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Clinical Decision Making

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Clinical decision making refers to the roles of a nurse of making clinical judgments (Alfaro-LeFevre, 2012). It involves the process of gathering data, interpreting and evaluating it and making evidence-based or informed choices related to the most appropriate nursing interventions for specific clinical cases or circumstances (Kaddoura, 2010). Nurses should apply effective critical thinking skills in choosing between alternatives and making quality judgments pertaining to the care of patients (Wilkinson, 2011). Notably, I apply critical thinking skills, such as information seeking, to collect and analyze information with a goal of applying standards of nursing care to provide high quality care to my patients. In this paper, I reflect on how I applied critical thinking skills in an evolving patient scenario within hospital settings. I specifically reflect on how I applied models of clinical decision making to make logical judgments and taking appropriate nursing actions in the patient scenario.

During the implementation of the repeated simulation, I switched roles with my team mates. This enabled me to play three nursing roles: lead, assessor and communicator. As a lead nurse, I was responsible for monitoring the care being given to Mr. Patience. My goal was to ensure that the patient received the highest quality nursing care possible (Alfaro-LeFevre, 2012). I applied my clinical reasoning skills, such as analysis and discriminating information, to synthesize and analyze information pertaining to the patient, such as age, gender, health status, medical procedures, prescribed medications, values and belief system in order to ensure that nurses in my team provided patient-centered care (Chang, Chang, Kuo, Yang, & Chou, 2011). Critical thinking also enabled me to solve complex problems related to the care of the patient. For instance, I helped nurses in my team to overcome challenges related to furthering conservative therapy plan as indicated by the physician. Critical thinking specifically allowed me to reason in a logical and systematic manner while monitoring nursing care services for Mr. Patience. I was open to nurses in my team while ascertaining the quality and safety of nursing interventions directed at the patient.

While I acted as a lead nurse, I provided nurses in my team with second opinions regarding the delivery of care services and providing maximum benefits to Mr. Patience. For example, I recommended that nurses in my team apply the nursing process as the most appropriate decision making model. During the assessment phase of the nursing process, I monitored nurses in my team collect information pertaining to the psychological, spiritual, sociological and physiological status of the patient. I specifically provided nurses in my team with guidance on how to interview the patient and family members to obtain a comprehensive medical and family history. I also assisted with physical examination to aid planning for the implementation of the most appropriate care interventions for Mr. Patience.

When I played the assessor role, I applied clinical reasoning skills, such as assessment of nursing processes, to evaluate the patient’s orientation and level of consciousness. I conducted head-to-toe assessment to ensure that I made logical judgments about the actual and potential health problems of the patient (Alfaro-LeFevre, 2012). I played the assessor role with a goal of defining the problems the patient faced and establishing nursing interventions that would improve his condition (Chang at al., 2011). My logical reasoning skills allowed me to consider all alternatives of improving the physical, psychological, spiritual and physiological status of the patient. I understood that it is through effective assessment of the patient that nurses are able to provide holistic care (Alfaro-LeFevre, 2012). I played my assessor role effectively, which allowed me to participate actively in the diagnosis process, which is the second step of nursing process decision making model.

My critical competence enabled me to consider clinical evidence and my experience to make effective assessment of the patient. The findings of my patient assessment were used in the planning phase of the nursing process. I participated actively within my nursing team to ensure that we planned for nursing interventions that were aligned with the needs of the patient (Chang at al., 2011). My team was able to attend to high risk factors and to focus on severe symptoms. For instance, patient became dizzy and anxious when he received the blood transfusion. I was aware that I had to apply clinical reasoning skills, such as interpretation of symptoms, interpretation of knowledge, logical reasoning and application of nursing standards to implement the most appropriate interventions for dealing with the incident. Therefore, I engaged in effective communication processes with members of my team in interpreting the meaning of the patient’s dizziness and anxiety. This enabled the team to apply the scientific method in addressing underlying conditions. The team was keen to follow the orders of the physician regarding the patient’s drug transfusion and administration of prescribed drugs.

While playing the communicator role, I applied my communication and transforming knowledge skills to engage in meaningful conversations with the brother and sister of the patient. Effective communication with the patient and family members enabled me to collect and interpret information on the needs of the patient and to report it accurately to members of my nursing team (Alfaro-LeFevre, 2012). During the evaluation phase of the nursing process, I engaged actively with the patient and family members to determine whether or not his goals for wellness were effectively met. I applied Maslow’s hierarchy of needs to prioritize the questions I posed to the patient. Maslow’s needs model supported clinical decision making as it allowed my team to establish the physiological, security, belonging and self-esteem needs of the patient and the best ways of meeting them (Saintsing, Gibson, & Pennington, 2011). I applied my critical thinking skills, such as predicting abilities and knowledge interpretation, to understand the needs of the patient and to determine whether or not they were met when I was making follow-up during the evaluation phase of the nursing process.

I am convinced that I played my communicator role well because it enabled me to identify the needs of the patient in the context of Maslow’s hierarchy of needs. I also served my communicator role to advocate for the patient and to ensure that the patient made informed decisions pertaining to the care services he received (Kaddoura, 2010). Effective communication also enabled me to define the unique problems that the patient faced in consultations with members of my team. Additionally, I was effective in communicating findings of patient assessment, which supported the diagnosis and planning of care interventions. Therefore, my active participation in clinical decision making processes is attributed to the application of both critical thinking and communication skills to engage in a meaningful way with the patient, family members and providers in my team.

In conclusion, I believe that I am adequately competent I applying critical thinking skills and effective communication abilities to make effective clinical decisions and to work effectively within healthcare teams. Participation in the evolving patient scenario enabled me to appreciate the importance of critical thinking, effective communication and teamwork in promoting the quality of care and in the implementation of patient-centered and evidence-based care. I plan to continue improving my clinical decision making skills and critical thinking abilities through practice and active participation in healthcare teams so that I can be more effective as a lead nurse, communicator and assessor in my future practice.

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