Nursing Decision Making - Essay Example

? Nursing Decision Making Due: Nurses are involved in many people’s day to day lives. It is important that a nurse has a variety of skills when delivering healthcare to patients in their day to day lives. For this reason, a nurse should have a sober mind that helps them make the right decisions in situations that involve them helping patients. The advancement of technology has fueled various practices even in the nursing profession that has in turn caused a revolution in the way that nurses make decisions. Nursing embraces technology especially since there has been tremendous revamp as a consequence of its incorporation in the nursing profession (Hardy, Garbett, Titchen, Manley, 2002, p.200). There are conditions where nurses have to make sober and most feasible decisions when it comes to patients suffering acute conditions. These patients have to be accorded precise care in order to ensure their comfortable recovery in health institutions. Many patients have faced situations where they do not recover out of their illnesses since nurses do not have ample reasoning skills (Del Bueno, 2005, p.202). This is a result of nurses not making correct assessment of the patients they have in their centers, where they are supposed to evaluate the most ill patients and offer them the help they need. This papers purports to evaluate the importance of critical thinking for nurses in their provision of healthcare to patients. The situation in health facilities is that ‘at risk’ patients are fitted with a device that notices complex fatal situations such as cardiac arrests and warns the health administration in order to offer them quick response (Ebright, Urden, Patterson, Chalko, 2003, p.635). Quite often though, the nurses in all over the world do not possess the right planning skills when offering administration of health care to patients. While the degree of complexity in diseases is increasing indefinitely, nursing profession has adopted the information and technology empowerment to offer their patients the best kind of healthcare. However, this has not been totally comprehensive in offering healthcare and it calls for additional endeavors to coach nurses. The profession management found it fit to complement nurses with teaching in critical thinking skills in an effort to reduce poor clinical reasoning. Research conducted by an Australian institution for instance, showed that the level of ‘unsafe’ nurses in the United States stands at 70%. This translates to the high number of fatalities of patients under healthcare and in retaliation critical thinking education scheme has been boosted to allow for better service provision. Critical Reasoning It is defined as the clinical way that nurses and other healthcare providers perceive the situations that face them in providing their services to patients. It may also be called problem solving, critical thinking, clinical judgment or decision making. Clinical judgment is assessing the problem a patient is facing. Nurses therefore need to be well equipped to make a distinction between symptoms, collecting evidence of illness, understanding them, evaluating the possible solutions to ease illness and implement the best possible solution. The process of clinical reasoning is the ability of a nurse to assess the situation of the patients in terms of their symptoms, understand them, evaluate possible solutions, implement the best solution, know the outcomes possible for the patient and to internalize the processes (Thompson & Dowding, 2002, p.50). There is not really a certain way that nurses have to make sober clinical reasoning solutions. The basic process however involves ?collection, description and understanding’. The reason why nurses should learn from these situations is because precedence is also a form of clinical reasoning. When for instance, a nurse encounters a problem in a patient they are best placed to make a decision if they had encountered identical problems in other patients and therefore make decisions based on their earlier encounters. Precedence is therefore a critical part of clinical reasoning. Hoffman (2007, p.13) conducted some research on nurses’ decision making skills. He collected data from a range on nurses evaluating how they made critical decisions involving their patients. In his clinical reasoning model, he identified strategies that many nurses used by both beginners and old hand nurses in the intensive care unit procedures. He identified the knowledge that beginners and experts used in making decisions for patients and made a conclusion that the ways they used were distinct. Evidently, experts tended to collect more wide spread data than beginners did. The former also had a wider field of making decisions through precedence than the latter. They also made decisions faster. On the other hand, beginners traced the problem deeply since they had not previously encountered the problem. In creating the model therefore, it was important to add on to it the ‘problem as well as enquiry based learning’ for nursing students. Its relevance surpasses the treatment cause to prevention of recurrence management in acute patients (O’Neill, Dluhy, Chin, 2005, p.76). Relevance of Clinical Reasoning to Learning Nurses The main objective of nursing is to provide healthcare to patients and saving lives (Andersen, 1991, p. 24). The level of ‘failure to rescue’ is directly attributed to nurses’ level of the clinical reasoning ability. Professionals have identified the three main reasons to increasing number of patient fatalities: poor diagnosis, inappropriate treatment administration and inadequate complication care. These are the traits of poor reasoning. Expert nurses tend to be better placed to make appropriate conclusions of patients’ situations. On sighting a patient, they are able to make quick observation of the patients, assessing the most credible and validated conclusions. This is because they have passed through this process many times and gained experience from them (Jacques, Harrison, McLaws, Kilborne, 2006, p.179). Their instincts to these conditions may seem automatic and quite often they are unable to explain these to other parties in the room. They will look, make a conclusive investigation and offer remedy quickly. Repeatedly practicing this awards them the experience to make quick memory recovery while likening it to another situation they may have faced and thus quick solution. Ericsson and Simon (1984, p.245) believe that if this is incorporated into the clinical reasoning model, then students will be able to acquire this imperative skill faster and make decisions faster and more soberly; thus the importance of Clinical Reasoning Model into nursing learning. It introduces novice nurses into unconscious reasoning. This will help them understand the nonverbal assumptions that expert nurses normally make. In order to make this endeavor worthwhile, it is important that students are made to understand the steps of clinical reasoning and this in turn helps them identify the critically ill patients and offer them appropriate healthcare. The Clinical Reasoning Cycle The clinical reasoning cycle involves five steps in order to be effectively carried out. This ensures that nurses collect the right data from patients, taking the most appropriate action, to right patient at the most appropriate patient. (i) Collecting the Right Data According to Elstein (1991, p.6), it is important that a nurse collects the right data in clinical reasoning. These are evident in patients simply by checking their physical or psychological symptoms. The collection of these indications is mainly influenced by such constraints as time available, anxiety of the nurse, health history of the patient and the judgment of the nurse. Wrongful judgment is the major cause of increasing fatalities among patients. Indications may be gained from health history of the patient, handover reports from other practitioners, charts or nursing assessments taken prior to this incident. For the nurse to make a conclusive report of this, it is important for the individual to have experience of bodily processes, therapeutics, pharmacy, law, ethics and epidemiology and much more in the nursing profession (Goldhill, 2001, p.68). Students therefore need to have clear memory of what they learned in the classroom setting pertaining to these cues. The case normally is that some symptoms are common for multiple ailments and it is up to the student to remember what they learnt in the classroom pertaining to these symptoms; which diseases are characteristic of certain symptoms. Some factors may adversely affect the cue collection process. Bigotry, stereotypical characteristics and invalidated hypothesis have an adverse effect on the collection of data from patients. Before student nurses can be introduced to the processes of clinical reasoning, it is important that they conduct a judgment of their prejudices and hypothesis since failure to do this will only result to wrongful acquisition of the cues. (ii) The Right Patient In this case, this refers to a patient prone to an adverse event due to critical ailment. The most right patient is the one who demands urgent health services. The nurse should be able to evaluate the patient who is in the most critical condition. This patient deserves the right to treatment and should therefore be accorded the best remedy suitable for them. For this reason, a nurse must in turn be awarded the knowledge to be able to reciprocate towards the patient. This encompasses the physical identity capability that is important in a nurse during provision of healthcare services. The adoption of Early Warning Scores and also the Modified Early Warning Scores rely on the physical identity treatment (Needleman, Buerhaus, Mattke, Stewart & Zevinsky, 2001, p.147). These systems point out those patients who are prone to critical illnesses. They mainly indicate the early or otherwise symptoms. Some of the most common late symptoms of an ailment may include lack of reaction to speech or sounds and unstable proportions of oxygen in the blood. They are some of the earliest components of the clinical reasoning model. They prove very helpful to beginning nurses in identifying the right patients at the health centers. These two symptoms’ observations also help them note those patients who are getting worse. (iii) Right Action In order for a nurse to make the right action, they have to possess proper communication skills, practice experience and thinking capability to execute the best action (Buist, Bernard, Nguyen, Moore, Anderson, 2004, p.139). In definition, it is the response one executes after the occurrence of something. Having the right action rule in the model insists the intensity to which the action to be taken is important. The student should be taught how to plan the order in which the actions are to be taken and also who most deserves immediate action. It has been revealed that about half of cardiac failures that end fatally had shown signs of deterioration in the course of the last day. (iv) Right Reason While a nurse is performing their duties, they should have in mind not to perform anything that is unethical, illegal or beyond the setting of their professionalism. The reason may be the right thing to do but it should not go beyond the parameters of saving life. The doer should keep in mind to ensure not to break the main reason that nursing upholds (Di Vito-Thomas, 2005. p.19). This demands the accuracy and soberness of the nurse in making decisions. Therefore, the nurse should be confident and experienced. The patient has all through been used as specimen, but during the reasoning right the nurse should look at the patient as human and therefore treat them as such. The strength of the clinical reasoning is knowledge of unit culture, the significance of the action to be taken and teamwork among groups of nurses. (v) Right Timing Bucknall (2000, p. 147) points out that every nurse serving in the intensive care unit encounters a problem that demands their Clinical Reasoning task in every half a minute. Through an 8 hour shift, a nurse has about fifty occurrences. Timing is of the essence if they are to save healthcare to an array of patients in order to provide the necessary healthcare. Science and technology advancement has seen the upbringing of the nursing profession as a whole. However, in order to reduce the number of fatalities in health centers due to poor reasoning among nurses. It is immensely important that student and graduate nurses are well equipped to make the most logical conclusion in offering precise and immediate care. Nurses should make the best decision among those they are endowed with (Palmeri, 1997, p.324). They are able to assess the symptoms of the patient, evaluate the options available to them for administration to the patient while checking those that are in critical conditions. This way, the number of fatalities will be reduced and eventually promote the nursing spirit that is to save life. Bibliography Ericsson, K., Simon, H., 1993. Protocol Analysis: Verbal Reports as Data, revised ed. Massachusetts: The MIT Press Cambridge Hoffman, K., Aitken, L., & Duffield, C. A comparison of novice and expert Nurses’ cue collection during clinical decision-making: verbal protocol analysis. International Journal of Nursing Studies. Andersen, B., 1991. Mapping the Terrain of the Discipline. Melbourne: Churchill Livingstone. p. 24 Ericsson, K. & Simon, H. 1984. Protocol Analysis: Verbal Reports as Data. Cambridge: The MIT Press. p.245 Elstein, A., Bordage, J., 1991. Psychology of Clinical Reasoning. Professional Judgment: A Reader in Clinical Decision-Making. New York: Cambridge University Press. P. 6 Bucknall, T., 2000. Critical Care Nurses’ Decision-Making Activities in the Natural Clinical Setting. Journal of Clinical Nursing 9 (1), 25–35. Di Vito-Thomas, P., 2005. Nursing student stories on learning how to think like a Nurse. Nurse Education 30 (3), 133–136. p. 19 Goldhill, D. 2001. The critically ill: following your MEWS. QJM. 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