Clinical Decision Making in Nursing

Introduction

• Instructor: Sharon Celestine, Clinical Instructor at Delgado.
• Focus: Process used by nurses to evaluate and select the best action to meet desired goals.
• Importance: Affects all aspects of nursing care including direct patient care, professional behavior, and accountability.

Key Concepts in Clinical Decision Making

• Questions to Consider:
  • Which patient should be seen first?
  • Next steps as a nurse?
  • Importance and timing of tasks or classes.
• Process Requirements:
  • Good quality judgment.
  • Critical thinking.

Implementation in Nursing

• Patient Prioritization:
  • Example: CHF patient and low sodium diet.
  • Medication decisions based on patient condition.
• Decision Characteristics:
  • Ethical and value-based decisions.
  • Prioritization of tasks.
  • Time Management and scheduling.
  • Personal and professional decisions.

Components of Clinical Decision Making

1. Critical Thinking

   • Defined by the National League for Nursing Accreditation Commission.
   • Essential for professional judgment and clinical decision making.
   • Involves logic and reasoning.

2. Clinical Reasoning

   • Involves understanding the nursing process or clinical judgment model.
   • Incorporates time management and evidence-based practice.

Critical Thinking in Nursing

• Importance:

  • Essential for high-quality, safe clinical care.
  • Nurses often deal with complex patients and diverse health needs.

• Attitudes and Skills of a Critical Thinker:

  • Independence, Fair-Mindedness.
  • Self-awareness, Integrity, Perseverance.
  • Confidence and intellectual skills like creativity, inquiry, reasoning, reflection, and intuition.

Nursing Process and Clinical Judgment Model

• Steps:
  • Assessment, Diagnosis, Planning, Implementation, Evaluation.
• Clinical Judgment Model Components:
  • Recognize and analyze cues.
  • Generate hypotheses and solutions.

Assessment Phase

• Data Collection:
  • Subjective and objective data.
  • Use of medical records and other sources.

Diagnosis Phase

• Analyzing Data:
  • Identifying health problems and formulating diagnostic statements.

Prioritization in Nursing

• CAB/ABC Framework:
  • Airway, Breathing, Circulation first.
  • Prioritizing life-threatening conditions over non-critical ones.
• Maslow’s Hierarchy of Needs:
  • Meet basic physiological needs before addressing higher-level needs.

Planning Phase

• Goal Setting:
  • Establish priorities and write expected outcomes.
  • Goals should be SMART: Specific, Measurable, Attainable, Relevant, Time-limited.

Implementation Phase

• Action-Oriented:
  • Carry out nursing interventions as per plan of care.
  • Consider patient preferences and need for nursing actions.

Evaluation Phase

• Reassessment:
  • Determine if desired outcomes are met.
  • Modify care plan if necessary.

Time Management

• Importance:
  • Key in prioritizing tasks and making effective clinical decisions.
• Strategies:
  • Plan day in advance, prioritize tasks, organize workspace.
  • Delegate tasks appropriately.

Evidence-Based Practice

• Definition:
  • Basis of making clinical decisions on the best available evidence.
• Steps:
  • Develop questions, evaluate evidence, integrate into practice.
• Benefits:
  • Improves patient outcomes, reduces costs, enhances nurse satisfaction.

Conclusion

• Critical thinking and evidence-based practice are cornerstones of effective clinical decision making in nursing.
• Ongoing evaluation and adaptation of care plans are essential to meet patient needs and achieve high-quality care outcomes.

Keep calm and think like a nurse!