Thursday, December 12, 2019
Clinical Judgement Decision Making Nursing -Myassignmenthelp.Com
Question: Discuss About The Clinical Judgement Decision Making Nursing? Answer: Introducation Decision making and judgment are significant facets of healthcare professionals identity and skills, including nurses. Decision making involves selecting a particular course of action to adhere to. Recent systematic and holistic approaches to the safety and quality of care provision have defined decision making as important non-technical skill. Nursing decision making, therefore, contributes in a significant management to the quality of care delivered. However, nurses can be presented with challenges while making decisions across the wide domain of this profession. Decision making models and theories act as analytical tools that when applied helps to solve complex situations for suitable decision making. Such models and theories guide the course of actions to be taken through a series of steps mostly involving intelligence activity, designing activity and choice activity. Some of the noteworthy decision making models and theories include intuition, information process theory, expecte d utility theory, cognitive continuum theory and social judgement theory. The present essay focuses on decision making in nursing practice in preparation for PEP (Professional Experience Placement). The essay discusses the three significant models and theories of decision making, namely Social Judgement theory, Information Process theory and Intuition that are commonly used in nursing practice. The paper critically analyses each of the theory and model by outlining the advantages and disadvantages of each. Further, inconsistencies, contradictions and complexities between the theories are highlighted. One theory/model is selected from the three that would be applied to nursing practice in PEP, and a clear rationale is provided to explain the selection. Examples from practice are provided to support the choice made. Connecting the theory to practice is an essential part of the paper. A comprehensive conclusion is provided at the end of the paper the summarises the key points discussed throughout the essay. According to Chinn and Kramer (2014) in a healthcare setting, nurses are repeatedly faced with a number of demands to engage in proper decision making for care delivery. The process of analysing the options and making a choice is the essence of decision making. Researchers view this process as a complex one and suggests that the complexity of decision making needs a strong knowledge base and access to information. The decisions that nurses take have a drastic impact on their effectiveness in clinical practice and influences patients live to a considerable extent. Knowledge about how to make proper decisions is thus of prime importance. Understanding the decision making process is a prerequisite for facilitating learning and development of skills in nursing education. Alligood (2014) in this regard highlighted that nursing students must develop a key understanding of the nursing decision-making models which serve as templates describing the process nurses are to use for reaching to de cisions. These models and theories are frameworks that break down the complex decision process into subcomponents which are validated. Three major models are put forth in this paper the Social Judgement theory, Information Process theory and Intuition. The first theory to be analysed in this context is the Social Judgement Theory that takes a noteworthy position in the discussion of nursing decision making process. Social Judgement theory is a self-persuasion theory that has developed during the past few decades on the basis of the research done by psychologist EgonBrunswik. The theory is a cognitive theory emphasising on the uncertainty inherent in the social, biological and physical environment, and the probabilistic nature of human judgement in such environment. As per this theory, a person is to weigh new idea and compare it with the present point of view for determining where the new idea must be placed on the attitude scale in the mind of the person. The theory has been denoted as the subconscious sorting out of concepts and ideas occurring at the instant of perception(Smith and Parker 2015). As outlined in this theory, judgement of human beings fall along the cognitive continuum with intuitive judgement at one extreme, the analytical judgement at another, and quasi-rational judgement in the mid-range. At one extreme, when there is certainty of information and when there are rules for applying it, the likelihood of events of the future is systematic. At the other end, information is uncertain and the number of possible outcomes increases. Under such a condition, there are no rules to govern the behaviour of the person, and cognition is intuitive (Adderley and Thompson 2015). As per the authors, most situations confronting healthcare professionals, including nurses present challenges that need both analytic and intuitive processes. On the basis of social judgement theory, a healthcare profesisonalsjudegment and decision making is reliant on the social environment. What is notable is that the social environment can be perceived from different dimensions. Thus, the impact of patient condition in a clinical scenario as an environmental truth caninfleucne the clinical decision making of the care giver. As opined by McEwen and Wills (2017) the only theory that considers bridging the normative and real-life judgment and decision making process is the social judgement theory. The theory evaluates quality in terms of accuracy. The theory views the process of decision making in terms of the social reality of the situation, and this aspect makes the theory highly suitable for clinical judgement. Accuracy is not always the most significant criterion against which quality of a judgement is to be assessed. For example, in case of clinical emergency situations, a judgment that is fast but effective might be better than the one which is accurate but slower. For instance, in case of leg ulcer management, since it is a chronic long-term condition, accuracy in care is of more importance. However, in case of a wound suffered, application of first aid is of more important than other accurate measures. Shaban (2015) however argued that a person using the social judgment theory might be influenced b y susceptible alternative interpretation of a situation. Some perceptions of an individual seem to be more clear, and these are often interpreted in an improper manner as ambiguous messages. Moreover, a person who is easy to persuade would demonstrate more openness to influences. Care professionals might be open to persuasion and inducement by other professionals regarding a subject that he is not aware about. This would have a negative impact on the care delivery. One example can be cited about the application of this theory in practice wherein the registered nurse had administered an incorrect medication to a patient. Upon understanding the mistake of the nurse she had taken initiative to report to the team leader. For ensuring safe care delivery and optimal patient outcomes, we had to check blood pressure for the patient at an interval of every 15 minutes for one hour for making sure that is fine. The nurse had applied social judgement theory by analysing the factors that had contributed to the poor outcomes of the patient. The nurse collected cues about the outcomes of the drug administration and had come to the conclusion that incorrect drug delivery was the cause of poor patient outcome. The second theory that is to be analysed in the context of nursing decision making process is Information Process Theory which was first put forward by scholars Newell and Simon. The theory is a notable descriptive theory of human reasoning with postulates stating that human reasoning is the effect of the relationship existing between the tas environment and the problem solver. The theory provides an effective framework for the study of decision making involving the determination of a patient condition in a clinical scenario (Tiffen, Corbridge and Slimmer 2014). Dickison et al. (2016) opined that information processing originates basically from the science of cognition, focusing on the memory capacity, clustering of information into distinct and clearly recognisable patterns, analysing substitute choices and looking for resolutions to issues. Information is accessible to an individual from cue assessment and long-term memory, which then undergoes transformation into units. These unit s have the ability to undergo cognitive manipulation in short-term memory. In nursing field, suitable information processing can be used with verbal protocols to analyse major cognitive processes applicable in clinical decision making. Information processing thus is an enhanced and restored theoretical match for the ambiguity and dynamic decisions of nursing practice. Clinical problems in the nursing field are marked by the need of defining goals related to nursing diagnosis or assessment of patient condition. The problem solves, therefore, needs to consider the degree of information available at every stage of the decision making process. As per the information processing theory, the mental representation of a certain clinical problem created by an individual is referred to as problem space. The person analyses the length and breadth through the problem space by moving through the array of knowledge states. The pieces of information that a person has at different points in time determine the knowledge states. The decision making process can thus be denoted as the sequence of the marketing transformation of problem states till the goal is achieved. The professional must select one of the two types of operators for permitting the transformations; heuristics and algorithms. While heuristics is more like the rule of thumb, an algorithm is the set of protocol that is to be followed for allowing the appropriate solution (Cherry and Jacob 2016). Bacon, Lee and Mark (2015) explored the clinical decision making process of nurses in their research. The main findings of the research highlighted that nurses have a predisposition to corroborate clinical situations with colleagues who can guide with specific information. With the application of information processing theory in practice, nurses think ahead of clinical scenarios and situations and tend to adopt preventive strategies for combatting anticipated situations. This relates to the acknowledgement of similar situations and potential adverse events. Nurses can relate to such similar situations and act in an independent manner to apply decisions regarding interventions or patient assessment. Johansen and O'brien (2016) criticised the application of information processing theory in clinical practice by stating that the theoretical approach has the assumption that there lie restrictions to the volume of information that can be processed by a person at an instance, and decision making is the adaptation to these restrictions. Standing (2017) further highlighted the drawbacks of the information processing theory stating that hypotheses considered in due course might be incorrect, often leading to propositions that are inaccurate. The theory has been denoted as a quantitative approach that assumes that knowledge is accurate and available at the time of taking the decision. Nevertheless, in real life situations, decisions have an underpinning essence of uncertainty. For highlighting an example of how the theory can be applied to practice it is dicussed in here how a registered nurse had administered wrong medication to a patient and later realised that through information process theory of decision making process. The nurse had reported that she remembered that the drug that was delivered to the patient had been previously given by her to another patient in the past who had different medical problems. This information processing based on memory made her realise the mistake that had been done. For ensuring safe care delivery and optimal patient outcomes, blood pressure was checked for the patient at an interval of every 15 minutes for one hour. Acknowledgement of the fact that intuition takes a prominent place in clinical nursing practice has increased in the past three decades. The third theory that would be analysed in this paper is Intuition as applicable to nursing decision making process. Conventionally, nursing intuition has been associated with experience, pointing towards the use by an expert practitioner. In the present times, since demands are high for measurable evidence-based care, intuition has evolved in the way it is applied to decision making process, now known as an eminent element of judgement (Holm and Severinsson 2015). The intuition theory of decision making is primarily based on the somatic marker hypothesis. The hypothesis has the proposition that decision making is regulated by changes in somatic feeling and emotion hat includes signals from bioregulatory processes. A somatic state is defined as the non-conscious state wherein neural activation configurations occur due to the learned connection betwe en knowledge, memory and pattern recognition. The intuition theory is a cohesive and logical theory that is testable predictive and explanatory. Middleton-Green (2015) pinpointed that in a situation when a nurse has to make a decision, development of intuition creates a signal that aids in taking the proper decision. In case of intuition is not developed, the person analytically and cognitively appraises the scenario through the integration of conscious memory and pattern recognition for making the decision. Analytical decisions need sequential and logical thought processes. Blais (2015) suggested that intuition fundamentally involves reflection on experience, sense of subtle changes either qualitative or quantitative, feelings of knowing, and linking of perceptions from the past to foreseen future. Knowledge and perceptual awareness can enable a nurse to identify rich and important information applicable to the clinical scenario. Intuition also can help a nurse to understand a particular scenario as a whole, instead of an array of segmented tasks. As a result, there is no need of deliberate, incremental analysis of multiple isolated informative pieces. The end result is less time consumption and speedy decision making. Hassani, Abdi and Jalali (2016) linked nurses personal intuition with practice and research and suggested that intuition leads to expert practice as practitioners can offer their best to the patients in a care setting. The author further suggests that the intuition, speaking on a general basis, utilises the evidence of the highest order a fter analysing information from more than one sources. Intuition encompasses an unexpected realisation succeeding speedyassimilation of information, fostering appropriate decision making and enabling action against the comprehensive patient's needs. Alligood (2017) criticised the application of intuition by highlighting that the same is not effective when a nurse does not have adequate personal wellbeing, thereby influencing patient assessment and care in a negative manner. The authors further argued that intuition is not considered as a valued method in practice and is often no considered as a legitimate element of decision making process since it is sole dependent on observer skills and not scientific evidence. Pretz and Folse (2011) gave a suitable example of how intuition can be beneficial for decision making process. The author cited a real-life example where a middle-aged male patient had walked through the entrance into the emergency department of the general hospital. The care staff fetched a wheelchair which the patient refused kindly to sit on, claiming that he was fine. He, however, seemed very pale and was sweating excessively. The nurses asked the patient to lie down for undergoing an examination and wanted to collect information about his symptoms. Mentioning that he was suffering from a stomach pain, he cited that the reason might be food poisoning. Since the pain had not improved after considerable time, the nurse performed an ECG and connected the cardiac monitor. Though the vital signs were normal, the nurse informed the cardiac arrest team. It was an intuition that the patient was about to suffer a cardiac arrest and after a short, while the patient indeed suffered arrest. When confronted the nurse could only explain that it was her instinct and perception that emerged instantaneously based on previous experiences and subject knowledge. At this juncture, it would be appropriate to provide an example of how intuition can be applied in decision making process. While on my previous placement the registered nurse had given wrong medication to a particular patient and upon realising the error she had informed it to the team leader. The registered nurse had reported that it was her intuition that made her realise the mistake that had been done. For ensuring safe care delivery and optimal patient outcomes, we had to check blood pressure for the patient at an interval of every 15 minutes for one hour for making sure that is fine. The decision making model of intuition had been applied in here. As the registered nurse had the intuition that an error had been committed, there was a chance of rectifying the issue. The strength of the intuition had urged the registred nurse to engage in critical thinking in addition to the regular duties. When a nurse believes in her intuition, subjective feelings get lined with objective sympt oms of patients, thereby enabling a comprehensive care plan. A Professional Experience Placement (PEP) plays an important role in the nursing education since it is valuable for preparing the nursing student to become a registered nurse, by expanding the skill and knowledge base. The chief aim of the PEP is to provide the nursing student with relevant real life experience that helps in the development of clinical skills and translation of theory into practice. A nurse is to demonstrate appropriate decision making skills, and in the present context, the decision making theory of intuition would be applied in the PEP. The main rationale is based on the research finding indicating that nurses tend to make fewer errors when intuition is applied in decision making process. Nurses intuition would act as a critical component in relation to patient care in PEP and guide in the nursing process. Intuition would be helpful in establishing connections of spiritual and physical relationships. The physical connection would involve two individuals, the patient and the nurse, and emphasise on non-verbal communication and body language patterns. Spiritual connections would be more abstract in nature and would involve the exchange of energy fields. A suitable combination of both physical connection and the spiritual relationship is essential for nursing practice (Traynor, Boland and Buus 2010). A rich pool of literature highlight that intuitive aspects are exhibited by nurses across all levels of expertise, and these aspects commences at an early point in their career, including clinical placements. Further, the aspects become stronger with time and developing skills. The research evidence contradicts the argument that intuition denigrates a nurses ability to take decisions (Melin?Johansson, Palmqvist and Rnnberg 2017). In PEP, a nurse would need to demonstrate proper utilisation of pattern recognition, gut feeling, understanding of similarities, common sense, tactic knowledge, rational considerations and skills to know how. Intuition can be applied alone or in combination with other decision making process, depending on the level of skills and task complexity. Nursing process entails establishing contact with patients and nurses applying intuition can establish a unique contact with the patient. This would help in examining the symptoms that are otherwise beyond the scope of assessment. Intuition, when applied about special patients, can permit recognition of logical reasons behind the patient condition. Personal qualities would be important for the development of intuition and nurses who are open and accessible would be more emotionally involved with patients. The nursing profession is truely a complex one, needing the members to apply the skills and knowledge in different clinical settings. Nurse s must define and understand intuition as the process of knowing something on an immediate basis that improves the clinical experience and informs decisions (Payne 2015). In conclusion, it can be stated that professional experience placement plays a key role in the professional career of a nurse wherein a nursing student is to demonstrate his competence and skill set. Decision making of nurses holds the potential to aid allocation of resources and promote health gain in a healthcare setting. Prevention of patient harm and enhancement of patient benefit is possible when a suitable decision making theory or model is applied by the nurse. The three most prominent theories of decision making models are Social Judgement theory, Information Process theory and Intuition. Critical analysis of the three models highlights that each one of these has its own set of strengths and weaknesses. Drawing in evidence supporting the models, the intuition model would be applied in PEP in future. Intuition when applied in decision making process would help in taking appropriate decisions in relation to patient assessment and care delivery. The strength of a nurses intuitio n would urge the professional to do something beyond the regular duties and responsibilities. Intuition can be developed through strong critical thought and deep knowledge base. The distinct outcome is the establishment of caring relationships with the patient. Research points out that intuition has often been neglected by healthcare care settings as a prominent decision making tool, and nurses have been discouraged to apply the same. However, the evidence pool highlighting the suitability of intuition in application weighs more. Further study would help in expanding the knowledge base and indicating intuition as a hallmark of nursing knowledge. References Adderley, U.J. and Thompson, C., 2015. 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Toward a Theory of Intuitive DecisionMaking in Nursing.Nursing science quarterly,28(3), pp.223-228. Pretz, J.E. and Folse, V.N., 2011. Nursing experience and preference for intuition in decision making.Journal of clinical nursing,20(19?20), pp.2878-2889. Shaban, R., 2015. Theories of clinical judgment and decision-making: a review of the theoretical literature.Australasian Journal of Paramedicine,3(1). Smith, M.C. and Parker, M.E., 2015.Nursing theories and nursing practice. FA Davis. Standing, M., 2017.Clinical Judgement and Decision Making in Nursing. Learning Matters. Tiffen, J., Corbridge, S.J. and Slimmer, L., 2014. Enhancing clinical decision marketing: development of a contiguous definition and conceptual framework.Journal of Professional Nursing,30(5), pp.399-405. Traynor, M., Boland, M. and Buus, N., 2010. Autonomy, evidence and intuition: nurses and decision?making.Journal of advanced nursing,66(7), pp.1584-1591.
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