Overview
This lecture covers the process of clinical decision making in nursing, emphasizing the use of critical thinking, prioritization, the nursing process, time management, and evidence-based practice to ensure quality patient care.
Clinical Decision Making in Nursing
- Clinical decision making is the process nurses use to choose the best actions to achieve desired patient outcomes.
- Nurses must decide which patient to see first, what actions to take, and how to prioritize tasks.
- Good clinical decisions require ethical judgment, professional values, prioritization, time management, and scheduling.
- Decisions range from patient care to professional development choices.
Critical Thinking in Nursing
- Critical thinking is a deliberate, nonlinear process of analyzing information, drawing conclusions, and evaluating actions.
- It involves logic, reasoning, and identifying the strengths and weaknesses of options.
- Essential for safe, high-quality care, especially with complex or diverse patients.
- Key attitudes: independence, fair-mindedness, self-awareness, integrity, perseverance, and confidence.
- Skills include intellect, creativity, inquiry, reasoning, reflection, and intuition.
The Nursing Process (ADPIE) and Clinical Judgment Model
- The nursing process includes Assessment, Diagnosis, Planning, Implementation, and Evaluation (ADPIE).
- Assessment: Collect and validate subjective (verbal) and objective (measurable) data.
- Diagnosis: Analyze data to identify health problems and formulate nursing diagnoses (distinct from medical diagnoses).
- Planning: Set patient-centered short-term and long-term goals; prioritize needs using frameworks like ABC (airway, breathing, circulation) and Maslow's hierarchy.
- Implementation: Carry out prioritized nursing interventions, considering patient preferences and safety.
- Evaluation: Assess if goals were met, partially met, or not met; modify the care plan as needed.
Prioritization & Time Management
- Use ABCs and vital signs to prioritize patient care.
- Maslow’s hierarchy helps ensure basic needs are met first.
- Effective time management includes planning, prioritizing, organizing, delegating tasks appropriately, and keeping the workspace orderly.
Evidence-Based Practice in Nursing
- Evidence-based practice combines research evidence, clinical expertise, and patient preferences for decision making.
- Steps include questioning, searching for evidence, evaluating and integrating evidence, and evaluating practice outcomes.
- Example: Implementing bedside shift reports reduced patient falls and improved satisfaction.
Key Terms & Definitions
- Clinical Decision Making — Choosing the best action to achieve patient care goals.
- Critical Thinking — Analyzing information and reasoning to make sound clinical judgments.
- Nursing Process (ADPIE) — Systematic framework: Assessment, Diagnosis, Planning, Implementation, Evaluation.
- Nursing Diagnosis — Describes patient response to health condition (not a medical diagnosis).
- Evidence-Based Practice — Using the best research and clinical expertise to guide care.
- Prioritization — Determining what actions or patients should be addressed first.
Action Items / Next Steps
- Review the steps and characteristics of the nursing process (ADPIE).
- Practice developing nursing diagnoses using NANDA guidelines.
- Prepare care plans with clear, measurable goals and appropriate interventions.
- Apply prioritization frameworks (ABCs, Maslow’s hierarchy) to clinical scenarios.
- Read any assigned materials on time management and evidence-based practice in nursing.