Clinical Decisions Surname1 Essay Example

  • Category:
    Nursing
  • Document type:
    Essay
  • Level:
    Undergraduate
  • Page:
    4
  • Words:
    2285

Clinical Decisions

Introduction

The integration of patient values, clinical expertise, and also the best research evidence in the process of decision-making regarding patient care is what is called EBP. Clinical skills, education, and the accumulation of clinician’s experience are what we refer to as clinical expertise. The expectations, values, personal and unique concerns are what the patient brings out as his/her encounter. To ensure that the best evidence is found and presented, the best clinically research should conducted while sound methodologies are used to ensure that best results are presented. In their knowledge, nurses know that they do make decisions that are important to the patients that they handle to determine the outcome. In the recent past, they have been considered to be active decision makers due to their active role in the healthcare sector, and they are considered to be heavy contributors to healthcare policy makers and also other members of the healthcare sector profession. In the UK, nurses have been asked to show professional judgment and also being able to make critical clinical decisions; the Chief Nursing Officer has outlined tasks that nurses are expected to ensure that the healthcare sector has been modernized to ensure that the boundary that exists between medicine and nursing is broken down. However, nurses are expected to show their capability in making all these decisions (Sakkett, 2000).

Main Body

When one takes of Evidence-based decision making, it means basing your decisions on the combination of knowledge one has gained throughout his clinical expertise experience, the preferences of the patient and the researchers have done it from the available in different resources. In this type of decision making, one has a wide range of options that he/she can choose from including doing nothing and waiting and seeing what will happen. The choices used at the end always inform by evaluating the available information basing it in the process of clinical judgment. When it comes to making evidence-based decisions, then it is required that research evidence not to be taken according to its face value, rather critical analysis should be done to ensure that the internal and external validity of the research is known. When it comes to the Integration of research evidence in decision-making, it involves the formation of a focused clinical question to act as a response to a recognized need for information. The search of the most appropriate evidence that will be needed to meet the desired needs being able to appraise the retrieved evidence critically, ensuring the incorporation of the evidence into an actionable strategy, and finally, evaluation of the effects of the taken decisions and actions. All the steps mentioned above are very important components when it comes to the process of active evidence-based decision making (Duff, 2000).

In its nature, evidence-based decision making is a prescriptive approach towards making choices in clinical judgments; based on the idea of how theoretical approaches used for the improvement of real life decision-making challenges. It is important for those involved in the process of decision making first to ensure that they identify the starting point, before planning on the strategy that will enable them to attain this ideal. A question asked on how nurses view researchers based on the information of decision making by evidence. What is so surprising, is the fact that there is very little research has been conducted based on this topic. However, there are some studies that have managed to use self-report data which is obtained from nurses and use it as a source of evidence. It’s a norm that there is a rejection of self-report to be used as the main of evidence in answering questions that favor “real time” observations which are clinical and also doing in-depth interviews which are meant to make us feel reflected in our actual decisions in different frequencies and also the observation of information (WHO, 2001).

Most of the theoretical models are used in the utilization of research implicitly way have recognized how important the process of decision making is a very vital step in the process of putting the knowledge acquired into action. Though this is an implicit way, most of this models have failed to recognize the relationship that exists between the characteristics of decisions, how to use the information, and how to process this information. An example of this is the Lomas who has proposed a coordinated research model in its implementation. It has proposed that the diffusion of knowledge can be negotiated and be applied in the research findings as they deal with patients during clinical practice. Other works done by Lomas have suggested that both types of research and decision makers have to increase their level of understanding to one another regarding thinking to ensure that both research and policy linked in a better way. The argument that those practicing clinical work is trying to make efforts that will enable them to understand research through initiatives like critical training appraisals or by trying to read journals that will give them information which is evidence based nursing. Those who are researchers and disseminators have often failed to fully understand to which products do the decisions made meant to be applied. According to decisions taken in organizations and their policies, Lomas have suggested that the researchers always should seek to understand the structures that are within the organization for them to take decisions, they should also understand their values by expression of ideologies, interests, and beliefs. The fact proven by the fact the evidence that there are some producers of evidence existing within organizations and their source of information is from evidence-based decision making. There are other theorists who have tried to come up with a context which they turn into models that research utilizes while neglecting the micro context of those actual decisions. They consider the following factors, the type of information required, how complex that research is perceived to be, the amount of information that is available for support and challenge, and also, the presence or absence of the principles meant for organizing the information (Hamm, 1988).

Some of the researchers have resorted to using clinical questions that are generated by clinical decisions to express the potential information needed for the whole process. The argument that should be in place is that all researchers should start to think deeper and begin the process of developing exploration of relationships that exist between the needs of information which include the information presented by questions and that information that come out of the behavior of the nurses. In addition to this, there is a need for recognition that simple mapping of the core choices to be at the heart of decision-making. This decision should involve the answering of uncertainty that that rose about given treatment, diagnosis, and prognosis. Where information may be sufficient, and the condition used are known well, then the insufficient information can be rejected at the end (Dowie, 1988).

Throughout our discussion, the links between information behavior and the clinical decisions made from the researcher’s perspective are the one that we have been focusing. It is prudent that we recognize how those strategies available for the purpose of clinical decisions. Those who are the decision makers can also be allowed to alter the relationship that exists with the information. According to the principles of the cognitive continuum, it expresses that it is possible to be at a position of simplifying decisions through the removal of some of the complex inducements by individuals in the application of the search and appraisal of the behavior of those involved. Taking this as an example, there are several nurses who have recounted on the usefulness of a structured approach as a way of gathering more information that will be used as a means of simple gathering of those important facts that are used when faced with situations that require complex judgment. The task of assessing a patient who has a chronic leg ulcer for venous or arterial aetiology is one that needs the doctor to be at the top level of judgement to enure that correct decicions are taken. These group of structured facts that include history, size and Doppler reading are formed on the basis of the decisions that are taken by the management. They are always formed on the informed national decisions that are generally based on guidelines that are approved and known to be the best. In addition to this, where single are decision making is used to observe text based information which is relatively common but it is said to be uncertain about use in the medication purpose. The accounts of the nurses have clearly indicated that the sources of information used in ensuring that they are fit for the questions that rose as they were taking decisions that were entirely focused on the well-structured decisions. This will lead to a collect mix that will lead to a particular desired outcome (Cooksey, 1996).

When simplification is done then automatically we will result to the shift of the desired rational to the end of the continuum. When looking things from this point, then one can easily imagine how this particular thinking about a given decision nurses will face in their daily practice of clinical decisions then an impact will be felt on how information will behave. This proves that there are some basic elements that are based on the evidence that is brought out in the nursing process that will be used as decisions in the clinical process. Narrowing down the scoop, when we develop clinical questions that are focused the it is easy to conceptualize them as a mechanism of removing some of the hiccups that may be surrounding the choices that are to be used and therefore enable us turn our attentions to the relevancy of population, interventions, the outcomes, and the other core types of uncertainty like intervention, prognostic or diagnostic. According to Croskery, he tries to come up with some proposals that are somehow more sophisticated, and the technique which is under cognitive forcing process. The techniques used here involve the act of retraining clinicians so as to think in a manner that is different regarding the problems they face through accounting the effects that are associated with limited memory, some erroneous perspective which include ignoring of the base rates of the diseases when making diagnoses which is limited to the capacity of self-critique and other poor methods of selecting strategies. The results that we see at the end are heightened by the sense of meta-cognition or “thinking about thinking”. The researches have indicated that there are so many types of approaches that are missing in the nursing profession to ensure that correct decisions are taken (CNO, 2002).

CONCLUSION

In the healthcare teams, nurses are regarded one of the most group of individuals who take critical decisions. While they are recognized as an important part in decision making, it is also required that they should use best available evidence when making their judgement ad decisions. Using the prescriptive model, to make evidence based decisions and also the search, appraise, and implement process that should accompany this process should be active. Those clinicians who need to implement research in their practice at a point forget that active information seeks many possible responses that are faced with uncertainties of clinical practices. The observations that done by nurses who are exercising their responsibilities has suggested that search and appraise of information should occur to all. Nurses should always try to view their colleagues to be useful and they should access sources of information more that the way they should do with research. Colleagues should always be perceived as those who have relevant information that is needed to be taken into account and the judgmental or decisions from them should be minimal making time used to be minimal. This is one of the elements in clinical decision that is necessary and it leads to high quality decisions that are more important those who are involved. The approaches that have been mentioned above have been able to explain the disconnection that exists between the traditional ways of decision taking and the modern way of doing things. All the above discussed ways of decision taking should be put into practice. Nurses and those who are on the clinical practice should always use evidence based decision making approach.

References

Case DO, (2002). Looking for information: a survey of research on information seeking, needs, and behaviour. London: Academic Press.

Chief Nursing Officer, (2002). PL CNO (2002) 5: Implementing the NHS Plan—Ten key roles for nurses. London: Department of Health.

Cooksey RW, (1996). Judgment analysis: theory, methods, and applications. New York: Academic Press.

Department of Health, (1999). Making a difference: strengthening the nursing, midwifery and health visiting contribution to health and healthcare. London: HMSO.

Dowie J, Elstein A, (1988). Professional judgement: a reader in clinical decision making. Cambridge: Cambridge University Press.

Duff L, Loftus-Hill A, Morrell C, (2000). Clinical guidelines for the management of venous leg ulcers. London: Royal College of Nursing.

Hammond KR, Hamm RM, Grassia J, (1987). IEEE Transactions on Systems, Man, and Cybernetics.

Hamm RM, (1988). Clinical intuition and clinical analysis: expertise and the cognitive continuum.

Pan American Health Organization and World Health Organization, (2001). Guiding principles for complementary feeding of the breastfed child. Washington: PAHO/WHO.

McCaughan D, (2001). What decisions do nurses make?

Sackett DL, Straus SE, Richardson WS, (2000). Evidence based medicine: how to practice and teach EB. Second edition. London: Churchill Livingstone.

Thompson C, Dowding D, (2001). Clinical decision making and judgement in nursing. Edinburgh: Churchill Livingstone.

Wilson T, Walsh C, (1996). Information behaviour: an inter-disciplinary perspective. British Library Research and Innovation Report 10. London: British Library Research and Innovation Centre.