Clinical Reasoning And Decision Making In Nursing Nursing Essay

All nurses use medical judgement to create decisions while looking after patients. These decisions impact the activities of the doctor and the delivery of health care the patient gets Jones and Beck (1996). It is the nurse’s responsibility to create clinical decisions based on their learnt knowledge and skills. Straight forward decisions such as for example, would a bed pan or commode become more appropriate? To making rapid, at that moment decisions, such as for example what measures to take if an individual began to swiftly deteriorate. Nurses depend on sound decision making skills to keep positive outcomes and up to date attention. Orme and Maggs (1993) identified that decision-making is an essential and integral aspect of clinical practice. Nurses are accountable for their decisions, therefore it is crucial they are alert to how they generate these decisions Muir (2004). This essay will discuss two decision building models, elements that may increase or interfere with clinical reasoning and decision making in patient centred care and attention and how they fluctuate across the different fields of nursing. The decision making models that will be discussed are Risk Research and Evidence Based.

Risk assessment plays a significant part in the process of supporting people and it greatly helps to maintain safety in medical center settings. Its main goal is not only to recognize potential risks but also remove preventing them. Assessment is considered to be the first step along the way of individualised nursing treatment Neno and Price (2008). Risk analysis provides facts that is vital in developing a plan of action that will help improve personal well being. It gets the potential to decrease the severity of chronic circumstances, helping the given individual to gain control over their overall health through self-care RCN (2004). Not only is risk examination for the patients safe practices but it is also there to ensure staff basic safety Kavaler and Spiegel (2003). It really is essential that nurses use suitable risk assessment tools as helpful information to enable them to make effective chemosynthesis decisions. After the device has been implemented, employing the gathered details and using their own scientific judgement, the nurse will be able to provide the right safety precautions for patients Holme (2009). There are many different types of risk assessment tools designed for patients and staff within the clinical setting up. For patients there may be the Waterlow score – risk of pressure sores and ulcers, the MUST device – Malnutrition Universal Screening Software, FRAT – Falls Risk Evaluation Tool and Pain Assessment Tools are only to name a few and they are commonly found in clinical practice. Staff have Illness Control Assessments and Discharge Risk Assessments only to name a couple nevertheless they should be kept updated and reassessed on a regular basis Daniels (2004).

The pressure ulcer risk assessment/prevention policy tool, is generally used in medical practice. Pressure risk-assessment tools have been described as the backbone of any avoidance and treatment plan Waterlow(1991). The Division of Health set total annual targets for an overall reduced amount of pressure ulcers by 5-10% over 1 year (DoH, 1993), so it is vital that nurses effectively determine which patients are at threat of developing pressure ulcers.

A pressure ulcer is an area of localised damage to the skin and underlying tissue caused by pressure, shear, friction or a mixture of these EPUAP (1998). The intention of the Waterlow pressure sore risk assessment is to recognise service users who are highly vulnerable to developing pressure sores, in order to avoid them becoming worse and/or even developing them at all, to serve as an early on predictive index before the development of pressure harm Nixon and McGough ( 2001). It is imperative that people are assessed employing this tool, especially patients with Intrinsic risk elements such as restricted flexibility and /or will be confined with their bed for extended periods of time, patients with poor nourishment, elderly patients, individuals with underlying health issues such as for example diabetes and clients who happen to be urinary incontinent and bowel incontinent happen to be also highly at risk of producing pressure sores, this due to the moisture, moist skin can be weak and susceptible to breakdown Andrychuk (1998). Based on the NICE clinical guideline 29 (2005) pressure ulcer grades should be recorded using the European Pressure Ulcer Advisory Panel Classification Program. There are four stages that pressure ulcers are graded at and it is down to the nurses own clinical judgement to choose what level the ulcer is. Depending on grade of the pressure sore, it’ll depend on the type of mattress that’ll be needed. There are factors to be considered before selecting a mattress for the individual which include, producing sure the mattress does not elevate the patient to an unsafe height and also to ensure the patient is at the recommended weight range for the mattress Good (2005).

Using their learnt expertise, experiences and own clinical knowledge, nurses have to decide what dressings should be used in the treatment of pressure ulcers. They must take into consideration the grade of the sore, any manufacturer’s indications for make use of and contraindications, previous positive effects of selected dressing and preference for comfort or standard of living factors Bouza et al (2005). Exclusively built dressings and bandages can be used to increase the healing up process and help guard pressure sores such as hydrocolloid and alginate dressings which is applied at the nurse’s digression NHS Choices (2010).

Nurses should always be aware of any potential risk factors that may worsen or add to the advancement of pressure ulcers when working with any pressure risk evaluation tool. The nurse will need to decide the frequency of re-positioning the individual, applying a turning chart to maintain times and dates documented also to communicate to other people of staff what time the individual needs turning. This calls for moving the patient into a different position to remove or redistribute pressure from part of your body Walsh and Dempsey (2010). By analysing the evidence on the effectiveness of repositioning this can help to lessen patient suffering and improve their standard of living, lighten the task load of staff and help reduce the monetary burden on the health support Luoa and Chub (2010).

In paediatric nursing, a child is usually to be assessed within six time of being admitted and then reassessed daily. Just about all paediatric pressure ulcer risk assessment scales were developed applying clinical knowledge, or by modifying adult scales Bedi (1993). The Glamorgan Paediatric Pressure Ulcer Risk Assessment Scale was developed using detailed paediatric inpatient data Willock et al (2008). It is just a clinical tool made to help nurses assess the chance of a child creating a pressure ulcer, it runs on the scoring program that takes things like mobility, equipment, haemoglobin levels and temperature into consideration and courses the nurse in regards to what interventions need to be put in place, such as for example what sort of mattress or dressings will become needed.

In learning disability and mental wellness nursing, a variety of pressure sore assessment tools are used including the Norton, Braden and Waterlow risk evaluation scales, these are mainly used for patients who aren’t very mobile as in the adult field. Nursing is even more concentrated on the patient’s psychological health O’Tuathail and Taqi (2011).

It may be the nurse’s duty to provide the best possible look after their patients and this involves using Evidence-based mostly practice. EBP allows the nurse to make decisions about patient care predicated on the most up to date, best available proof. It allows the nurse to supply high quality care to patients based on knowledge and analysis Rodgers (1994). Concepts of evidence-based mostly practice and the crucial elements involved in the process are described by Cleary-Holdforth and Leufer (2008) in five steps. Measures are there to equip nurses with the required knowledge and abilities to use evidence-based mostly practice effectively and to make confident contributions to patient outcomes. The five steps Ask, Aquire, Appraise, Apply, Analysis and Ajust will be to just guide healthcare professionals to make effective clinical decisions when problem solving.

Early Warning Score (EWS) is an evidence based approach. Carberry (2002) identifies that the purpose of EWS is to provide nursing and medical personnel with a physiological rating made from recordings of vital signs. Good Clinical Guideline 50 (2007) suggests that physiological track and result in systems ought to be implemented to screen all adult clients in acute hospital configurations, providing help with the standardization of EWS. Physiological signs that should be monitored and recorded will be heart rate, blood circulation pressure, respiratory level, oxygen saturation, heat and degree of consciousness. Vital signs ought to be recorded upon admission, at standard intervals throughout a patient’s stay and in addition before, during and after certain procedures create a thesis Castledine (2006) and the regularity of monitoring, if abnormal physiology is certainly detected should enhance. EWS uses a scoring system 0, 1, 2, and 3 and color codes white, yellow, orange and red, #3 3 and the color red being the highest risk indicators Morris and Davies (2010).

Nurses should adjust to following guidelines the Early Warning Score offers, to help with making medical decisions that are ideal for their patients. Elements that may boost or prevent effective decision making while using the EWS could be down to capability, know-how and ignorance. If health care professionals are well ready and confident in documenting and documenting patient’s vital signs, then any alterations could be observed and prevented or dealt with quickly. The EWS execution adds automated alerts time before a rapid response would be initiated and can lower treatment delays by up to three hours Subbe et al (2003). It takes merely one nurse to absence competence when using the EWS, therefore adding patient’s life’s at risk.

Early Warning Score can be used in the Mental Health and Learning Disability areas of nursing though it may not be utilized normally as in Adult nursing, it really is imperative that patients who are actually or mentally unwell, require monitoring of their essential signs within an acute setting. Nurses may need to use their knowledge to improvise different ways of obtaining essential signs from some clients with learning disabilities or mental health problems, such as making it a game or distracting them especially if they lack the mental capability and are unwilling to comply Hardy (2010) Medicine can have serious results on a patient’s overall health. Indications of the effects may be noticed in their EWS, combined with knowledge and scientific judgement of health care professionals NIMH (2008) . If the EWS tool is not used as it ought to be in these fields in that case it’ll be hard for medical care professionals to obtain the needed evidence to create accurate clinical decisions.

In the kid field of nursing a similar instrument to the EWS can be used called PEWS, Paediatric Early Warning Scores. There are four PEWS charts applied within the NHS for unique age ranges, 0-11months, 1-4 years, 5-12years and 13-18 years, the difference getting the ranges for children’s vital signs NHS (2013). A key factor that may hinder correct PEWS scoring could possibly be simply because the child is scared in terms of checking their vital signs, also very young children could be unwilling or fidgety Kyle (2008), this is where the nurse would have to use their knowledge to overcome such concerns. The nurse will make it fun for the kid, explain the equipment and what they are going to do and why. It really is vital that the nurse gains consent from the child’s parent before undertaking any procedure. It’s important that the family play a significant role in the attention of the child DOH (2001).

I have learnt several things while researching into the chosen decision making models and methods. I have been made aware of potential risk elements that may arise when using both tools in every fields of nursing and what could be done to prevent them. Personally i think confident in looking out for any risks involving the EWS and Pressure ulcer risk evaluation tools while out in practice and believe that using these tools effectively can in the end save lives.