Nursing Clinical Decision Making
Nursing clinical decision making is something that will develop over time, but with practice and experience you will build your confidence and intuition.
Nursing Clinical Decision Making
1 New nurse? It can be hard to know how to make decisions.
The nurse’s decision-making process incorporates several important factors. The context of the situation, the patient’s perspective, and own beliefs and values are all taken into account.
When you make a decision in nursing practice, consider these factors:
- Context — What is happening around you? Is there a code on-going? Are there other nurses involved in this patient’s care? If so, who are they? Where are they located relative to your location at any given time (i.e., near or far)? How many people are present in this room at any given moment? Are there multiple patients for whom you will be making decisions simultaneously? Is this person awake or asleep when making their decision(s)? Do they have access to their own health care information (if applicable)? What medications/supplies might be needed prior to implementing interventions (i.e., electrocardiogram electrodes).
2 How do we know what to do?
When you are caring for a patient, the first thing that you need to do is to ask questions. You have to know what you are dealing with and make sure that you understand the problem. Then, use the nursing process, which is an approach used by nurses everywhere. It will help guide your actions and solve problems when needed.
Some of the things that you should think about before deciding what to do include:
- What information do I have?
- Do I have enough knowledge?
- Do I have enough experience?
3 What do we need to know?
As nurses, we need to know the following:
- What are the patient’s problems?
- What is the patient’s history?
- What is the patient’s current situation?
- What is their diagnosis?
- What is their prognosis?
- What are their goals (what do they want)?
4 We need to think about the situation in a different way.
When we think about situations from the patient’s perspective, we can better understand the health problem. When we think about situations from the nurse’s perspective, we can see how our actions affect others and make recommendations accordingly.
When we think about situations from the family’s perspective, it helps us to understand what they are going through and how they may be feeling. We can also learn more about their expectations for care and treatment so that there are no surprises along the way.
When thinking about situations from a healthcare team perspective, it is important for everyone involved in providing care for patients to work together as a team. This includes nurses, physicians, dietitians/nutritionists (etc.), pharmacists (etc.), social workers or case managers who help coordinate medical services outside of nursing homes or hospitals including home-based palliative care programs; chaplains who provide spiritual support; physical therapists who assess mobility problems related to disease processes such as stroke or spinal cord injury; occupational therapists who assess fine motor skills such as self-feeding after stroke; speech pathologists who assess verbal communication challenges caused by brain injury or neurological disorders like Parkinson’s Disease which could result in difficulty swallowing safely if not addressed early enough during recovery period following acute illness episode requiring hospitalization.”
5 Using the nursing process is a good way to be organized about it.
The nursing process is a systematic way to think about what you need to do. It helps you organize your thoughts, so that if you are confused or get stuck on something, it will help guide you through the decision-making process. A good way of using the nursing process is by creating a flow chart. Once all of your information is organized in columns and rows, it will be much easier for you and others involved with making decisions about how to proceed with care.
6 Clinical decision making is a skill that develops over time, but with practice and experience you will build your confidence and intuition.
Clinical decision making is crucial to your role as a nurse, and it is an important part of the nursing process. Clinical decision making is a skill that develops over time, but with practice and experience you will build your confidence and intuition.
When you approach a patient in care, it’s important to be prepared for what you might need to do next. You can use this checklist:
- What are your goals for this patient?
- How will I know if I have met those goals?
- Are there any obstacles that could prevent me from reaching my goals?
7 Nursing practice requires a lot of critical thinking and applying that knowledge through clinical decision making.
Nursing clinical decision making is a complex process that requires a lot of knowledge and skill. It involves the ability to apply principles, concepts, and theories of nursing care to individual patients in order to meet their needs while ensuring safe care delivery.
Nursing practice requires a lot of critical thinking and applying that knowledge through clinical decision making. Nursing clinical decision making is an integral part of evidence-based practice (EBP). EBP requires nurses to collect data about current practices, evaluate those practices based on research findings and other evidence-based sources, then make recommendations for changes in practice when needed
Closing
Clinical decision making is a skill that you can develop over time. It will take practice and patience, but with time and experience you’ll have more confidence in your ability to make the right decisions for your patients.