Clinical Decision making and the Nursing Process

Clinical Decision making and the Nursing Process sexual and external variables such as the restrains personal experience, knowledge, creative thinking ability, education, self concept, as meshed with the bears working environment, and situational stressors all can work to enhance or inhibit effective clinical decision making for a have got. (OReilly, 1993) Clinical decision-making is defined as the ability to sift and synthesize information, make decisions, and appropriately go for those decisions within a clinical setting. Practicing nurses must efficaciously identify and solve the problems of patient diagnosing and intervention by using such a model. integrity means of doing so, paradoxi telephone cally, is to identify the barriers to decision making so they can be overcome by the use of more effective decision-making tools. The nursing mathematical operation itself involves the make for quality decision-making at every sage of assessment, diagnosis, designning, implement ation, and evaluation of patient needs and demands. (Nursing process, 2006, Wikipedia) Thus, twain processes are interrelated as to be a good nurse a nurse must be a good decision-maker.Describe Patricia Benners stages of clinical judgmentAccording to the nursing theorist Patricia Benner (2004), the novice nurse has lower-ranking experience, and must essentially proceed by rote to function as an effective nurse in the clinical setting, such as a starting line year nursing student who needs constant guidance from other hospital staff members. A recent graduate nurse or forward-looking beginner possesses some minimal clinical practice and can grasp attributes but not aspects of the clinical setting without constant assistance. In contrast, a efficient nurse has a filtering device of experience to know what to ignore and what to assimilate in the clinical setting, based upon greater levels of experience than the advanced beginner nurse. A proficient nurse has made the leap beyond basic competence into a more holistic assessment of understanding of patient needs. Finally, the expert nurse no longer relies upon clearly articulated analytical rules of judgment regarding patient diagnosis and treatment at all, but can proceed to judgment on a more intuitive, but still rational level. The expert can deploy both creative thinking and rational thinking simultaneously and effectively in the clinical environment.Discuss the ways in which the nursing process contributes to effective clinical decision-makingThe nursing process of assessment, diagnosis, planning, implementation, and evaluation are dependant upon both the nurses personal qualities as well as upon the setting of the assessment. (Quan, 2006) For example, during the assessment, increased knowledge on the part of the nurse practitioner leads to greater clinical accuracy in judgment. The more experienced nurse knows what to look for, based upon clinical knowledge and personal experience, and can use that obse rved and filtered knowledge in making a more competent diagnosis. A more competent diagnosis leads to a mitigate-planned and implemented course of treatment, and a disclose assessment of how and if the treatment is working. (OReilly, 1993)But treatment is not merely a checklist. Intuition is also said to be the hallmark of expert judgment, where intuitively on a subconscious level amass knowledge kicks in in helping the nurse understand what, if anything, in the patients state of health may be wrong. Creative thinking when assessing the patients psychological and tangible state, the ability to fuse emotion and reasoning in the mind of the seasoned nurse, can lead to a better mental selection of important entropy and a more effective diagnostic conclusion. (OReilly, 1993)Also, self-concept, the empowered use with arrogance of ones knowledge that comes with experience and the practice of years can increase the speed and dexterity of the planning of the treatment and its impleme ntation and evaluation. However, it is important to remember that even in expert nurses, stresses such as less then optimal staffing or undercutting confidence through interpersonal staff conflicts can increase anxiety, and can threaten the ability to make an effective diagnosis. A lack of sleep, an overwhelming patient load, or staff condescension, especially in less confident novice nurses can all inhibit the use of ones personal assessment tools and thus disrupt the process of effective nursing in the clinical environment. (OReilly, 1993)Provide examples of how planning for the provision of nursing care might differ at each stage of clinical judgment.Nursing processes are thus always in a dialogue between the nurses own personal competence (internal factors) and the external stressors of the environment. For example, take a exceedingly contentious situation in the ER when a patient may come in, late at night, complaining of chest paints, agitated, and certain that he or she is s uffering a heart and soul violate. A novice nurse, in her process of assessment, diagnosis, planning, implementation, and evaluation might merely register the patients emotional distress and immediately call for a doctor specializing in cardiac care, accepting the patients own assessment and diagnosis as if it were valid. The nurses lack of confidence and fear of the possible consequences of an untreated contend might drive her to seek immediate assistance to help in the planning and implementation of a plan to aid a heart attack victim.An advanced beginner nurse, less shaken by the emotion of patient, but proceeding by rote and by the knowledge given to her by nonrecreational mentors during her minimal previous clinical experience, might go down a checklist of evaluating the patients pain, such as where is the pain localized, when the pain began, then asking the patient to find out and rate the pain, and based upon such an assessment, diagnosis the cause and severity of the ca se forward seeing assistance in planning and implementing a treatment plan either for a cardiac condition or for heartburn.A competent nurse might, by sight, be able to evaluate if the patients pain was nausea, as in heartburn, or if the clutching pain seemed to affect the patients breathing or numb the patients limbs as might be typical of an oncoming heart attack. A proficient nurse might be able to assess the immediate severity of the condition-even if the pain was heart-related, she or he might be able to offer a finer-tuned diagnosis and plan. For example, if the patents angina was life threatening and required immediate care, or if the pain could be taken care of through a nitroglycerin tablet, for example, and patient rest, before a doctor was called for to evaluate the patients physical health and provide advice regarding future heart care.Finally, an expert nurse might be able to assess, having seen many heart attacks and heart burn patients go through the ER, might know w hat was needed almost by sight. The expert nurse would likely be also better skilled in comforting the patient and thus lessening the trauma of the patients trip to the ER and the final diagnosis.However, it is important to remember at all junctures of this decision-making process, that a crowded or understaffed ER can interfere with such holistic judgment, although the more experienced a nurse is in high-pressure situations, the better able he or she will be to filter out such unnecessary environmental static such as an argument with a colleague, the lateness of the hour, or an uncooperative patient. Experience is not a panacea, but feature with an effective use of clinical decision making and the nursing process, experience combined with the simultaneous and effective deployment of rational and intuitive judgment is the best personal asset a nurse offer to a patient.