Complete Guide on Clinical Decision Making in Nursing

One of the most valuable skills to have as a nurse is clinical decision making for you to have a successful career.  There are many advantages for patients and society when nurses are offered the freedom to make healthcare decisions based on evidence and established standards of Practice. Improved patient outcomes, increased nurse satisfaction, and a lower overall risk profile are some positive impacts of clinical decision making in nursing.

This article aims to help healthcare practitioners make clinical judgments and decisions during challenging situations when providing care to patients and their families. We have taken the opportunity to discuss what clinical decision-making entails and theories of clinical decision-making.

What is clinical decision-making?

You must undergo thorough training and years of experience to deliver healthcare services as a nurse. This will help gain more insights about a patient’s condition before they visit a doctor. Nurses are the first professionals to notice when patients are in discomfort or their health is rapidly deteriorating. This is one reason why nurses need to be able to think critically and make informed decisions about patient care.

Nurses engage in clinical decision-making by analyzing a patient’s condition and making treatment decisions based on evidence. The optimum course of treatment is decided upon after input from multiple medical professionals. Patients and their loved ones are involved in the clinical decision-making process because it is understood that individuals have the best understanding of their medical conditions and can best advocate for them.

Clinical decision-making requires critical thinking, teamwork, communication, collaboration, and familiarity with quality standards. Open lines of communication are maintained between nurses, their colleagues, and their patients, and they all adhere to the evidence when providing healthcare services to their patients.

Four main steps of the clinical decision-making process

The process of making decisions in the hospital is intricate, involving both art and science. Though there is no one best way to do things, it can be beneficial to reflect on your strategy so that you can make adjustments as necessary to provide the best possible care for your patients. Follow the steps below to ensure you make clinical judgments and decision making:

1. Evaluate your prospects

What is the chance of a specific diagnosis based on the patient’s symptoms, history, and other factors? For instance, if a patient has a fever, a productive cough, and a loss of appetite, your conclusion might be signs of pneumonia, bronchitis, or an upper respiratory disease.

2. Gather more relevant information by examining the patient

This requires a more detailed history, vital signs, and a physical exam to confirm or deny your theory.

3. Adjust your probability based on the information you’ve acquired

This covers the pre-test probability of any exam you would want to order. The next step is carefully collecting and interpreting more data from diagnostic testing. The most likely diagnosis should rise to your differential diagnostic list.

4. Examine an intervention to see if it exceeds your treatment threshold

The lower the threshold, the greater the therapeutic advantage of the potential risk. You can also consider other possibilities, such as acquiring more data or patiently waiting if you don’t have enough knowledge to convince yourself to cross the line.

Clinical decision-making models

Teams can adjust these concepts, tools, and templates to their population, personnel, and changing conditions. We will continue to add best practice examples and more materials as they are produced and made available.

1.     Warwick model

The researchers at the University of Warwick based their model on an analysis of current procedures for determining whether to escalate a patient’s treatment and who should be admitted to the intensive care unit. The principle of reasonable accountability is incorporated into this approach. Information gathering is the main focus, as this will be used to guide analysis and treatment planning.

It also directs the patient’s application, communication, and ongoing review. After analyzing the process, we can say that establishing this model was doable, that it facilitated patient and family involvement, that decisions were made with the patient at the center, that the justification for those decisions was documented, and that there was transparency in the process. The FICM sunset recommendations include it.

2.     Moral balance model

This is an expedited method for applying the four tenets of medical ethics at the point of care. It was initially developed for ICM students as part of NHS Blood and Transplant’s Deceased Donation Course but had broad applicability. Over five years, more than 300 ICM trainees have been introduced to the paradigm, and it is also recommended in the FICM’s guidelines for end-of-life care.

Theories of clinical decision making

Clinical decision-making requires input from many different experts. It considers the perspectives of all experts participating in a patient’s care plan. It can also be applied at the patient level. The following theories are the most common for clinical decision-making in nursing:

·        Decisions relating to progressive medication

In the National Health Service (NHS), patients, their families, and their doctors face the challenge of making challenging decisions daily regarding clinical care. The GMC defines the good medical practice as making decisions with patients and families. The Mental Capacity Act mandates that these conversations occur when determining what is in a patient’s best interests, even when they lack the mental capacity to decide for themselves.

It is advised that a systematic strategy be followed when making such judgments during the COVID-19 pandemic to guarantee that all patients have equal access to critical care. The most important, ethically, and emotionally draining decisions are whether or not to increase, restrict, or withdraw life-sustaining treatments. A patient’s treatment is not a sequence of independent decisions but a series of interdependent ones.

Clinical decision theory holds that all care decisions must follow the patient’s values and preferences or the patient’s best interests in the absence of such deals and choices. This is not always as simple as deciding between life-prolonging treatment and comfort care; there are typically various options to consider. Decisions should be taken after thoroughly investigating the issues and setting.

·        Involving other parties

This article presumes that the patient has the mental capacity to participate in the decision-making process. To make a best interests decision when a patient lacks the ability, clinicians should talk to family and friends whenever possible. A health care power of attorney is a legal document that gives one person the authority to make health care decisions on another person’s behalf.

The medical community recommends that at least two senior practitioners collaborate on major best interests choices (such as intensive care unit admission or discontinuing life-sustaining treatments). This may not always be feasible in situations of high clinical pressure, especially outside an intensive care unit. Organizations should consider methods to implement mechanisms to make this a reality.

·        Fostering effective patient-caregiver interactions

The clinician-patient interaction will occur in various settings, including general care, telehealth, and inpatient treatment. Illness and isolation can leave a person without friends and family to rely on for emotional support and to speak out for their wishes if they lose mental capacity. The need for telephone or electronic contact across clinical teams must be balanced against the risks to patient privacy. Companies need to establish internal guidelines for telephone interactions.

What is the importance of clinical decision making in nursing?

There are many positive outcomes for hospitals, patients, and nurses when clinical decision-making is implemented. The process originates in science and the scientific method (hypothesis, test, repeat). In place of a rigorous procedure or list of steps, it encourages nurses to draw on their extensive background in patient care.

Nurses have the training and expertise to make medical judgment calls. The following advantages accrue to healthcare institutions that value nursing professionals’ ability to exercise judgment and critical thinking:

·        Achieving credible patient results

Clinical decision-making can enhance patient outcomes, as demonstrated by the abovementioned instances. Nurses do various tasks related to evaluating patients, including teamwork, communication with patients and their families, and determining health care needs. They can utilize evidence and study results to guide their choices.

They can think critically, which allows them to choose when a change in a patient’s treatment is necessary. Clinical decision-making in nursing has been discovered to enhance care quality and patient experience.

·        Benefits of the hospital and the services provided

Patient outcome measurements are becoming increasingly significant as the healthcare industry shifts from fee-for-service to value-based reimbursement. Soon hospitals and doctors will be paid more for the quality of care they deliver than for the number of procedures they perform. Data like hospital-acquired infections, falls, and Medicare use readmissions to penalize hospitals. Empowering nurses to make independent decisions based on evidence might increase the bottom line of healthcare facilities.

·        Help in ensuring job satisfaction

The strain of COVID-19 has contributed to an already severe nursing shortage. Employee satisfaction increases, and nurses feel more valued when given more autonomy in the workplace. They may experience less burnout and be more inclined to remain in the field. Employers that value their nurses’ clinical expertise are more likely to keep them on staff, which is crucial in light of the current crisis in the nursing profession and the resulting strain on the healthcare system.

Examples of clinical decision-making in nursing

·        Measures for fighting COVID-19

A COVID-19 infection in a hospital setting could rapidly worsen a patient’s condition during the pandemic. Skilled nurses used their expertise in patient care and data analysis of previously treated COVID-19 patients to determine which patients most likely required immediate medical attention. It was discovered that nurses were better able to respond quickly to complicated and ever-changing information when they relied on their intuition and experience rather than on predetermined norms.

·        Infections related to catheter use

A BMJ Open Quality report found that Foley catheters caused 9 % of hospital-acquired illnesses at Boston Medical Center. A group composed of hospital administrators, nurse educators, urologists, and other interested parties formed a task force.

This group analyzed the data and designed awareness campaigns to curb the spread of disease. Between 2013 and 2017, the number of infections caused by catheters dropped by 83% because of the campaign.

·        Cases of patient fall

Most injuries sustained by hospitalized patients are the result of falls. A data analytics tool was studied for its potential to reduce patient falls in a 2021 study published in the Journal of Medical Internet Research.

According to the findings, fewer falls occurred after nurses began using the data analytics application because they were more conscious of the risk factors associated with those incidents. Evidence-based medicine relies on studies like these to guide treatment decisions in the clinic.

Final thoughts

This article proves that clinical decision-making in nursing is essential for all healthcare practitioners to help them deliver quality services. Providing students with facts and the latest concepts related to nursing is part of our charm at onlinenursingpapersmarket.com. Shake hands with our experts today to gain more knowledge on theories of clinical decision-making.

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