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Clinical Decision Making In Nursing

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CLINICAL SCENARIO AND IDENTIFICATION OF DECISION CHOSEN As part of my exploration to fulfill the requirement of the clinical decision- making analyses, I have identified a scenario in my working environment, which is Penang Hospital in Psychiatric Department. A female patient has been admitted into the female psychiatric ward, which was diagnosed to suffer bipolar mood disorder. In brief, the patient, who is 38-years old, has been further analyzed to undergo auditory hallucination and it could not be controlled due to allergic of anti-psychotic medication (Haloperidol and Clopixol Acuphase). Describing further on her condition due to bipolar mood disorder, she was irritable and restless most of the time. Therefore, she was unable perceive …show more content…

The use of heuristics in nursing reflects assessments of subjective possibility that are dependent on nurses' memory and past experience (Cioffi J, 1997). Cioffi suggested that heuristics enable nurses to develop short cuts to reduce the complexity of real practice. The main principles of heuristics consist of representativeness, availability, and anchoring and adjustment (Elstein & Schwars 2002). Representativeness can be viewed as estimating the possibility of diseases by judging how similar a case is to a diagnostic prototype (Elstein & Schwars 2002). Representativeness is the most typical type among three types of heuristics and it is more likely to take place in high-complexity cases than low ones (Cioffi & Markham 1997). Another type of heuristics is availability that refers to the estimation of probability of clinical events by the ease with which previously experienced relevant instances come to mind(Tversky & Kahneman 1973). Nurses always estimate the likelihood of the outcome based on similar events that they can recall (Buckingham & Adam 2000). However, nurses in real practice may place overemphasis on rare and salient conditions because unusual cases can be memorized more profoundly and easily than regular ones (Elstein & Schwars 2002). The third form of heuristics is anchoring, which involves the decision-making strategy that seeking for an anchor as a standard when nurses make decisions. In some cases, anchoring is valuable and even desirable in profession practice (Cioffi J, 1997). (Thompson 2003) implied that experts are commonly experts because they are proficient in employing these anchors that are led by accumulation of experience. However, he also argues that not all anchoring is desirable because anchoring sometimes may distort reasoning and it is a challenge to accumulate enough experience to establish anchors in every

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A patient’s decision-making capacity is variable as their medications or underlying disease processes ebb and flow. You should do what you can to catch a patient in a lucid state - even lightening up on the medications if necessary and safe - in order to include her in the decision making process. Delirious patients have waxing and waning abilities to understand information. However, if a careful assessment is done and documented at each contact, and during lucid periods the patient consistently and persistently makes the same decision over time, this may constitute adequate decisional capacity for the question at

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Limitations recognised throughout the SDM process were related to risk of further deterioration in the Consumer’s mental state. As the Consumer was slowly taken off his medications, in a safe clinical manner, his presentation deteriorated. The Consumer’s sleep pattern worsened due to the elevation in his mood, there was a noted increase in impulsivity and poor boundaries with others on the inpatient unit, leading to the Consumer becoming vulnerable. There was a prominent increase in erratic and aggressive towards others, leading to the assault of a staff member on the inpatient unit and subsequently required the use of restrictive interventions. The decline in mental state resulted in the Consumer’s father, case manager and treating team coming together for a family meeting with the Consumer present in which the previous medications the Consumer had been previously prescribed were recommenced in an attempt to re-stabilise his presentation, unfortunately this was a substituted decision made by the consumer’s father and treating tream.

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