciding about the treatment. The patient prefers gluing and the nurse agrees to implement it. The experience of the nurse practitioner helps her in treating the wound efficiently. Due to this reason, the nurse was able to assess the severity of the wound and was able to provide the patient with two options. The alternative method of suture was also explained to the patient, but the patient preferred gluing to suture. Selection of Proposed Method Suture and gluing are the two methods that were explained to the patient. Among these two proposed methods, the patient was comfortable with gluing. Since the patient was afraid of stitches and its distress, they opted for gluing. The nurse agrees to implement it as this is also an efficient method in treating it. (Easen & Wilcockson 1996) Implementation The gluing procedure was implemented only after consulting the patient. This step is the final and important one as careless approach might lead to several other problems. The skill and experience of the nurse practitioner helped them in dealing with the wound easily. The gluing was done and the patient was relieved of pain. The experience of the practitioner plays a vital role, as they must be efficient enough to provide the right treatment at the right time. (Effken. 2001) Intuitive Approach This decision making process is more related to an intuitive decision-making process. The patient decided to opt for gluing and this was purely her own choice. She preferred this because suture involved stitches and she was afraid of needles and its distress. Intuitive decision making is based on one’s inner feeling and consciousness. The patient was keen on selecting gluing, as she analyzed the problems in the alternative method. Her intuitive approach towards deciding this method helped her since gluing was also an easier and efficient approach in treating the wound. (Elstein & Schwarz 2002) The outcome of any decision-making process depends on the decision and its effectiveness. It may turn out to be positive or may affect the concerned people in a negative way. (Field 1987)The experience and skill of the deciding authority and the practitioners are considered as the important aspects in the process of decision-making. It affects the process to a greater extent. Since the nurse practitioner had a rich experience, she managed to provide a quality treatment. This clearly shows that the skill and experience are the two pillars of decision-making process. (Flanagan 1997) Hypothetico—Deductive Method Hypothetic-detective method can deconstruct this decision. This method is used to make decisions based on contradicting factors. A decision is not made by the positive aspects and available concepts. Instead a hypothesis is derived and the possible predictions are devised. (Gadsby 2008) Using these predictions, the observations of a particular process are analyzed. The observations are compared to the hypotheses and it is proved that the derived hypothesis does not suit the concerned decision-making process. Hypothetic-deductive method can be used to deconstruct the proposed decision of any process. (Gadsby 2007) In this case, the patient selected the gluing method. Hypothetic-deductive method analyses the negative aspects of the suture method and compares the effects of gluing method. Then the positive aspects are highlighted and it is proved that gluing method is more effective in dealing with this wound. This is accomplished by comparing the negative aspects of suture and the positive effects of gluing. This might deconstructs the decision, as the effect of any treatment depends on the severity of the wound (Hamilton 2004). Advantages of Hypothetico-Deductive Method Any deductive method has its own advantages and disadvantages. A method like hypothetic-deductive method concentrates on portraying the weakness and inefficiency of a decision. (Hams 2000) In any case, the derived hypotheses might give them an idea about the process and its pros and cons. This will guide them to arrive at a better decision. Since it aims to falsify the proposed hypotheses, the advantages of the other part of decision can be easily understood. (Harbison 2001) The disadvantages of suture methods are also explained by the nurse practitioner and this makes the patient to opt for the gluing method. The derived values of the hypothesis are tested with prior experience and if the hypothesis is falsified, they can arrive at a better decision process. (Harbison 1991) This enables them to find out the best decision for the concerned process. This enables the people involved in the decision-making process to have a complete outlook on how the proposed decision will be. (Kendrick 1994) Disadvantages of Hypothetico-Deductive Method Hypothetico-deductive method relies on the hypothesis that is derived and deduced from the process on which a decision is made. The hypotheses are derived each time a new decision is made. This poses several challenges to the process and the people involved in the process are pushed to an extent where they need to find an alternate solution. In certain cases, the alternate solutions might not be effective enough to deal with the proposed process. (Koch & Speers 1997) In the process of falsifying the deduced hypotheses, most of the decisions proposed by the concerned person might get falsified. Since this is a continuous process, a final solution cannot be obtained in all the situations. (Lamond & Thompson 2000) This leads to other related issues in the process. As there are only two methods to treat this wound, it was easier for the patient to select the feasible one. If the options were more, the probability of arriving at a decision is less. (Mallik et. al, 1998) Difficulties and Constraints in Decision Making Process Decision making process, in general constitutes of several sub processes which affect the decision making. The patient was bleeding and she had to be treated immediately. (Martin 2002) Time was the major constraint as further delay might aggravate problems. The nurse practitioner explained the available methods in treating the wound and the patient took some time to decide about the treatment. The type of treatment was left to the patient’s choice as they might have their own difficulty in coping up with certain treatments. (Moore 1996) The patient was explained about the nuances of each treatment. The after effects and the procedure of each method were also described. (Thompson 1999) As the patient selected the gluing method, the treatment process was easier and it did not pose any difficulty to the nurse practitioner. Apart from these difficulties, the decision-making process was not affected by constraints and deficits Conclusion In the past, nursing practitioners have always had a minimal say in decision-making process, especially when it involves institutional policies. Later, as literature drew its roots from several quarters, public became exposed to the sociology of professionalism which stabilized the thought of a professional person being able to make individual decisions, provided he/she is capable with the skills and knowledge required for that profession. This combined with the patients demands for getting involved in decision-making has pushed the boundaries for nurses. The current trends of patient care require nurses to be in the hot seat for making decisions that decide on the life and death of patients. Such accountability of nurses increases their autonomy, moving their position from a service oriented person to a more executive position in patient care. (Truman 2003) With the responsibility of making life or death decisions being officially handed to them by the new rule imposed by the British Medical Association, it has become all the more important on how nurses make decisions. Every decision they are bound to make could therefore make or break their career. Another important factor is that it could affect the future of the patient in an inexplicable way and every nurse holds the reputation of the clinic in their hands. Hence, the experience of the nurse as well as their knowledge plays a major role in decision- making process. (Walsh1998) The healthcare profession is getting complex day by day and each day tests the flexibility and compatibility of nurse practitioners to cope with the hindrances and come out with the best effective decision for patients. In a clinical environment, there are several factors that need to be taken care of, for providing the best opportunities for the nursing staffs to make their best efforts in decision- making during critical stages. As mentioned before, experience and knowledge always play a determining factor of the effectiveness of the decisions. In addition to this, the critical thinking aspect of the nurse also plays a big role. The ability to reason out and imagine future outcomes based on interpretations of past history determines the critical thinking quality of the nurse practitioner. Such kind of thinking can be brought in only through its promotion during the nursing studies itself. Intuitive skills cannot be gathered in a day. It is an everlasting process that needs to be fed in every day. (Muir 2004) Also, factors that may dilute the self-confidence of the nurses in a clinical environment should be eradicated to allow them to control the outcomes of the decisions they make. Some of the factors include stress of handling too many patients at a time. It results in nurses lacking care and losing focus on any particular patients and eventually, they find themselves losing out on their self-efficacy. Handling too many patients happens also due to the lack of adequate staffs. It is the clinic’s responsibility to take care of allocating adequate staffs to take care of the patients. Another stress creating issue could be the lack of proper interpersonal communication between the colleagues. As a result conflicts may arise among the staffs leading to a race for supremacy and hence an opening for negligence in decision-making processes. (Rew 1988) Professional nursing is characterized by the effectiveness of their decision-making abilities. There should always be continuous encouragement among the nursing communities to take up responsibilities and make decisions. For that to happen, the above explained factors should be well publicized along with their ramifications. Such factors should be identified in every clinical environment and strategies should be put in place to allow the nurse practitioners to make their best possible decisions under all circumstances. References Adair, J 1999. Decision making and problem solving. London: CIPD Publishing. Benner, P. 2004. Using the Dreyfus model of Skill Acquistion to Describe and Interpret Skill Acquisition and Clinical Judgment in Nursing Practice and Education. Bulletin of Science, Technology & Society. 24(3) p188-199 Benner. P., 2001. From Novice to Expert: Excellence and power in Clinical Nursing Practice. California: Addison Wesley. 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