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The effectiveness of a nurse’s role is achieved through the assessment of the social, physical, mental, and spiritual and health factors which define the needs of the patient. This paper is based on a clinical case study where the roles of nurses in assessment of the patient and related factors and decision making and practice are discussed. The discussion is based on Carnevali’s model of clinical judgment and decision making which evaluated in terms of its effectiveness and impact on the execution of nursing roles in patient assessment and decision making. The assessment of Jack’s physical, social, mental, spiritual and health care needs will be based on an integration of critical thinking and observation. Wolf (2012, p. 20) explains that the ability of a nurse to identify the needs of the patient during the assessment process is effectively achieved through keen observation and application of higher cognitive processes of thought. Kearney and Penque (2012, p. 32) adds that the legal and ethical standards of nursing and evidence based practice should also be included in trying to identify the needs of the patient. In Jack’s case, his symptoms are used to assess his health care needs. For example his dehydration is identified through the nurse’s observation. This leads to a critical thinking process through which the nurse will make a decision of the nursing intervention and therapy which is relevant for his condition. The significance of Carnevali’s model of clinical judgment and decision making is disclosed in this case because effectiveness in assessment of the health care needs of the patient would only be achieved through observation of his symptoms. Carnival’s model presents the first stage of diagnostic reasoning process as the collection of information and data on the patient and the family (Carnevali, 2003, p. 45). Aitken, Marshall, Elliott and McKinley (2009, p. 38), add that the roles of nurses in patient diagnosis are guided by collection of patient data on the social and cultural aspects and applying them in the prescription of relevant intervention and therapy. Jack for example is affected by social factors such as lack of appropriate support and care from the parents. This is disclosed by the fact that the parents want to leave him in the hospital with a neighbor. Nonetheless, critical thinking and prioritization must be applied in nursing care to ensure that the health care needs of the patient are provided before further assessment achieved. Jack’s dehydration and weakness requires immediate nursing intervention even before a complete analysis of all factors surrounding his condition are ascertained. Huiqin and Thompson (2010, p. 2752) points out that nurses play a critical role in meeting the needs of patients for care with due consideration of the standards of care and maintenance of high standards in practice. However Carnevali’s model of clinical judgment and decision making fails to show emphasis on the role of ethical and evidence based nursing practice. In accordance to Carnaveli’s model of clinical judgment and decision making, the second stage in diagnostic reasoning process is entry into the patient assessment (Carnevali, 2003, p. 45). This includes priority setting. Jack’s health care needs are prioritized by the nurse because of his weak condition and continuous crying. This is the reason why the nurse must prioritize the health care needs of the patient. Sutcliffe (2011, p. 35) emphasizes that the Nursing and
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