Clinical Decision Making in Nursing

Overview

• Clinical decision making involves evaluating and selecting the best action to meet a desired goal in nursing.
• It affects all aspects of nursing care, from bedside care to professional behavior and accountability.
• Good clinical decision making requires critical thinking and quality judgment.

Key Concepts

Prioritization

• Nurses decide what is most important in a given situation.
• Determine what must be done personally, what can be delegated, and what can wait.

Time Management

• Efficient use of time is crucial in nursing.
• Consider specific factors affecting each patient.

Scheduling

• Tasks are bounded by parameters, such as doctor’s orders that are marked as urgent (stat).

Professionalism

• Decisions about career paths, certifications, and work settings are part of clinical decision making.

Components of Clinical Decision Making

Critical Thinking

• Defined as a process of collecting, interpreting, analyzing, and drawing conclusions.
• Essential for safe, high-quality clinical care.
• Important for managing complex patient needs and cultural diversity in healthcare.

Clinical Reasoning

• Involves understanding the nursing process or clinical judgment model.

Evidence-Based Practice

• Incorporates the best available research, clinical expertise, and patient preferences.

Nursing Process

Steps

1. Assessment
   • Collect subjective and objective data.
   • Validate and document data.
2. Diagnosis
   • Analyze data to identify health problems.
   • Formulate diagnostic statements.
3. Planning
   • Establish goals and expected outcomes.
   • Develop nursing interventions.
4. Implementation
   • Carry out nursing interventions.
5. Evaluation
   • Assess if goals were met.
   • Modify care plan as needed.

Components

• Assessment: Gathering data from the patient, caregivers, and medical records.
• Diagnosis: Formulating nursing diagnoses based on patient responses and health conditions.
• Planning: Setting specific, measurable, attainable, relevant, and time-limited goals.
• Implementation: Acting on chosen interventions and documenting actions.
• Evaluation: Reviewing outcomes and making necessary adjustments.

Critical Thinking Skills

• Independence: Think critically without bias.
• Integrity: Challenge own ideas and methods.
• Perseverance: Persist in obtaining the best results.
• Confidence: Understand the limitations of knowledge.
• Inquiry: Continuously seek knowledge and understanding.
• Reasoning: Analyze situations and respond appropriately.
• Reflection: Learn retrospectively from experiences.
• Intuition: Trust gut feelings in patient care.

Prioritization Techniques

• CAB/ABC/BCA: Address Airway, Breathing, and Circulation first.
• Maslow’s Hierarchy of Needs: Attend to basic physiological needs before higher-level needs.

Evidence-Based Practice

• Promotes high-quality, cost-efficient care.
• Involves developing questions, searching for evidence, integrating findings into practice, and evaluating outcomes.

Practical Application

• Nursing students should engage in creating care plans and using critical thinking in clinical settings.
• Regular evaluation and adaptation ensure effective patient care and support professional growth.

Conclusion: Clinical decision making is integral to nursing and requires critical thinking, effective prioritization, and evidence-based practice to provide optimal patient care.