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Anotated bibliography, the topic is implementing models of clinical decision making in nursing practice. Essay Example

  • Category:
    Nursing
  • Document type:
    Article
  • Level:
    Undergraduate
  • Page:
    3
  • Words:
    1569

Sands, N. (2009). An exploration of clinical decision making in mental health Triage. ScienceDirect, p. 298-308.

In this article the author sets out to explore clinical practices related to mental health (MH) Triage. According to the author MH Triage is an important aspect in the delivery of mental health services (Sands, p. 298). In developed countries mental health (MH) Triage is widely used because it provides costs effective mental health services to the large population that characterise the developing countries (Sands, p. 299). In this article the author provides a clear discussion about the central features of MH triage decision making process, the process of triage decision making as well as the influences, issues, and other factors that impact on triage decision making.

In order to achieve the above objectives, the author utilised a sample of 21 interviews and a survey questionnaire containing 139 questions. The author also employed an exploratory research design as well as a mixture of different methods of data collection (Sands, p. 300). A focus group of experts MH triage clinicians was employed to develop relevant and appropriate content for the survey questionnaire.

The sampling process employed for the semi-structured interviews was underpinned by the aim of interviewing at least 10% of the survey respondents with equal representation in the sample of rural and gender and metropolitan practice setting (Sands, p. 302). The data collected was analysed using the secondary analysis of both survey and interview data. The results indicated that the most outstanding feature of MH Triage practice is the complex process of making decisions in each phase of the process (Sands, p. 307). 80% of the respondents indicated that MH Triage decision making process is stressful, particularly performing complex risk assessments in pressured situations. (Sands, p.306). Decision making under pressure was commonly cited as a key stressor in MH Triage practice.

According to Angermeyer (2006) the findings from the above study are important in enhancing the performance of nurses in MH Triage practice. This is because high levels of stress associated with high level and complex decision making process in HM Triage may impact negatively on retaining nurses in the Triage workforce (Angermeyer, 2006).

The article is peer-reviewed and informative. It contains vital information required to improve the delivery of MH Triage services. The information about the working environment in the MH Triage workforce is also vial because it serves as the platform upon which improvement should be made in order to improve MH Triage practice in Australia and other parts of the world. The efforts of the author should be appreciated especially organizing the rigorous exercise of carrying out a research study where time and other numerous resources are involved.

Hoffman, K., L. & Duffield, C. (2009). A comparison of novice and expert nurses’ cue collection during clinical decision-making: Verbal protocol analysis.
International Journal of Nursing Studies, 46 (2009) 1335-1344.

In this article the author set out to explore how the type of cues used in the context of clinical decision making is understood by both the expert nurses and the novice in the type and range of selected cues as well as the clustering of the cues when making key decisions in the clinical setting in the ICU or intensive care unit when taking care of post-operative patients.

The authors held that complicated decisions undertaken in taking care of critically ill patients require well skilled and knowledgeable nurses who can make decision on how to deliver, effective and safe care in order to prevent any form of complications that might occur in the process. The accuracy of detections by nurses of cue clusters and cues indicating patient deterioration is an important aspect of clinical decision making (Hoffman & Duffield, 2009). The authors held that nurses have incomplete knowledge on how cues should be processed when making decisions. In their research study, the authors utilised a sample that comprised of four expert nurses and four novice nurses caring for post-operative patients specifically post Abdominal Aortic Aneurysm surgery in an Intensive Care Unit (Hoffman & Duffield, p. 1338).

Purposive sampling method was employed in selecting the participants because only novice and expert nurses were required to be included in the study sample. Think Aloud (TA) method of data collection was applied since nurses were required to think aloud as they delivered care to the patients (Hoffman & Duffield, p. 1341). Audio taping of the nurses was executed in order to enhance the data collection process. The protocol analysis method was used to analyse the data collected. The results of the study indicated that expert nurses collect a wide range of cues than new or novice nurses.

Another finding from the study indicated that significant disparities exists between new and expert nurses when using cues for assessing respiration. Expert nurses were found to use additional cues when assessing respiration movements such as chest movements, the strength of the muscle, air entry, smoking history and tidal volume (Hoffman & Duffield, p. 1342).

In terms of cue clustering novice nurses noted the blood pressure of the patient, then the novice assessed the CVP of the patient, then assessed intra-operative fluid lost and no further steps were taken in the assessment of the patient.

According to Anderson et al, (2004) in clinical practice it is important to detect the extensive cues. This is because focussing on few cues or the wrong types of cues may be lead to the wrong detection of the problems of the patients. This means that extensive cues assessed by the expert as noted above are important because they increase the chances of identifying the patient’s problems and increasing the effectiveness of nursing practice. Hence, Anderson et al. (2004) noted that new or novice nurses need to be exposed to more education and guidance on how to use more cues to assess pro-operative patients.

The article is peer-reviewed and informative. The article presents key concepts and aspects of pro operative patient care by drawing a clear line of separation between expert nurses and novice and their skills and knowledge on cues. The efforts of the author should be appreciate particularly the manner in which the author manages to shed light on shortcomings of the novice nurses in assessing cues related to different patient problems such as respiratory problems. This is vital in streamlining the nursing care profession particularly streamlining the process of assigning novice to pro operative patients in the ICU.

Guhde, J. (2010). Using Online Exercises and Patient Simulation to Improve Student’s Clinical Decision-Making. Teaching with technology, Vol. 31 No. 6, pp. 387-389.

In this article, the author explores the manner in which nurses must respond with accurate and correct clinical judgement when faced with intricate clinical situations. The aim of the article is to help nursing students to address clinical problems through effective analysis of the problem that face them. According to Guhde (2010) nurses improve on their clinical-reasoning skills after an error occurs in clinical judgement because this gives them the push to analyze where the error occurred. Hence, the author emphasized the need to provide students with online exercise on different levels of interventions in order to enhance and increase the understanding of the nurses regarding clinical judgement.

The author stressed the need for online learning because the students are provided with an opportunity engage in different levels of discussion and building the confidence of the students in handling different problems that arise in the clinical setting. Through a practical online assessment or assignment administered to groups of 10 clinical students (100 subjects) and utilizing a complex clinical situation in order to enhance their critical thinking skills the author established that online assessments and evaluations are key to enhancing the understanding of the students regarding different clinical issues such as the importance of considering more data and avoiding “jumping” into pre-mature conclusions. The results of online discussion indicated that online discussion generate much discussion which gives the learners a wide environment to learn.

Bain (2004) observed that both patient simulation and online discussion are important because they provide the students or learners with an opportunity to analyze their critical thinking as compared to their online peers. In order to change behaviour and thinking learners need to be challenged by their peers in order to realize what they do not know.

The article is peer-reviewed and provides key guidelines on the important of engaging and encouraging online discussions particularly to the nursing students because online assignment and discussions help the students to identify their misconceptions about what nurses are required to do in different situations. The efforts of the author should be appreciated in increasing the awareness of the students and lecturers regarding the need for online assessments and discussions.

References

Anderson, et al (2004). An integrated theory of mind. Psychological Review 111 (4),

1036–1060.

Angermeyer, et al. (2006). Burnout of caregivers: A comparison between partners of psychiatric patients and nurses. Archives of Psychiatric Nursing, 20(4), 158−165.

Bain, K. (2004). What the best college teachers do. Cambridge, MA: Harvard University Press.

Guhde, J. (2010). Using Online Exercises and Patient Simulation to Improve Student’s Clinical Decision-Making. Teaching with technology, Vol. 31 No. 6, pp. 387-389.

Hoffman, K., & Duffield, C. (2009). A comparison of novice and expert nurses’ cue collection during clinical decision-making: Verbal protocol analysis.
International Journal of Nursing Studies, 46 (2009) 1335-1344.

Sands, N. (2009). An exploration of clinical decision making in mental health Triage. ScienceDirect, p. 298-308.