Clinical Reasoning And Decision Making In Nursing Nursing Essay

clinical Reasoning And Decision Making In Nursing Nursing EssayAll nurses use clinical mind to suffer closes piece of music caring for diligents. These decisions have an effect on the actions of the health cargon professional and the deli actually of health c ar the patient receives Jones and Beck (1996). Its the nurses responsibility to convey clinical decisions based on their learnt cognition and skills. Simple decisions such(prenominal) as, would a bed pan or commode be more steal? To making quick, on the spot decisions, such as what steps to sequester if a patient began to rapidly deteriorate. Nurses rely on sound decision making skills to assign positive outcomes and up to date c be. Orme and Maggs (1993) identified that decision-making is an indispens adequate and integral aspect of clinical practice. Nurses be accountable for their decisions, therefore it is decisive that they ar certain of how they make these decisions Muir (2004). This essay will discuss two decision making models, factors that whitethorn mitigate or interfere with clinical reasoning and decision making in patient centred accusation and how they metamorphose across the contrastive fields of treat. The decision making models that will be discussed are Risk Analysis and Evidence Based.Risk assessment plays a major part in the process of supporting patients and it greatly jocks to maintain safety in hospital settings. Its main purpose is not further to identify potential perils but also remove and block them. sound judgment is considered to be the first step in the process of one-on-oneised nursing care Neno and Price (2008). Risk analysis pass ons information that is vital in under developed a plan of action that back tooth help improve personal health. It has the potential to decrease the severity of chronic conditions, helping the individual to gain control over their health through self-care RCN (2004). Not however is run a run a insecurity analysis f or the patients safety but its also there to fix staff safety Kavaler and Spiegel (2003). It is imperative that nurses use suitable take chances assessment shafts as a guide to enable them to make strong decisions. Once the tool has been use, using the gathered information and using their give birth clinical judgement, the nurse will accordingly be able to exit the right safety precautions for patients Holme (2009). in that respect are m any different types of risk assessment tools available for patients and staff within the clinical setting. For patients there is the Waterlow malt whiskey risk of nip sores and ulcers, the MUST tool Malnutrition Universal Screening Tool, br differenthood Falls Risk Assessment Tool and Pain Assessment Tools are only to name a few and they are commonly utilise in clinical practice. Staff have Infection Control Assessments and sort out Risk Assessments only to name a couple but they should be kept up to date and reassessed regularly Da niels (2004).The pull ulcer risk assessment/ ginmill policy tool, is frequently utilize in clinical practice. jam risk-assessment tools have been described as the backbone of any prevention and treatment policy Waterlow(1991). The Department of Health set annual targets for an general reduction of pressure ulcers by 5-10% over 1 year (DoH, 1993), so it is vital that nurses accurately determine which patients are at risk of ontogenesis pressure ulcers.A pressure ulcer is an area of localised detriment to the skin and underlying tissue ca employ by pressure, shear, friction or a combination of these EPUAP (1998). The intention of the Waterlow pressure sore risk assessment is to complete service users who are highly at risk of developing pressure sores, to avoid them becoming worse and/or even developing them at all, to serve as an early predictive index forward the ripening of pressure dam develop Nixon and McGough ( 2001). It is imperative that patients are assessed using thi s tool, oddly patients with intimate risk factors such as restricted mobility and /or are curb to their bed for long periods of time, patients with poor nutrition, elderly patients, patients with underlying health conditions such as diabetes and patients who are urinary incontinent and bowel incontinent are also highly at risk of developing pressure sores, this repayable to the moisture, moist skin can be weak and susceptible to crack-up Andrychuk (1998). According to the NICE clinical guideline 29 (2005) pressure ulcer grades should be enter using the European Pressure Ulcer informatory Panel Classification System. There are four stages that pressure ulcers are graded at and it is down to the nurses own clinical judgement to find what stage the ulcer is. Depending on the grade of the pressure sore, it will cipher on the type of mattress that will be needed. There are factors to be considered before selecting a mattress for the patient which include, making sure the mattres s does not prove the patient to an unsafe height and to ensure the patient is within the recommended exercising weight range for the mattress NICE (2005).Using their learnt skills, experiences and own clinical familiarity, nurses have to make up ones mind what dressings should be used in the treatment of pressure ulcers. They have to conduct into consideration the grade of the sore, any manufacturers indications for use and contraindications, previous positive do of current dressing and preference for comfort or lifestyle reasons Bouza et al (2005). Specially designed dressings and bandages can be used to speed up the healing process and help protect pressure sores such as hydrocolloid and alginate dressings which will be used at the nurses digression NHS Choices (2010).Nurses should always be aware of any potential risk factors that may worsen or add to the development of pressure ulcers when using any pressure risk assessment tool. The nurse will have to decide the frequenc y of re-positioning the patient, implementing a turning chart to keep times and dates documented and to communicate to other members of staff what time the patient needs turning. This involves moving the patient into a different position to remove or redistribute pressure from a part of the body Walsh and Dempsey (2010). By analysing the evidence on the effectiveness of shift this can help to reduce patient suffering and improve their forest of life, lighten the work load of staff and help reduce the monetary burden on the health service Luoa and Chub (2010).In paediatric nursing, a youngster is to be assessed within six hours of organism admitted and then reassessed daily. Most paediatric pressure ulcer risk assessment scales were developed using clinical experience, or by modifying adult scales Bedi (1993). The Glamorgan Paediatric Pressure Ulcer Risk Assessment Scale was developed using elaborate paediatric inpatient data Willock et al (2008). It is a clinical tool designed to help nurses assess the risk of a child developing a pressure ulcer, it uses a scoring system that takes things like mobility, equipment, haemoglobin levels and temperature into account and guides the nurse as to what interventions need to be put in place, such as what type of mattress or dressings will be needed.In learning disability and mental health nursing, a range of pressure sore assessment tools are used such as the Norton, Braden and Waterlow risk assessment scales, these are mainly used for patients who are not very mobile as in the adult field. Nursing is more strong on their patients psychological health OTuathail and Taqi (2011).It is the nurses duty to provide the best likely care for their patients and this involves using Evidence-based practice. EBP enables the nurse to make decisions about patient care based on the most current, best available evidence. It allows the nurse to provide high quality care to patients based on knowledge and look Rodgers (1994). Princ iples of evidence-based practice and the crucial elements involved in the process are explained by Cleary-Holdforth and Leufer (2008) in five steps. Steps are there to equip nurses with the incumbent knowledge and skills to use evidence-based practice effectively and to make positive contributions to patient outcomes. The five steps Ask, Aquire, Appraise, Apply, Analysis and Ajust are to simply guide healthcare professionals in making effective clinical decisions when problem solving.Early sample Score (EWS) is an evidence based method. Carberry (2002) identifies that the purpose of EWS is to provide nursing and medical checkup staff with a physiological score generated from recordings of vital signs. NICE Clinical Guideline 50 (2007) suggests that physiological track and trigger systems should be implemented to monitor all adult patients in acute hospital settings, providing steering on the standardization of EWS. Physiological signs that should be monitored and recorded are feel rate, blood pressure, respiratory rate, oxygen saturation, temperature and level of consciousness. Vital signs should be recorded upon admission, at regular intervals during a patients stay and also before, during and after certain procedures Castledine (2006) and the frequency of monitoring, if abnormal physiology is detected should increase. EWS uses a scoring system 0, 1, 2, and 3 and colour codes white, yellow, orange and red, number 3 and the colour red being the highest risk indicators Morris and Davies (2010).Nurses should adapt to following guidelines the Early example Score offers, to help make clinical decisions that are best for their patients. Factors that may improve or prevent effective decision making while using the EWS could be down to capability, knowledge and ignorance. If health care professionals are well able and confident in recording and documenting patients vital signs, then any changes can be observed and prevented or dealt with quickly. The EWS imple mentation adds automated alerts hours before a rapid response would be initiated and can decrease treatment delays by up to three hours Subbe et al (2003). It only takes one nurse to insufficiency competence when using the EWS, therefore putting patients lifes at risk.Early Warning Score is also used in the Mental Health and encyclopedism Disability fields of nursing although it may not be used as often as in Adult nursing, it is imperative that patients who are physically or mentally unwell, require monitoring of their vital signs in an acute setting. Nurses may have to use their knowledge to improvise different ways of obtaining vital signs from some patients with learning disabilities or mental health problems, such as turning it into a game or distracting them especially if they lack the mental capacity and are unwilling to comply stout (2010) Medication can have serious effects on a patients health. Indications of these effects may be noticed in their EWS, combined with the knowledge and clinical judgement of health care professionals NIMH (2008) . If the EWS tool is not used as it should be in these fields then it will be hard for the health care professionals to obtain the needed evidence to make accurate clinical decisions.In the child field of nursing a similar tool to the EWS is used called PEWS, Paediatric Early Warning Scores. There are currently four PEWS charts used within the NHS for different age groups, 0-11months, 1-4 years, 5-12years and 13-18 years, the difference being the ranges for childrens vital signs NHS (2013). A key factor that may hinder accurate PEWS scoring could be due to the fact the child is scared when it comes to checking their vital signs, also very young children can be unwilling or fidgety Kyle (2008), this is where the nurse would have to use their knowledge to overcome such problems. The nurse could make it fun for the child, explain the equipment and what they are going to do and why. It is vital that the nurse gain s consent from the childs parent before carrying out any procedure. It is important that the family play an important role in the care of the child DOH (2001).I have learnt various things while researching into the chosen decision making models and methods. I have been made aware of potential risk factors that may arise while using twain tools in all fields of nursing and what could be done to prevent them. I feel confident in looking out for any risks involving the EWS and Pressure ulcer risk assessment tools while out in practice and believe that using these tools correctly can ultimately save up lives.