Clinical Judgement and Decision Making - Essay Example

?Clinical Judgment and Decision Making Insert Clinical Judgment and Decision Making Introduction In the current world, there is a well-established and mounting body on judgment and decision-making (JDM). There has been a recurring discussion concerning the constructs and description of judgment and decision making process (Grobe, Drew and Fonteyn 2001). Numerous authors have tried to define the constructs of human clinical judgment using different expressions to illustrate the same phenomena. This means that there is no universal definition of JDM because these descriptions range significantly across disciplines, philosophies and professions. Nevertheless, in a professional clinical background, judgment is observed as a professional selection other than task: genuine life practice rather than imagined actions of those who view professional status as a good in its own other than a way to an attractive, namely the higher quality care and treatment of patients (Benner, Hooper-Kyriakidis and Stannard 2009). The ultimate aim of this context is to examine the aspect of clinical judgment and decision-making. This is done by identifying a clinical judgment and decision-making in a clinical environment. It also examines a theoretical framework and associated concepts that has been studied and that is considered relevant in judgment and decision-making. Description Identification of Clinical Judgment and decision-making R. L is a 76-year-old man with pressing on Parkinson’s disease. He has reasonably extreme dysarthria and a history of aspiration pneumonia and weight loss. On access to the hospice, he refuted incidents of choking or other challenges with swallowing. He lives alone, and has a part-time assistant. Before accessing the hospital, he marked an advance instruction not to have a stomach tube put at any level in his disease. The key doctor feels that the patient is capable enough to make this choice. The speech pathologist, focused on R. L’s present steep weight loss, in company with the history of ambition pneumonia, finished a bedside ingest assessment. She discovered the patient had an intensive deal of difficulty ingesting both thin liquids and certain solid food. Besides, the patient seemed confused, and had difficulty following directions. After that discovery is when R. L could be treated and despite the fact that he took time to heal, he eventually recovered from all the diagnosis. This clearly implies that R. L had a problem with judgment and decision making process. Clinical judgment is a very critical aspect of human life because a clinic or healthcare is an environment that deals with human life (Luker and Kenrick 2002). Any judgment made is related to human life. For example, R L’s case is a problem on his body where he is unable to swallow food properly. Decision-making is very crucial in such a situation because R.L was suffering and when he goes to the hospital he refuses to share his problem with the physician. In such cases, the doctor is unable to make judgment concerning the best approach for R. L’s condition. In some cases, decision-making becomes a dilemma. For example, during operations of transplant of kidney from one person to another where both people are operated, the physician is forced to save one person meaning that he or she has to make a critical decision. In fact, judgment in clinical field is very crucial and it requires professionalism and experience as observed in R. L’s situation. According to Dowie, judgment in clinical context is defined as the evaluation of the alternative, the choosing between alternatives, and suggests that judgments are normally in certain way an evaluation of the future (Dowie 1993). R. L’s future was determined by the speech pathologist who made a very crucial decision of assessing him and finding out what his problem was and moving further to treat him. In suggesting this, Dowie debates that if a decision is to be regarded sensible then certainly some knowledge of what the prospect might seem like after the decision is made, is needed. This clearly means that the nurses and physicians must be aware of what might be the consequence of the decision or judgment they make. For example, the speech pathologist was very professional when she decided to take some tests on R. L and noticed he had difficulty with swallowing Food and he also had traces of pneumonia (Davis-Floyd and Arvidson 2007). It is actually sad to just watch a patient die who actually would have recovered if treated and taken good care. Dowie adds that people foresee the future when making decisions all the time; nevertheless, choices would be made with no thought as to the probable outcomes of the decision (Dowie 1993). For example, the speech pathologist fore sore the future of R.L and made a decision as acting as professional physician by testing him and treating him accordingly. This clearly implies that people should not make decisions before assessing the situation and having a clear picture of the outcome. Rushing to decisions without assessing the case is in most cases, with harsh consequences. When making choices, people draw on a range of sources of information: experience, the initial principles of amassed knowledge or facts, the know-how of other, and infrequently the experiences of tens, hundreds, even thousands, of others in form study proof (Chapman and Sonnenberg 2000). Speech Pathologist employed professional experience and principles of jointed knowledge to take a critical action on R.L. Decisions are not often made with full or real objectivity and indeed several wages a discussion that complete and objective judgment issuing the truth is more or less biased, to some extent. Saddler and other colleagues suggest that no deliberation of the natural world of qualitative judgments continues far before the matters of prejudice and impartiality are hoisted (Groves 2002). Other people persist that the idea of doubt is an undervalued component of judgment and decision making processes, especially in stressful situation and backgrounds. Nevertheless, there is no evidence to this statement because in clinical context, it does not apply. There is no way an individual can say that doubt is undervalued as far as judgment and decision-making process is concerned (Pruitt, Cannon-Bowers and Salas 2000). When dealing with human life, there should not be the aspect of doubt because for example, the doctor cannot give a malaria patient a medication with a doubtful mind. Alternatively, give the patient the right medication and give him or her doubtful prescription (Cioffi 2003), as in the case of R.L who received the right medication and got well. That is not being professional and it does not concur with the basic definition of judgment issued in a professional clinical context. This irreducible doubt can only apply in the social field where a person can ask you the direction of going to a specific place and since u do not know the exact place, issue a doubtful direction. That is very true because if the physician could have doubted what she was doing, R.L could not have gotten any better. In other words, all the physicians should perform their duties as professionals who knows what they are doing in order to give patients confidence. In fact, Hammond proposes that there subsists a level of irreducible doubt in JDM, especially in the background of social policy, and discusses that all judgments and decisions are faulted and imperfect on some level (Hammond 2000). Therefore, in most cases, doubts in judgment and decision making occur because no one is perfect and in medicine field, doubts begin to emerge when a patient fails to cure up when issued with the right medication and prescription. However, that is not evident on R.L’s case where the doctor was perfect and she knew what she was doing because she did it without any form of doubt (Benner 2001). Therefore, it is true that there persists certain extent of uncertainty in all JDM but to some, the doubts help come up with novelties especially in healthcare field where failure of drug leads to more research. According to Thompson and Dowding, the experiences of people are normally distorted with hindsight, and individuals can be selective in issuing the information they feel is required where first principles always have to be recast as fresh knowledge replaces the old notions (Dowding and Thompson 2003). Theoretical Framework applied on Judgment and Decision-making Descriptive Theories There are several theories that address the concept of decision-making and judgment among them being classical decision-making paradigm, naturalistic decision-making paradigm, descriptive theories, normative theories, prescriptive theories, social judgment theory, intuition and expert novice theory among others (Thompson and Dowding 2002). However, this context selected descriptive theories as the theoretical framework because it is consistent with the concepts and notions suggested in R.L’s case. The descriptive theories, behavioral and naturalistic in nature, instigate from the philosophies and specialists of psychology and behavioral science. Precisely, descriptive theories are involved in comprehending how people in fact, do make judgments and decisions (Hammond 2006). This is evident on R.L’s case where the speech pathologist’s decision was wonderful and crucial for R.L’s health. Descriptive theories have no constraint on whether the person is lucid and reasonable or illogical and unreasonable and look forward to comprehending how people make judgment and decisions in the actual world, concentrating on the real conditions, backgrounds, ecologies, and surroundings in which they are made (Hamers, Abu-Saad and Halfens 2004). To put it clear, R.L had no idea of such things and that is why he was afraid of making critical decision concerning his life. Irrationality in this case, talks about the cases where people do not give any thought to the process of judgment or decision-making as proved by R.L. At the same time, even if they do, are not able to implement the desired procedure. This was not evident on the speech pathologist because she was able to perform her duty with confidence and implement every crucial measure to ensure R.L was able get well (Hopkins 2000). Therefore, irrationality cannot be accepted for JDM in healthcare environment as far as medication and human life is involved. These theories inquire about comprehending the learning and cognitive potentials of ordinary individuals and focus to identify if their behavior is consistently lucid. Interactions, context and ecology are foundations to the elucidation and study of descriptive JDM theory (Sadler 2003). Debatably, the most effective and often employed descriptive theory or model used in nursing and the midwifery is that of information processing theory (IPT) which is consistent to R.L’s case. This theory is also known as hypothetico-deductive loom, proposes that human judgment and the truth of rationale are bounded and constricted to the ability of human memory. This implies that a person should only make judgment that is within his or her reach where they can provide good explanation as to why they came up with such judgment or decision (Bell, Raiffa and Tversky 2000). That is why the speech pathologist was able to convince R.L to receive medication. This is actually, what needs to happen in the medical field where the physicians and nurses make decisions based on their knowledge. This is appropriate because they are able to give explanations as to why they settled on the specific judgment or decision (Radwin 2000). Good explanation of R.L’s condition made R.L to understand the importance of treatment and thus, receive the required medication. IPT proposes that people, in making decisions, undergo through certain stages that are directed by the attainment of prompts from the environment. Several authors have suggested disparities of fundamentally similar phenomena with this theory. The descriptive models and theories of JDM put massive stress on examining, heuristics, doubt, prejudices, and error in JDM (Reason 2002). Therefore, descriptive theories as techniques of inquiry have been employed in several professions for approximately half a decade. This is evident on speech pathologist’s case where she was able to employ professionalism in her treatment of R.L. Huge bodies of descriptive theory study have been carried out, especially in the nursing profession. This is because this theory is very significant in clinical judgment and decision-making (Orasanu and Connolly 2000). Evaluation Researches have traditionally engaged one specific JDM model or values solely. Very little, if any, have sought to observe or evaluate JDM in more than one pattern, which is a current and augmenting criticism of the present body of research (Calderwood and Zsambok 2003). This is evident enough particularly in case of ideas and notions that uncertainty is part of all concepts of decision-making and judgment (Flin, Salas, Strub and Martin 2007). That notion is right to some extent but it does not apply to all situations. In fact, in clinical judgment and decision making process, the concept of uncertainty is like 1 percent, was not evident on R.L’s case, and is only applicable when the patient does not react or respond positively to the treatment, thus creating more room for research on other various powerful medications to treat the same illness (Lanza and Bantly 2001). The concept of uncertainty does not apply to R.L’s case at all because the doctor employed sufficient prove and professional treatment. This means that criticism is right because some researchers come up with wrong results and theories that have no clear proof. For example, the classical decision making paradigm was dismissed after a couple of decades with the naturalistic decision making process after some concepts were proven wrong. This theory cannot apply in clinical judgment and on R.L’s case. This apparently shows that the researchers need to carry out a thorough research and come up with complete evidence of their findings before providing definitions and ideas concerning JDM (Zsambok and Klein 2007). Nevertheless, the descriptive approaches and theories are well researched with concrete proof of their concepts concerning decision making and judgment processes. This is because much of the work to present day has employed descriptive approaches, like information processing theories to judgment procedures, in an effort to add on massive comprehension of how judgments are made (Vincent 2002). The best example is the R.L case where descriptive theory applies well. In performing that, these researches, in the central, have issued greater imminent into the cognitive procedure engrossed, especially with respect to evaluation practices. Despite the fact that some people have questioned the ecological validity of several of these studies concerning JDM especially with criticism that they have concentrated on representatives of the judgment tasks, descriptive theories tackle the concept of JDM as it is without beating about the bush (Edwards 2000). Conclusion The literature and speculations of JDM are widespread and inclusive as they are contentious. There is no single way to organize the research and literature on JDM. It is apparent that there are distinguished and contesting accounts of JDM in the research and literature. There are several researches done on Judgment in paramedic practice. Some of them are researched well with deep explanation and concrete evidence on facts. However, some researches and theories are not up to their tasks because some of their findings had no concrete proofs. However, the speech pathologist carried out test and her findings were concrete since they helped in diagnosis and treatment of R.L. However, for all the theories written concerning judgment and decision-making process, descriptive theories are the best because they are consistent with all the rules and principles of nursing and healthcare as practiced by the speech pathologist on R.L. Bibliography Bell DE, Raiffa H and Tversky A., 2000. Decision making: descriptive, normative and prescriptive interactions. Cambridge: Cambridge University Press. Benner P, Hooper-Kyriakidis P and Stannard D., 2009. 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