Clinical Decision Making Paper

Clinical Decision Making Paper
JUDGMENT AND DECISION MAKING THEORY IN NURSING: THEORY TO PRACTICE
The demands of the current health care system provide a powerful reason for advanced clinical
decision making. It is undeniably a responsible approach to providing best possible care to patients.
Nurses are required to integrate evidence–based clinical decisions as they solve problems regarding
patient care during the nursing process. Nursing knowledge, as well as patient values, expert
opinions, and evidence on how best to care for the patient are incorporated during the nurse's
clinical decision making. There are a lot of decision making theories and models that are widely
used in clinical setting. Therefore this paper will discuss how decision making is used in placement
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Ethical Decision Making : Medical Indications, Patient...
Health care providers are often confronted by various ethical dilemmas in their course of practice.
When a person's values and beliefs conflicts with another person's values and beliefs, an ethical
dilemma occurs. An example of an ethical dilemma in a healthcare setting is when a nurse interacts
with an elderly woman who is diagnosed with terminal breast cancer and hears that she is in a lot of
pain and wishes to end her sufferings. When confronting this issue, it is beneficial to follow Jonsen's
Model of case–based approach to ethical decision–making. The model consists of four paradigms
that provide a framework for analyzing a clinical ethical situation and propose a potential solution.
The four paradigms are medical indications, patient preferences, quality of life, and contextual
features.
Medical Indications
The first paradigm in Jonsen's Model of case–based approach to ethical decision–making is medical
indications comprising of all clinical encounters such as diagnosis, prognosis, treatment options, and
an assessment of goals of care. This section incorporates the principles of beneficence and
nonmaleficence. Beneficence means placing the best interests of the patient ahead of self–interest
and nonmaleficence means to do no harm or hurt (Edelman, Kudzma, & Mandle, 2014, p. 293).
Per the ethical dilemma provided above, the elderly woman is suffering from terminal breast cancer,
which is a chronic condition and nearly impossible to reverse. According to the Merriam

Clinical Decision Support System ( Cdss )
ABSTRACT Clinical decision support system (CDSS) is a technology application that assists
clinicians at the point of care to make clinical decisions for patients with specific conditions. The
healthcare is implementing many electronic tools that are aimed at improving health and health care
delivery. It is designed to make clinical decisions about patient care. Today technology plays an
important role in patient care. It involves a patient, a clinician and computer but most of the work is
done by computer. CDS helps the clinician to make decisions. While interacting with the patient the
clinician can focus more on entering information on hearing to the patient and considering the
information said by the patient. Implementing CDS can effect clinician–patient communication.
CDS can help clinician by providing clinical guidelines, reminders, of recommended care,
prescribing and diagnostic support. In practice this software can lead to confusion and lack of
communication. This technology helps with continuity of care. The aim was to compare the design
and implementation of CDSS to compare diagnostic accuracy before and after its implementation in
patient care. INTRODUCTION: Clinical decision support is a combination of person–specific
information and knowledge that is provided to the staff, patients, and clinicians which helps to
enhance health care and health. In early 1960s efforts began in health care to automate its aspects
but the use of computers and information

Adapting A Holistic Care Package For A Patient Requires...
Complexities in Children 's and Young Peoples Nursing
Formulating a holistic care package for a patient requires children 's nurses to make clinical
decisions by identifying needs, prioritising, planning and delivering care. Nurses are expected to use
current and relevant evidence in their judgement and decisions to ensure the best practise is
implemented (Thompson, C. et al. 2004). Nurses within the healthcare team must integrate scientific
knowledge, patient and family perspectives, available resources and sufficient experiential
knowledge to ensure that their decisions will also be accurate and safe (Gillespie, M. & Patterson, B.
2009).
Within this assignment a scenario has been chosen to discuss the elements of clinical decision
making made by nurses. To justify the decisions which have been made, a critical appraisal of the
available information will be utilized. The scenario focuses upon Joe (See Appendix), an infant who
was born prematurely at twenty–eight weeks gestation and is diagnosed with short gut syndrome
and is close to being discharged. There many needs within the scenario which have been identified,
such as medication training for parents, Joe 's physiological development, travel issues but this
assignment will concentrate on managing an ileostomy, discharging Joe on Total Parenteral
Nutrition (TPN) and social support for the home environment. The aim of the nurses clinical
decisions will be to prevent infection, skin breakdown and re–admission, therefore

Essay on Evidence Based Practice in Nursing
Within this essay Evidence based Practice will be identified and the significant effect it has on the
nursing profession, barriers will also be explored in the implementation of Evidence Based Practice.
Individuals need specific care tailored to them, it is vitality important to have the correct
professional and appropriate personal care. In order to receive this we need to get the patient
involved in the decision process, listen to their views and opinions and receive the relevant,
accurate, professional and medical information. Once all the information is collaborated a personal
care package can be put into practice. Evidence – Based Nursing, An introduction (2008, p.1) " At is
core evidence based 'anything' is concerned with using ... Show more content on Helpwriting.net ...
This outlines the fact it is crucial to have the best external evidence including both clinical and
professional inputs. It also highlights the patients' rights preferences and their autonomy should be
without doubt taken into account during the research process. The best method for treating patients
for nurses and any other medical professionals is to use Evidence Based Practice. This is because it
brings together years of accurately recorded clinical knowledge from previous cases with will be
relevant in the treating of your patient. The process of using Evidence Based Practice in a patients
care plan consists of five key stages. Asses the patient and formulate the problems from this you will
then need to access the relevant clinical articles. Using this information you should then be able to
assess which is the best method of treatment discarding any misleading or ambiguous articles. You
then need to incorporate this knowledge into the patients care plan. Finally you need to evaluate and
assess the patient during treatment to ensure effectiveness. Evidence – Based Nursing, An
introduction (2008, p. 285 ) " The rapidity of change and the reorganization of nursing services
within the health care sector presents challenges for the advancement of EBP. Managers and
administrators should facilitate the uptake of practice based on current, high–quality research by
formalizing the expectation that nurses care be Evidence Based".

Knowledge In The Clinical Application Environment
5–What is knowledge management in the clinical application environment and how can network
technologies, wired or wireless, support knowledge management? Come up with examples of a
clinical application environment and network support to link all its necessary elements together.
There are two main classifications of knowledge, tacit and explicit. Tacit knowledge is the
knowledge that is in each person, whereas, explicit knowledge can be collected, stored, shared,
retrieved, and used (Karamitri, Talias, & Bellali, 2015). It is this explicit knowledge that is at the
core of knowledge management (KM) and network technologies have a significant role in
improving KM within the healthcare setting. Knowledge in the healthcare setting is worthless ...
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In fact, if they were switched to VLAN it could provide an added layer of security since the devices
would be accessing the internet. The devices can access the internet either through a wireless router
which is shown in the diagram or via a wired internet connection; whichever access method is used,
the connection needs to be reliable since physician's and nurse's need to depend on the CDS tool
when they are taking care of patients. The advantage of using a web–based clinical application for a
CDS tool is fewer man hours are required to ensure the application is up to date. If this application
was housed on an application server in house, then the HCO would need to assign an application
manager to be responsible for ensuring the most up to date version of the CDS tool application
software was available. By choosing a web–based application, updates occur as they are available.
This is just one example of how IT and clinical applications intertwine in order to enhance patient

Essay on Nursing Process and Clinical Decision Making
Nursing Process and Clinical Decision–Making The nursing professional faces a myriad of
decisions on a daily basis. The effectiveness of the decision–making process is crucial to ensuring
positive outcomes in the clinical setting. If the nursing process is misunderstood or misapplied to the
decision–making process by a failure to use critical thinking skills, the results can be catastrophic to
the anticipated outcomes. Furthermore, an immaturity in critical thinking may influence decisions
because of insufficient knowledge and experience. This paper will explore the role of critical
thinking and the nursing process in making clinical decisions. Additionally, clinical maturity will be
addressed as a key component of critical thinking ... Show more content on Helpwriting.net ...
Finally, the intervention must be evaluated for effectiveness. If the intervention fails to achieve the
desired outcome, then the process returns to the fourth step and the selection process for the next
intervention is initiated. (Kozier, Erb, Berman, & Burke, 2000, p.261) Closely linked to this
decision–making model is the ubiquitous nursing process. The nursing process includes data
collection and documentation, analysis of the data to determine current condition and real or
potential health related issues, development of an individualized plan of care to deal with these
issues, implementation of that plan of care, and evaluation of the plan of care to determine its
effectiveness and adjust the plan as needed. (Blais, Hayes, Kozier, & Erb, 2006) Underlying both the
clinical decision–making process and the nursing process is the skill of critical thinking. Critical
thinking has been described as the ability to gather and process data in such a way as to arrive at the
best conclusion using the filters of prior knowledge, experience and external resources to overcome
personal emotions, biases, and assumptions. (This description was developed during NUR/300 class,
University of Phoenix, S. Colorado, March 16, 2006) Note that critical thinking is described as a

Mistake And Mistake In Decision Making
Nursing had developed own internal links between research and professional activity in order to
enhance clinical decision making. Knowledge and decision making had been a crucial element in
clinical decision making. Errors are also known to take place due to failure in decision making. Slips
and lapses, error due to action and memory are defined as failure to carry out proper action
connected with decision making to achieve the objective of the task. As a human all of us tend to
make mistake and mistake is define as failure in judgemental. According to Thompson & Dowding,
(2009), slips, lapses and mistake work at different level of thinking. Slips and lapses happen as
accidental, whereby on the other hand mistake involves making judgement and decision making by
processing the information. Mistakes can cause more harm than errors, however, this may not
always be the case. All three, slips, lapses and mistaken may occurred in the same incident. In
medication error a simple step, clarifying can help in preventing it from happening. This is where
nurses are important to decide to do it or not, failure to do this simple's step leads to a disaster event
(Handler, et. al. 2004). I realize that ... Show more content on Helpwriting.net ...
Nurses' role had been constantly becoming more and more challenging and now nurses are doing
expended roles. It is high time to analyze what kind of decision making nurses do in their clinical
practice areas. In today's nursing profession nurses are urged to do clinical decisions making and it
is being establish by guidelines, policy and practices'. Today nurses are given power and autonomy
to assist them on their decision making. However, this comes with higher responsibility for the
nurses and their expertise are demonstrated in their clinical decision making (Cioffi,

Gillespie And Paterson's Clinical Decision-Making Model
The foundational knowledge within the situated clinical decision making model is the knowledge of
nurses that informs their decisions. Gillespie and Paterson (2009) divides foundational knowledge
into five ways of knowing; knowing the profession, knowing self, knowing the case, knowing the
client and knowing the person. Knowing the profession is defined by Gillespie and Paterson (2009)
as reflecting an "incorporation of knowledge of the scope and standards or nursing practice,
including competencies, skills, and roles of nurses, into clinical decision–making" (p. 166). Within
knowing the profession during my decision making process I relied on foundational knowledge of
the CRNBC professional standards as well as the CNA code of ethics to inform my decision. Under
CRNBC professional standards of ethical practice the nurse ensures that the patient who is receiving
care is the primary concern, ensuring that the patient is receiving care in a way of preserving the
patients dignity. (CRNBC Professional Standards) "To treat someone with dignity is to treat them as
being worth, in a way that is respectful of them as valued individuals" (Baillie & Gallagher, A.,
2012, p. 44). As I observed the situation I felt that the patient was not being respected as an
individual. ... Show more content on Helpwriting.net ...
"Nurses intervene, and report when necessary, when others fail to respect the dignity of a person
receiving care, recognizing that to be silent and passive is to condone the behavior" (CNA Code of
Ethics). During this situation I recognized the vulnerability of the patient as well as what I felt was
inappropriate behavior on behalf of the registered nurse and there for intervened because I did not
agree with the situation that was

What Hierarchy Of Evidence Is Used When Making Decisions...
EBP Research Paper What hierarchy of evidence is used when making decisions about clinical
interventions? (p. 114) There are many versions of the hierarchical evidence levels. When deciding
on basing clinical interventions on evidence, there are two specific models to look at. They both
describe levels of evidence and are depicted as pyramids. The first is the 6S model, with the "more
patient–specific" information listed at the top of the pyramid (Houser, 2015). The top of the pyramid
has the least amount of information as compared to the base, it is more relevant, but it yields the
least amount of information (2015). Conversely, the more abundant information found at the bottom
is less relevant to the specific intervention in question (2015). Also, the searches conducted at the
more basic levels typically take less time to yield results due to the broader relationship to the
intervention in question (2015). The 6S model of hierarchical pyramid of evidence are listed as
follows from highest to lowest: Systems – this level includes "clinical decision support system
(CDSS)". This level is ranked the highest because evidence is acquired from point–of–care
databases that are linked to electronic medical records of specific patients (2015). Summaries –
Evidence is taken from practice guidelines that were established by healthcare organizations and
entered into the National Guidelines Clearinghouse databases. Summaries can be appraised rapidly
because they are given a

The Importance Of Patient Autonomy In Clinical Management
Patient autonomy is crucial in clinical management, nursing and treatment and is especially relevant
in chronically ill patients as informed consent determines the direction of treatment. Decision–
making by patients is closely related to autonomy and is based on patient preferences to help
promote patient involvement in treatment to expedite care (Wiens,1993; Halliday, 2009). Patients
must be respected for being masters of their own lives. Delmar (2013) claimed that patient
autonomy is a dominant concern and could affect the fundamental values of caring, consequently
affecting the dignity of patients. Delmar (2013) studied this interplay of patient autonomy and
dignity and conducted research through qualitative interviews with patients, suggesting that patients
do perceive their autonomy in decision–making as closely related to their sense of personal dignity.
Patient autonomy or decision–making forms the basis of ethics in nursing and clinical management
(Delmar, 2013). However, there is a lot of confusion about patient autonomy as there are no clear
clinical directives or standards on clinician authority to create, use and revoke patient autonomy
(Hobbs and Elliot, 2009). One of the primary concerns in decision–making is patient capacity and
this could be related to patient mental capacity, emotional or cognitive status, physical and
psychiatric diagnoses as well as situational and medical condition.
One of the cases or situations that may necessitate revoking patient

Assignment On The Aspects Of Clinical Decision Making
Assignment #2 Clinical Decision Making According to Mary Gillespie nurses do range of thinking
process before making a decision in the clinical settings. It is subjective and is made on the basis of
data collected by various assessments (Gillespie M. , 2014). This assignment gave us opportunity to
study and analyze a case study where we witnessed the effects of clinical decision making directly
on a patient's health. Through this case scenario we see the main factors that influenced Kathy's
clinical decision making are assessments, personal knowledge, previous experience, collaborative
practice, information from family, and most of all ethics. Paterson's Frame Work in this Scenario
The basic knowledge of the nurse helps her to make positive clinical decisions, in addition, a nurse
remains engaged with both existing knowledge and accruing new knowledge or skills related to the
specific patient or situation (Gillespie M. , 2014). In this scenario the nurse Kathy shows various
aspects of her knowledge and ability as the base of her clinical decision making. Knowing the Self
Knowing the self is about nurse not only know her skills, strengths, experience, limitations but also
believes in influence of her own personal beliefs, values, assumptions, and perceptions while this
guides her in decision– making process (Gillespie, 2014). As Kathy reflected and used her
experience with her co–nurse to effectively communicate with Mrs. A's daughter who was upset to
see her mother's

Clinical Decision Making
Introduction: Nursing is an exciting, challenging, satisfying and rewarding profession. Nurses are
required to have a wide and an extraordinary range of skills and talent in managing their clinical
duty and responsibilities. Nurses are urged to deliver the highest achievable of quality care in a
compassionate approach. In order to achieve these nurses need to access and evaluate extensive
clinical information and integrate it to improve clinical decision making. Nurses are seen as lifelong
learners, having the ability to reflect on, evaluate and modify their clinical practice based on new
knowledge and thoughts. Nurses are advised to become producers of new knowledge via nursing
research (Fink, et. al. 2005). Over the last fifteen years nursing profession had grown and developed
far more advance by having policy and procedures to be endured. However, the development of
policy and procedures had placed increased pressure on nurses to be more responsible for their
actions. At the same time, integrating research into clinical decision making and research
information used by nurses had remarkable increased. In healthcare industry evidenced based
approached was introduce for effective ... Show more content on Helpwriting.net ...
According to Sackett, et. al. (1996), nurses do have the potential to contribute to an evidence based
practice. Nurses today are believed to understand and conduct research studies based on their own
professional practice. Nursing research is a process that validates and refines existing knowledge
and creates new knowledge that directly and indirectly influences nursing practice scientifically
(Burns & Grove, 2001). EBP is defined as the use of the best clinical evidenced and such evidence
characteristically comes from research conducted by nurses and other healthcare providers
(Newhouse, et. al.

Questions On Clinical Decision Making
Clinical Decision Making This paper will write the story of JT, clinical patient of mine. The paper
will document her account of our interactions using her eyes and voice. The story will include health
assessment data, labs, and a physical assessment. Elements of JT's journey will also include her
culture, level of pain, spiritual and psychosocial stance and ethical issues that arose. The paper will
then detail the patient decision making process and strategies in a systemic manner to analyze the
situation and help determine what could have been done better. The decision making process will
also attempt to identify elements where the patient care could have been improved and determine
what went well and what actions or assessments made had no basis in the guidelines or protocol.
Additionally, analysis concepts will be integrated with continuous quality improvement (CQI)
initiatives. An approach for change process using the Plan–Do–Study–Act (PDSA) model will be
described as it applies to this patient scenario and will include clinical guidelines. The paper will
then utilize the results from my completed self–assessment tool as well as the self–reflection and
self–discovery to analyze the process of clinical decision making. JT is a clinical patient who was
born in the 1930's. By the time she was 12 years old, WW2 was in full effect and the nation was
faced with its biggest challenge yet. By the 1950's JT had graduated high school and was enrolled in
College for

Critical Thinking
Critical Thinking Article Review Over the last thirty years, the health care system has incurred
dramatic changes, resulting in new advances in technology and medical theories. Greater demand
for quality care by consumers, more knowledgeable patients, remarkable disease processes, shorter
hospitalizations, and the continuing pressure to lower health care costs are all contributing factors in
the necessary changes to the nursing practice. In order for nurses to deliver optimum care, they must
develop a higher quality of thinking capability. We will review the information given in this research
paper to discuss the impact of critical thinking in the nursing profession, as well as the various
strategies / techniques used in assisting ... Show more content on Helpwriting.net ...
Simpson and Courtney (2002) state "an important step in problem solving and decision–making is
the need to utilize critical–thinking abilities to reframe a problem or situation." Critical thinking
involves questioning all the features of a situation and analyzing solutions. The meaning of clinical
decision–making is a systematic process of assessment of a range of actions, evaluation and
decision–making that will be a factor of a desired outcome (Simpson & Courtney, 2002). Simpson
and Courtney (2002) state "incorporating critical thinking skills during the clinical decision–making
process will provide clarification, a range of potential solutions appropriate to the circumstances or
setting and reasoning to support the clinical decision made." Creative thinking is described as being
intuitive, being creative and visual; and discovering new ideas. Creative thinking asks questions
such as why? What if? What else? In creative thinking, a person can envision potential ideas and
alternatives as an approach to problem solving. According to Simpson and Courtney (2002), creative
thinking is of its greatest value when known solutions have failed and change has not occurred.
Students need to take an active role in learning how to evaluate the information given, developing
analysis skills, communication, and utilizing information in new ways. Students need to do more
that memorize facts. They need to process the information so that it can be

Information Based Decision Making Essay
| Information based decision making | Unit 5002V1 | | | 4/1/2015 |
Task 1 (600–700 words):
A.C.1.1 – Examine the nature of data and information
Data comprises of factual information. Data are the facts from which information is derived. Data is
not necessarily informative on its own but needs to be structured, interpreted, analysed and
contextualised. Once data undergoes this process, it transforms in to information. Information
should be accessible and understood by the reader without needing to be interpreted or manipulated
in any way.
Knowledge is the framework for understanding information and using it to inform judgements,
opinions, predictions and decisions – a pyramidal relationship (See diagram 1)
Diagram ... Show more content on Helpwriting.net ...
Therefore, I prefer circular model (Diagram 2) of the relationship as knowledge can influence what
data is collected thus generating information to enhance knowledge that in turn can generate more
data.
There are different types of data and information. These are examined in Table 1:
Type of data | Definition | Pros | Cons | Qualitative data/ information | A rich and detailed method to
capture how and why people behave in certain ways and the impact of these processes on behaviour.
| Captures participant's lived experiences.Allows a deeper understanding of a topic.Smaller sample
sizes so less expensive to do.Takes researcher bias in to account – an ethical strengthCan help to
provide new ideas to shape a service for people. | Smaller sample sizes, so less generalizable to
larger populations.Not possible to create statistics – which can help to shape and plan service
effectiveness and deliveryTime consumingDifficult to make comparisons within the sample.Poor
re–test reliabilityResults vulnerable to researcher bias and experience. | Quantitative data/
information | Analysis of numerical data to explain outcome, prevalence, frequency, time, cost. |
Based on explicit knowledge and this can be easy and fast to capture and analyse.Results can be
generalised to larger populationsCan be repeated – therefore good test re–test reliability and
validityStatistical analyses and interpretation are

Culture In The Clinical Decision-Making Process
The article A mixed methodological analysis of the role of culture in the clinical decision–making
process is written by Hays, Prosek and McLeod (2010). In this article, the authors indicate that
counseling process in the United States becomes more complex due to the dramatic growth of
racial/ethnic minority populations. In this article, researchers try to address how culture as a factor
impacts the clinical decision–making process with clients, and a special focus on clients' cultural
identities, counselors' (including counseling trainees) biases and stereotypes towards clients' cultural
identities, and cultural matches between clients and counselors are also investigated.
In order to figure out how cultural and diverse backgrounds influence

Evidence Based Practice For Quality Healthcare Delivery...
Evidence–based practice (EBP),as characterized by the integration of clinical expertise and
experience, patient values and preferences, and ideal research evidence (DiCenso, Guyatt & Ciliska,
2014) is vital for quality healthcare delivery and improves patients' health outcomes. Several steps
must be fulfilled in order to achieve EBP in practice. To begin with, clinicians assess the patient,
then question the patient on issues regarding their preferences and values. Next, clinicians conduct
research to appraise the patient's clinical case then evaluate the credibility of the sources used in the
research. Lastly, clinicians apply the information collected and integrate it with their clinical skills,
patient preferences and values. The balance between knowledge, experience, and information
gathering, characterizes the process of clinical decision–making, a process through which clinicians
ascertain the right course of action. (Vincent et al., 2015). The ability to make relevant and suitable
clinical decisions via this process determines the clinician's effectiveness. Thus, the successful
integration of patient values, clinical expertise, and ideal evidence in clinical decision–making,
reinforces clinician effectiveness, resulting in positive patient outcomes. This study will evaluate
how registered nurses use clinical decision–making to encompass patient values, clinical expertise,
and ideal research evidence. Clinical decision–making and patient values Initially, patients

Effectiveness Of Clinical Decision Making
The effectiveness of clinical decision making is crucial in nursing practice to ensure positive
outcome (Goodman, 2014). This essay will explore the clinical and decision making process in adult
nursing by analysing how nursing practice is applied in decision making considering the individual
needs of the patient. Ms LG is a 42 years old white British female with a history of dyspepsia,
constipation, continuous poorly localized abdominal pain, bloating and history of vomiting
(NA2010/3010). Ms LG had chemotherapy for ovarian cancer prior to being admitted to the gastro–
intestinal oncology ward.
Ovarian cancer is a fifth most common cancer in women in the UK (NICE, 2011). Ms LG is
currently in treatment phase which comes under stage 4 of ... Show more content on Helpwriting.net
...
Stage one of ovarian cancer involves just the ovaries. Stage two indicates cancer has spread outside
of the ovaries however, not outside the pelvis. Stage three indicates the cancer has spread outside of
the pelvis however, not to other parts of the body and lastly, stage four indicates the cancer has
spread to other parts of the body. Ms LG is in the stage three of ovarian cancer as her cancer has
metastases into her bowel. Problems & establishing goals Ms LG has problem with her bowel as she
had undergone resection of a tumour bearing ilea segment with bowel reanastamosis. According to
Bayless, Hanauer, and Bayless, (2014) a bowel reanastamosis is an operative union of two hollow or
tubular structures. It is likely that the cancer could metastasis and Ms LG could have another bowel
obstruction. The nurses would therefore monitor for any signs and symptoms of bowel obstruction.
For example, vomiting is an early sign of of bowel obstruction, abdominal pain, constipation, severe
bloating, decreased appetite and diarrhoea (Moore, 2005). The nurses would have to develop a
ceiling of care for Ms LG's goal if surgery was not an option in the case of more than one
metastasis.
Ceiling of care is the patient's expectation from a healthcare setting of their treatment and what is in
the best interest of the patient (BMJ, 2015). As nurses are the advocates for

reflective essay
Introduction
This assignment will be a piece of reflection based on a clinical decision I have assisted in during
my placement. This reflection will relate to a situation that occurred in my clinical work where I felt
that I have learnt something that is of value to my practice. The clinical decision was based on
wound dressing. I will identify what I have learned from the experience and how this relates to
theory that has been researched. To help me with this reflection I will use Gibbs (1988) model of
reflection. For the purpose of confidentiality I will call the patient Mrs H. The description of events
will be in the appendix.
Feelings
I remember that when we found out about Mrs H's new wound I was feeling a mixture of confusion,
... Show more content on Helpwriting.net ...
Tissue Viability Society 2012 states that with moisture damage prevention, the most important factor
is keeping the skin clean, dry at all times. However Kray 2013 states that when the skin is too
frequently cleansed with soap and water and dried, the permeability of the skin increases and the
natural barrier function of the skin is reduced. Best Practice Statement (BPS) 2012 recommends that
soap & water should not be used when cleansing following episodes of incontinence, as most soaps
increase the skin's pH to an alkaline level. Cleansing with soap and water can contribute to the
development of pressure ulcers (Cooper and Gray, 2001). The moisture lesions management strategy
that BPS suggests instead is to use warm water, protect skin with barrier cream, spray or film,
ensure appropriate continence aids are supplied, to increase frequency of personal care and skin
inspection and use pH balanced foam cleansers not soap. This is the advice we have given Mrs H's
daughter which helped the wound to heal as quick as it did.
Conclusion:
I have drawn two conclusions from the above reflection. The first being that clinical decision
making has various factors such as pattern recognition, critical thinking, evidence based approach
and team work (Thompson, 2002). Nurses confront situations such as this relatively unprepared and
react as considerately as possible. Experience can be

Freedom And Freedom : The Importance Of Clinical Freedom
Clinical freedom is the right of medical practitioners to decide and do whatever in their opinion was
best for their patients. It had been common practice that medical practitioners subject patients to
treatment procedures without any evidence of their efficacy, which not only will increase
expenditures, but also may put patients to potential harm. Hampton considered clinical freedom as a
myth and 'a cloak of ignorance', and believed that medical practitioners should base their clinical
practice on evidence from randomized controlled trials to guide medical decision making and set
aside dogma and biases (1). Using an example from the issue of active management of myocardial
infarction, the author highlighted the importance of managing resources effectively on clinical and
economic considerations, and suggested that interventions should not only be assessed for their
efficacy in increasing likelihood of their desired effect, but also assessed with comparative trials
against other alternative treatments. (1). In his conclusion, author felt that the end of clinical
freedom is not to be regretted, for its end would allow treatment to be applied only after a properly
conducted clinical trial and approved on a large scale after considering available resources and the
efficacy of treatment.
This paper raises interesting questions in economics and resource management healthcare
Furthermore, the procedures would also have to be compared with other alternatives in terms of
cost.

Evaluation Of The Clinical Decision Making Process
Clinical reasoning can be best described by the process of collecting indications, processing,
understand the problem or situation, plan and implement interventions, asses outcomes and learn
reflect on the whole process (del Bueno, 2005). Positive outcomes of this process can be determined
by an individual's preconceptions, attitude, perspective and willingness (mentally and physically)
(McCarthy, 2003). In a report by the clinical excellence commission of NSW Health they conclude
that there are three explanations for negative patient outcomes in which are failure to correctly
diagnose, failure to adequately implement appropriate treatment and inability to manage
complications. In this essay the author will outline a situation in which they were involved in
explaining the background of the situation, factors which influenced a clinical decision to be made
whilst describing the clinical decision making process.
On the last day of a placement block for Nursing clients with chronic conditions at an unnamed
Gold Coast Hospital, I was assigned five patients with the supervision of a registered nurse in the
orthopaedics ward. With awareness of the environment, I noticed and retained times patients were
coming and going from surgery that weren't assigned to me. On completion of the shift with bag in
hand, I walked past an elderly lady in her room whom I remembered had come back from surgery
approximately two hours earlier. I noticed she was quite flushed with a slight grimace on

Clinical Decision Making Model
Hello Everyone! Clinical decision–making (CDM) identify by the method including skills such as
critical judgment and problem solving which is also keystones of the effective care of patient
(Wainwright, Shepard, Harman and Stephens, 2011). As Physical therapists (PTs) we make decision
every day. This decision is accepted throughout the client interview and verified during physical
examination (Goodman and Snyder, 2007). The decision making style may differ based on level of
experience, knowledge, judgmental power and condition like limited time frame. Now, talking about
my CDM process in initial phase as PTs which was limited to particular area like neuro–
musculoskeletal due to limited knowledge, experience and clinical exposure. Moreover, ... Show
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moreover, to decrease patient load they (physicians, admin) categorized care unit based on division
as severity but instead of solving problem its increased. Money is very serious motivator to continue
to look the other way, So to reduced workload and specific treatment who actually indeed required,
Goodman's developed a new clinical algorithm in three criteria but none accepting initially this
method (Crist, McVay and Marocco, 2016). Cook county hospital have accepted first and tried this
method on patients who fit in this criteria get's priority first and this model was more reliable(70%
better than regular system), convenient than experts view (Crist, McVay and Marocco, 2016). In
2005 Klein, point out five pitfalls in the study and one of them is confirmatory bias, as physical
therapist, we need to aware of bias and overcoming while diagnose the patients. For example,
ligament injury in knee joint can be conflict with meniscus injury or fracture but by using
differential diagnostic test and analytic–deductive thinking process help out for proper rule out
specific condition. Training in these threats can

Clinical Decision Making
The clinician decision making is the process of determining what the patient needs and when they
need it. This process is subjectively done by the healthcare provider. Clinical decision tools are an
enhanced guide in giving the provider information to make a more educated decision. The use of
clinical decision support tools can help lower hospital costs, increase patient satisfaction, and
improve efficiency of care. The use of clinical decision support tools can avoid many errors and
adverse events and increase the quality the care the patient is receiving. These support tools should
only be used as a guide to assist the healthcare provider in making a decision. A healthcare
provider's decision should not be made solely on ... Show more content on Helpwriting.net ...
Overall, Micromedex is an engaging and useful tool for myself, healthcare providers and for patient
education. Dxplain is a different type of support tool then Micromedex. It suggests a set of diseases
that are associated with the clinical findings that are entered in the search box. DXplain is easy to
use especially with those who have no computer background. The diagnoses that are suggested
always have a justifiable interpretation which is significant in giving the provider education on the
diagnosis. The abbreviation terminology and synonym feature is vast which makes it quick and
effortless to search. I currently work on an orthopedic med–surg unit and DXplain had limited
information on Orthopedic diseases and procedures. There is also limited information on psychiatric
and dermatologic diseases. When searching for laboratory tests that are commonly completed in a
hospital setting there was no data obtained. DXplain had no path physiological knowledge which
personally does not guarantee accuracy. The program mainly focuses on the clinical symptoms but
the patient personal, family, social, or employment factors are not recognized. I believe that that all
aspects should be assessed in order to make the best

Decision Making And Clinical Reasoning Skills
I understand how to employ leadership, decision–making and clinical reasoning skills to provide
optimal patient care. Pediatric care in a rural, level III, county owned emergency room is somewhat
of a precarious subject. In my hospital, we have a small pediatric floor that only admits the mildly
sick and transfers the rest of the patients. Therefore, the axiom of the emergency room is transfer as
quickly as possible. When a pediatric trauma or emergently sick child does come into our
emergency room, it can quickly become a cluster and making do the best you can with what supplies
you have. I am unsure why but the consensus is to be scared to take care of children. Fear does not
excuse you from a lack of education, but rather education ... Show more content on Helpwriting.net
...
The use of the warmer has decreased the amount of infants and children we have had difficulty in
regulating their body temperatures. Even our local flight team was happy to have access to the
warmers while transferring a patient. Through my research and learning, it has changed the way I
treat my pediatric patients and their families. I no longer avoid these patients and I now advocate for
them. I now understand these are tiny humans but their treatment must be tailored to them much
differently than their adult counterparts. I have learned that children can sense fear quicker than
adults can. I have also learned the parents are typically the best medicine. If possible, let the child
stay with or in the parents lap for procedures. In addition, I have learned that taking care of children
is quite rewarding. To see them get better and know you had a part in that feels amazing. I look
forward to continue growing, learning, and expanding the knowledge to my co–workers in the field.
Optimal and excellent patient care should be provided to all no matter the age. I can demonstrate
prioritization, delegation, and reflective practice to transition from novice to advance beginner
nurse. After graduation from nursing school, I began working on a medical surgical floor on night
shift. I was much younger than all my coworkers were. I did not like to ask for help. I thought I had
to know and do everything for myself to prove

Applying Clinical Decision Making in Adult Nursing Essay
Applying Clinical Decision Making In Adult Nursing Ahh2036–N This assignment will critically
analyse and justify the decisions based around a fictitious patient using a clinical decision making
framework highlighting its importance to nursing practice. The chosen model will demonstrate
clinical decision making skills in the care planning process. The patient's condition will be discussed
in–depth explaining the pathophysiology, social, cultural and ethical issues where appropriate in the
care planning and decision making process. Any vulnerability that the patient may experience will
be discussed and dealt with in the care planning and decision making process. The supporting
evidence based literature will be analysed and ... Show more content on Helpwriting.net ...
Huber (2006, p154) states that clinical decision making in nursing relates to the quality of care the
patient receives and how competent the nurse is. Over the past 30 years nursing has evolved from a
task–oriented to a logical and systematic approach to care, using theories and models to guide
practice. According to Jasper (2007, p117) theories of decision making in medicine tend to favour
logical, precise analytical models which are held to be testable, unambiguous and repeatable,
therefore satisfying scientific principles. These represent important ideas of certainty and rationality
that are intended to provide a sense of security and reliability. When used correctly a nursing model
should give direction to nurses working in a particular area, as it should help them understand more
fully the logic behind their actions. It should also act as a guide in decision–making and so reduce
conflict within the team of nurses as a whole. This in turn should lead to continuity and consistency
of the nursing care received by patients according to Pearson et al (1999,p ). Banning (2008, p )
states knowledge for decision making is obtained from many sources and has been described as both
informative

Clinical Decision Making Essay
Clinical decision making is a contextual, continuous, and evolving process, where data are gathered,
interpreted, and evaluated in order to select an evidence–based choice of action. An Effective
Practitioner is tasked with making clinical decisions with patients and clients many times during
their health and care journey. Factors that affect decision making There are many factors involved in
clinical decision making and each of the core skills has the potential to impact effective decision
making. 1.Knowing the evidence – Any clinical decision maker should rely on a knowledge base
which contains a wide array of literature review.Thanks to the digital advancements and technology,
we can embed a wide variety of information in the form of E–books, articles, journals, reference
materials related to the current practice, so that we as a clinical decision makers can rely on them for
decision making process or even patients if they want information about the disease or treatment
protocols, can utilise to research the evidence base, many of the physicians as well are simply
referring them a bunch of latest treatment articles or their website link in their portals to justify their
... Show more content on Helpwriting.net ...
3.Knowing yourself as well as your team members completely – In many multinational
organizations, there is always a special segment which concentrates on the overall well being of
their employees, be it in the form of personality development classes, art of positive thinking,
cultural peogrammes, leaves, vacation, sponsoring health insurance, ensuring employee safety, this
is because any health care or other industries their biggest investment are the employers, and the
employers work and their decisions highly impact the entire organisation, that is why they make
sure they know all their team members thoroughly, and any chief decision maker should have
command over himself and his attitude at his work then only he can make clear decisions for his
organization and lead it to

Clinical Decision Making : Clinical Judgment Essay
Clinical judgment Clinical judgment is the clinical reasoning, which includes clinical decision–
making, critical thinking, and a global grasp of the situation, coupled with nursing skills acquired
through a process of integrating formal and informal experiential knowledge and evidence– based
guidelines (AACN, n.d.). In the case of F.S., he was on isolation precautions due to his infection.
The results from the cultures had yet to return, therefore the infection was not identified at that
current moment. The registered nurse that was assigned to F.S. went into the room several times
without wearing proper protective personal equipment. This nurse stated that if she wasn't touching
the site, she was not at risk. This was a bad clinical judgment. Unfortunately, this was not the first
time this student nurse witnessed the lack of use of the personal protective equipment. What most
nurses don't seem to understand is that the risk of infection is not only towards the patient but
towards the nurse as well as everyone the nurse encounters. Contact precautions were researched
and found to be associated with activities likely to reduce transmission of resistant pathogens, such
as fewer visits and better hand hygiene at the exit while exposing patients on contact precautions to
less healthcare worker contact, less visitor contact, and potentially other unintended outcomes
(Morgan et al, 2013). Although it can be depressive for the patient to become isolated due to an
infection, this

Systematic review paper
Systematic Review
Systematic Review
The purpose of this meta–synthesis research was to synthesize a qualitative study performed to
better understand the underlying reasons why only a fraction of cancer patients participate in cancer
research trials. The attempt is to explore factors that influence participation in this type of study.
Literature in the subject indicates poorly understood process of how patients are enrolled into
clinical trials. This systematic review tries to improve the patient decision–making process in
participating in cancer clinical trial and to provide Oncology nurses to treat patients with solid
background utilizing evidence based practice (Biedrzycki, 2010).
The study was conducted in hope to ... Show more content on Helpwriting.net ...
Three studies tested an educational intervention and two studies used an experimental design. 50%
of the studies did not report timing of the research in relation to the decision regarding clinical trial
participation (Biedrzycki, 2010).
During meta–analysis, response rates varied by type of measure and study design, only 50%
reported response rates (range = 21% – 95%, median=71%. 29% declined participating because they
had no interest and 24% declined with no reason given. One major reason people declined to
participate was because they had no access or could not use a computer. Multiple time measures
were conducted in decision regret, it was noted that responses were reduced (Biedrzycki, 2010).
The process used to pool the data together was clinical trial decision making. The main factors
influencing this process consist of patient, provider, and treatment. Two studies specifically explored
decision making by the patient. Education requirements impacted decision making since
understanding the risks and benefits of clinical trials was the most important factor taken into
consideration by the patient. Educational interventions were noted to have increased patient
enrollment. (Biedrzycki, 2010).
If the patient found the education from the provider to be coercive, treatment was considered a
burden. Time and travel also posed an inconvenience on the patient since it adversely affected
quality of life and therefore deterred

What Hierarchy Of Evidence Is Used When Making Decisions...
Research Worksheet Jesse Travis Midwestern University Research Worksheet Questions What
hierarchy of evidence is used when making decisions about clinical interventions? While research
has long paralleled medicine, the use of strong research evidence as the basis for clinical action is
more recent (Houser, 2015). The historically accepted hierarchy of evidence separates evidence into
levels of trust, from highest to lowest (Greenhalgh, 2010): 1. Systematic reviews of randomized
controlled trails 2. Randomized controlled trails 3. Controlled clinical trials 4. Observational studies
(cohort studies or case–controlled studies) 5. Case studies, expert opinion, bench studies While this
structure provides a starting point for the critique of evidence strength, the prudent evaluation and,
subsequent, translation into practice guidelines requires further consideration (Greenhalgh, 2010).
Research can be scrutinized into measures of quality. John Hopkins Hospital grades evidence on a
high to low scale, A through C, based on criteria including consistency of results, reproducibility of
findings, sample size of study, level of study control, organizational design, and expert opinion
(Newhouse, Dearholt, Poe, Pugh, & White, 2005). Using this evaluation tool, an A score would
result in a recommendation for clinical practice while a score of C should alert the clinician to a low
quality of research and should not be incorporated into practice guidelines (Newhouse et al., 2005).

The Pros And Cons Of Clinical Decision-Making
Decision making is the cognitive process leading to the selection of a course of action among
alternatives (Kelly &Crawford). Nurses' decision, particularly focuses on clinical scenarios. Clinical
Decision making is by deciding what information to gather, which tests to order, how to interpret
and integrate this information to draw diagnostic conclusions, and which treatments to give
(Douglas L, 2015). The nurse's decision is judgments as to whether it will be helpful to the
client/patient or it will harm. I noticed that the patient's life or health are placed in our care which
before we make the conclusion of our decision, nurses must access or weigh the positives and
negative impact and other considerable alternatives before we conclude our

Clinical Decision Making For Physical Therapy Assistant
Skinner, S. B., & McVey, C. (2011). Clinical decision making for the physical therapist assistant.
Sudbury, MA: Jones and Bartlett.
This guide is built to help develop the essentials to caring for patients. To help people or students to
make decisions to the pathway of Physical Therapy. The book then later proceeds to talk about
internships and how to score a high grade for the NPTE which is the National Exam for Physical
Therapy. A good thing about this book is that it can be used at any level of Physical Therapy
Assistant education.
Dreeben, O. (2007). Introduction to physical therapy for physical therapist assistants. Sudbury, MA:
Jones and Bartlett.
In this book we see that it consists of five parts which are The Profession, Physical Therapy
Specialties, Ethical and Legal Issues, and the Communication. Another factor is the development
and evolution. Half of the textbook discusses rehab treatments and the culture of physical therapy
itself. It is also mentioned on how to choose your specialty such as neurology, pediatrics, orthopedic
and more
Fetters, L., & Tilson, J. (2012). Evidence based physical therapy. Philadelphia: F.A. Davis.
This book mentions the five steps which is to focus on clinical questions, conduct a search, appraisal
for the research, interrogation, and the evaluation. An interesting chapter is the chapter of finding the
real diagnosis and finding out the specific treatments for them. Another interesting chapter is
Chapter Four where the

Clinical Decision Making In Nursing
Clinical Decision Making I believe that the clinical decision making process associated with the
actions to be taken in Jack and Jacqueline's care were quite similar between the Canadian and the
Rwandan perspectives. This is because both perspectives took on a holistic view of Jack and
Jacqueline's situation and thereby worked to develop goals that would not only address Jack's
physical health, but also the emotional and mental health of Jack, Jacqueline, and even Charles.
These holistic based goals included, but were not limited to the utilization of various community
supports to foster Jack's cognitive development as well as the formation and implementation of
diverse coping strategies for Jacqueline and Charles to use during times of stress. ... Show more
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This is because the nurse had already provided Jack with a referral to the local hospital so that a
physician could further assess his symptoms and possibly prescribe him one or more medications
that could assist in controlling his symptoms. I also believe that this goal will be easy to achieve
because despite Charles having recently begun smoking inside the family's home, he will likely be
able to make the transition to smoking outdoors without much difficulty, which will thereby prevent
Jack's illness from progressing further and protect his daughters from falling ill as well. Moreover,
when reviewing which of the health practices within the care plan will need to be better
accommodated to Jack and Jacqueline's health needs, it is evident that the nurse may have to adapt
how he or she works to improve upon Jacqueline and Charles' current knowledge of Down
Syndrome. As Charles has difficulty accepting Jack and his disorder, providing him with accurate
information regarding his son's diagnosis may be ineffective as he could decide that what he is being
told is not important or that it is of no use to him. Therefore, the nurse must work with Charles to, at
the very least provide him with some general information about Down Syndrome. If he or she then
notices that Charles has decided not to listen to what is being conveyed, this relay of knowledge
must cease. From here, all of the crucial information regarding Down Syndrome that the nurse has
gathered for both Charles and Jacqueline must only be relayed to Jacqueline. This will thereby
prevent any further fuelling of Charles' rejection of Jack while also ensuring that at least one of
Jack's parents is accurately informed about his

The Development Of Decision Making
The Development of Decision–Making in Nursing Nursing is a profession that has traditionally
attracted individuals who have a desire to help others and have an interest in the health sciences
(Ruesink, 2012). In the complex world of health care, good intentions only go so far in terms of
client safety, quality of care, and achieving the best possible outcomes, and that is why critical
thinking, decision making, and evidence based practice are crucial to the nursing profession when
acting on the behalf of our clients (Fero, Witsberger, Wesmiller, Zullo, & Hoffman, 2009; Ruesink,
2012; Thompson, Aitken, Doran, & Dowding, 2013). In this paper I will discuss and explore three
decision–making models that support nursing decision–making, how ... Show more content on
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The College of Registered Nurses of British Columbia (CRNBC), defines Clinical decision–making
as: A complex and dynamic process, occurring within a larger context and drawing from various
dimensions of knowledge, in which nurses collect and organize information in order to form
conclusions and choose actions, with the intent of creating the best outcomes for clients (2014, slide
19). The nursing profession demands a high standard of quality and safety, compelling nurses to act
professionally, be accountable for their own actions, and embrace their Professional Standards
(CRNBC, 2013). The CRNBC Professional Standards requires nurses to know where to access
information to support their knowledge to deliver evidence–based, competent nursing care, as well
as use decision–making tools to guide their assessments, diagnoses, and treatments (2013). For
nurses to make clinical decisions that enhance a client's health, promote realistic solutions, and
reduce potential risks, decision making and critical thinking must happen in sync (Fero et al., 2009;
Standing, 2005). To support critical thinking in nursing practice, and help novice nurses compensate
for the lack of clinical experience, decision–making models have been constructed to help navigate
the multi–dimensional complexities of the

Apache V. Apache IIi System : Acute Physiology And Chronic...
APACHE stands for Acute Physiology and Chronic Health Evaluation and the first system was
developed in 1981. The newest APACHE system was developed in 1991. The APACHE III system
was designed to predict an individual 's risk of dying in a hospital. It compares each individual 's
medical profile against nearly 18,000 cases in its memory before reaching a prognosis that is, on
average, 95 percent accurate (Open Clinical website, 2005). This system can be used in the Intensive
Care Unit setting and it can predict the patient's risk of dying in the Intensive Care Unit. This system
takes into account several variables such as, diagnosis and psychical conditions upon admission to
the Intensive Care Unit, age, pre–existing medical disorders and other variables. A physician gives
the system facts, and based upon the facts the system can predict the patient's risk of passing away.
This system does not spit out an answer and healthcare workers have to follow it, it is rather a tool
to help healthcare providers make a decision on whether to discontinue "heroic" measures and it
allows them to ponder these issues in a realistic way. The Clinical Decision Support System is a
system that uses patient data to generate specific advice relevant to the patient's case. Clinical DSSs
are typically designed to integrate a medical knowledge base, patient data and an inference engine to
generate case specific advice. (Open Clinical website, 2006). Overall, this system can be helpful
when

Video Consultations As Tools Of Clinical Evaluation
The current study analyses the potential of shorter video consultations as tools of clinical evaluation.
It also provides evidence in the later parts of the report of short video consultations being used to
accurately diagnose clinical disorders; discusses the scenarios where shorter consultations can be
profitably used and also explores the future implications of reducing clinical evaluation time. In the
current study, short video consultations are being studied as tools of asynchronous telepsychiatry.
Ever since the advent of telemedicine, telepsychiatry has taken great strides in embracing this useful
and efficient way of consulting patients. Synchronous Telepsychiatry (STP) has been used for more
than thirty years to make psychiatric experts available in areas with provider shortages. 1 It was in
the year 2010, that a new study by researchers at University of California, Davis School of Medicine
established that psychiatrists could accurately assess patient's mental health by viewing stored
videotaped interviews. This method known as asynchronous telepsychiatry has now been adopted
worldwide as a convenient and economical alternative to face to face consultations.2 Contemporary
literature reflects the growing need to reinvent the traditional ways of practicing medicine.3
Accurate clinical judgement is the goal of every physician's practice. Decision making deals with
the processing of information. Technological advances have allowed the current physicians to
control

Information Between Professionals For Well Over A Decade
Introduction It has been NHS policy to actively share information between professionals for well
over a decade. In England clinicians should send copies of their clinical letters to their patients. 1
This will give patients a written record of their consultation, the discussion, the decisions made and
the reasons for making them. It will give patients the opportunity to read information that they might
have misheard or may have forgotten, to reflect on the conclusions arrived at and to discuss them
with important others such as friends and carers. It recommended including patients as a partner in
their healthcare, encourage greater openness and transparency. There should be an assessment of the
patient's capacity to make decisions about ... Show more content on Helpwriting.net ...
An 'Easy read' is a presentation of information in a simple and easy to understand format involving
short sentences and images. It is often useful for people with Intellectual disability and for people
with conditions which affect the way they process information.3 Patients have a right to see or have
copies of their records. The Code of Practice also states that it is important to recognise different
communication needs of different patients such as with disability and difficulty in communication
does not remove the obligation to help people understand.4 Aims 1) Ascertain the practice of
copying clinical letters as per GMC guidelines, Royal college of Psychiatrist guidelines and code of
practice from department of health. 2) To find if the implementation of the service improvement
project 'Easy read' improved the team's performance. Audit Standards 1)Department of Health
(2003a) Confidentiality: NHS Code of Practice. pp. 212. London: Department of Health.
2)Department of Health (2003b) Copying letters to patients: good practice guidelines. 3)Royal
College of Psychiatrists (2006) Good Psychiatric Practice: Confidentiality and information sharing
(CR133). London: Royal College of Psychiatrists. 4)GMC: Good medical practice (2013) Methods
The setting was Salford Intellectual disability team. All clinical letters for the month of

Reflection on My Nursing Decision
Pearson (2013) clarifies "clinical decision making is essential to every aspect of care delivered to a
patient" (p. 214). It is the ability to blend information and make decisions that will later be
implemented in the situation. Evidence–based decision making involves choosing from a variety of
possibilities and combining the knowledge through research and the scientific evaluation of one's
practice. The purpose of this paper is to analyze my decision of administering ativan by advocating
for the patient and anticipating her change prior to confirming signs; which provided a therapeutic
response. Clinical Decision During my community placement of the cataract clinic at St. Joseph's
Hospital, one patient I observed looked extremely anxious ... Show more content on Helpwriting.net
...
Rationale for Framework The CAEN Decision Making Model for Nursing Practice Framework was
chosen for this analysis due to its incorporation of foundational knowledge, thinking processes,
context and decision–making processes. The model places major emphasis on the quality of
relationships, salience and pattern recognition, healing initiatives, critical reflection to analyze a
situation pre and post and to value different ways of knowing. The client along with the nurse is
intertwined in the center of the framework highlighting the importance of their relationship. All
critical decision making for nursing practice is the client's lived experience of health and healing;
which is essential to the inquiry process where a nurse will enter into and become engaged in the
new relationship. In this situation, being directly involved with the patient provided an opportunity
to create a relationship on the basis of providing health and healing measures (CAEN, 2008).
Coming to Know the Client The first stage of this framework is coming to know the client, which
requires the nurse to understand that the personal meaning of health and healing is individualized
and the context of this area is highly subjective. Gillespie and Paterson (2009) state that "clinical
decision–making processes are triggered by recognition of a cue from a patient" (p. 167). In the case
of this patient, the decision was based off a cue; a change

Clinical Decision-Making And Clinical Judgment Analysis
Although clinical decision–making and clinical judgements are closely linked, but the concepts are
separate. Clinical judgement defined as "an assessment between alternatives" whilst clinical
decision–making defined as "a choice between alternatives" (Dowie, cited by Thompson and
Dowding 2009). To choose the best between two alternatives requires the rationale behind decisions
which can obtain by asking questions to create information (Standing 2010). Furthermore, Levette et
al's (2010, p. 515–20) define clinical reasoning as "the process by which nurses collect clues, gather
information, come to an understanding of a patient problem or situation, plan and implement
interventions, evaluate outcomes and reflect on and learn from the process".

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