Clinical Decision Making and Nursing Process

Afza.Malik GDA

Nursing Process and Decision Making

Clinical Decision Making and Nursing Process

What Is Decision Making,Research On Decision Making,Factors Affecting the Process Of Decision Making,Decision Making As Nursing Process.

What Is Decision Making 

    Clinical decision making is the process nurses use to gather patient information, evaluate the information, and make judgments that result in the provision of patient care (White, Nativio , Kobert , & Enberg, 1992). 

    Clinical decision-making ability is defined as the ability by which a clinician identifies, prioritizes, establishes plans, and evaluates data. Decision making is central to professional nursing and has vital links to patient-care outcomes ( Catolico , Navas , Sommer, & Collins, 1996). 

    Researchers have investigated the process, types, and quality of clinical decision making. Catolico and colleagues (1996) studied decision making of practicing staff nurses. It was demonstrated that nurses with better communication skills had a greater frequency of actual decision-making practices. 

    Intuition was a critical component of clinical decision making in a qualitative study of 10 novice nurse practitioners ( Kosowski & Roberts, 2003). Some researchers have looked at approaches such as informatics or algorithms to aid decision making. 

    Akers (1991) showed that nurses who used algorithms to aid their decision making utilized more thorough patient assessment and a more informed nursing response, which resulted in better patient management. 

    Another critical issue is the educational level and preparation of the nurses who are formulating decisions. Studies have explored the decision-making process of student nurses, staff nurses, and nurse practitioners. 

    A group of nursing students were given didactic and interactive teaching sessions on clinical decision making. Students' decision making was in accordance with the decision making of experts significantly more often than that of the student nurses who did not receive the decision-making content ( Shamian , 1991). 

    A study in the United King did demonstrate that nurses having a college education were significantly better at decision making than their colleagues educated in diploma programs ( Girot , 2000). 

    Advanced practice nurses in specialty practices tend to generate fewer hypotheses in their clinical decision making. Those nurses must be aware that formulating a diagnosis too early in the data-gathering phase precludes the possibility of considering all options (Lipman & Deatrick , 1997),

 Research On Decision Making 

    When investigating the decision making process, researchers have utilized simulations, together with interviews regarding the thought processes individuals use to reach decisions. 

    The quality of decision making is defined as having the ability to make frequently required decisions ( Catolico et al., 1996). That aspect of decision making has been studied by using computer-assisted simulations requiring nurses to make decisions in controlled clinical situations. 

    To investigate clinical decision making by nurse practitioners, the nurses care for patients via computer and interactive videos. To more objectively assess student clinical competencies, the clinical decision-making skills of nurse practitioner students were evaluated using a standardized simulated patient encounter (Stroud, Smith, Edlund , & Erkel , 1999).

 Factors Affecting the Process Of Decision Making 

    Various factors have been shown to affect clinical decision making, such as the experience and the knowledge base of the nurse. Those with case-related experiences are more likely to choose appropriate interventions. 

    A study of nurse practitioners by White and colleagues (1992) concluded that case content expertise is crucial for clinical decision: making from the aspect of understanding the significance of the data acquired and in making the correct decision. Nurses' decision making is also affected by the socio demographics of the patient. 

    Age, sex, race, religion, and socioeconomic status can impact on decision making. Racial disparities in health care may be due to racial biases when formulating clinical decisions. Non-white patients presenting to the emergency department with chest pain are hospitalized less often than white patients (Pope et al., 2000). 

    There was a significant difference in reports of suspected abuse after the evaluation of fractures between minority and non-minority children (Lane, Rubin, Monteith, & Christian, 2002). Competent clinical decision making by nurses requires being cognizant of potential biases.

 Decision Making As Nursing Process

    Decision making is critical to nursing practice. Gathering, organizing, and prioritizing data are major components of the process. Continued research in this area can foster the development of decision-making skills in novice nurses and cultivate high clinical decision-making ability in expert nurses.

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