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Clinical decision making models nursing
The triangle of clinical decision making
Clinical decision making models nursing
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Yes, I believe clinical reasoning is an example of the DIKW transformation. Clinical reasoning is practice among nurses every day. Clinical reasoning is display in all nurses’ care activities and choices, in diagnosing, in choosing appropriate interventions and evaluating results. Nurses use clinical reasoning to gather and interpret data which is transformed into information which is then transformed to knowledge and with the new knowledge comes wisdom which is utilizes to make clinical decisions to provide the best patient care and outcome. As a nurse expands in clinical competence and experience he or she is better prepared with the wisdom to make sound nursing judgments.
Nursing practice requires both critical thinking and clinical reasoning. Critical thinking is the process of deliberate higher level thinking to define a patient’s problem, examine the evidence-based practice in caring for the patient’s, and make options in the delivery of optimal care. Critical thinking involves the demarcation of statements of fact, judgment, and opinion. The progression of critical thinking requires the nurse to think imaginatively, use reflection, and engage in logical thinking (Alfaro-LeFevre, 2013). Critical thinking is a vital skill needed for the recognition of patient’s problems and the execution of interventions to endorse effectual care outcomes (Bittencourt & Crossetti, 2012).
The goal is to improve the health and safety of patient while also providing care in a cost-effective manner to improve the outcome for both the patient and the health care system at large. According to Melyn and Fineout-overholt(2005)Evidence-based practice should be a problem-solving approach to clinical practice that integrates a systematic search for critical appraisal of the most relevant evidence to answer a burning clinical question.
INTRODUCTION The patient-practitioner relationship has undergone several changes in the past decades. It has moved from a paternalistic relationship, in which the practitioner acted as a guardian and made the decisions on behalf of the patient, to a deliberative relationship in which the patient is more autonomous, informed, empowered and involved in decisions regarding his healthcare. [1] Recently, there has been an increasing interest and research in shared decision making (SDM), which is one of the pillars of patient-centred care. [2] Research suggests that engaging patients in healthcare decisions makes a significant and permanent difference to healthcare outcomes.
Patient safety experts have demonstrated that “patient safety increases when teamwork and collaboration skills are taught and empowered; when teamwork and collaboration are not present, medical errors will result” (Creasia & Friberg, 201, p. 348). As a nurse, it is imperative to collaborate with other interdisciplinary members in health care and also strive to research and implement evidence-based practices. Evidence-based practice is necessary to “ensure the highest quality of cost-effective care and the best patient outcomes” (Fineout-Overholt, 2011, para. 16). With a collaborative and innovative attitude on safe health care practices, an increase in patient safety and effectiveness of care will
"The tension between the practice and knowledge development is inevitable and act in a positive way as source of advancement the knowledge" Dunn & Foreman said: In my opinion, it is normal to have some conflicts between the knowledge and practice during the practical life, where some of the professionals have their own beliefs which do not match with the evidence. Therefore, this conflict could be considered as a good opportunity for the professional either to build up a clinical decision based on his beliefs which may contradict with the evidence or search for the evidence that assist and support him or her to take the most optimal decision. Consequently, this process will facilitate the knowledge development. In addition, practice can open
All day long a nurse will use critical thinking, reasoning and judgement. These three go hand in hand and are a constant process. One cannot accomplish a task without using all three together. To perform all three, the individual performing the task must be able to use thought process to be able to perform the task safely and efficiently. After critical thinking and reasoning have been accomplished, the final step is being able to make a judgement call based on the outcome.
4). The clinical reasoning cycle assists nursing students in identifying important issues for an individual patient and allows the student to look at the situation from a holistic point of view (Meissner 2011, p. 88). This process of critically analysing and using the memory enables the student to develop experience and a deeper understanding of nursing
Clinical reasoning: "Clinical reasoning is the cognitive process that uses thinking strategies to gather and analyze client information, evaluate the relevance of the information, and decide on possible nursing actions to improve the client's physiological and psychosocial outcomes". I had the opportunity to use clinical reasoning when caring for a patient that was admitted due to being hypotensive. It was after lunch and the patient wanted to go on a walk around the unit. Before hand I decided that even though the patient stated that she felt fine, it would be best to get a set of vital signs to see if she was stable enough.
They found that communication failure was a latent cause, which influenced patient safety in the hospital and is a large contributor to adverse clinical outcomes. Ineffective communication can also lead to the patient 's misunderstanding of instructions because of inadequate question-and answer opportunity. Communication is an important part of quality nursing care and predominantly influences patient and resident satisfaction; it is a core element of nursing care, a fundamentally required nursing skill (Fleischer et al., 2009). The nurse plays an important role in coordinating care for the client by integrating the management and delivery of treatment, encouraging health promotion and improving quality of service being provided by taking into consideration the client, client 's family and other health care workers. Nurses can communicate well with patients when they use a patient centered approach, which supports the active involvement of patients and their families.
Giving care to a patient is not a straightforward process because a patient is made up of advanced systems. Symptoms and the severity of a disease process are dependent on a particular patient, and it may not always be uniform from patient to patient. Because of this, nurses must be able to use their knowledge appropriately to help a patient. Nurses use techniques, such as Evidence Based Practice, in order to integrate new and advanced knowledge into their patient care (Canada, 2016). By exercising evidence based practice, nurses effectively seek knowledge, take experience from past situations, and apply this intelligence to best give patient care (Canada, 2016).
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).
As a professional, registered nurses are individually responsible for their own practice and have an individual accountability to maintain their competency and meet professional standard (Department of Health 2013, p. 2). The ability of decision-making is a core part for their professionalism, so the ability belong to the nurses and they should have a responsibility to assess, plan, implement, direct, supervise and evaluate nursing care (Department of Health 2013, p. 3). According to a national framework for the development of decision-making tools for nursing and midwifery practice, there are two principles contributing to her unprofessional decision-making and the first principle is that a decision by registered nurses has to enhance health
The critical thinking processes I used was inquisitiveness (Information seeking) the best source of information is the member and by asking open ended questions, she will express her feelings, fears, emotions, attitude towards care all of which will assist me to better care for her. I will also use flexibility to create a plan of care that is base on her priority and her preferences which will ensure better adherence to the plan of care which will ultimately result in better patient outcome. 2 We used creativity because I had to “think outside the box,” to come up with possible information that can be tight or wrong. Information that with more information seeking can be clarified.
Through this initial assessment, the nurse can obtain information that is crucial in providing the client with effective holistic care. Nursing assessment framework tools are used to help the nurse obtain accurate information about the patient’s wants and needs. This initial assessment based on subjective and objective data, helps to determine the patient’s actual problems and potential problems (Weber & Kelley, 2013). An assessment is carried out to obtain objective data and a physical baseline of the patient on admission.
