Reflective Essay on Clinical Decision Making

Reflective Essay on clinical finality devisingClinical conclusiveness devising in nursing involves applying vital thinking skills to select the best uncommitted reason based pickaxe to control essays and address tolerants needs in the provision of high forest shell out that nurses are accountable for. Standing, M. (2011)Nurses are accountable for the quality, safety and say-so of their clinical termination reservation. We are accountable to the patient of ofs, clients and service practisers to whom we owe a duty of tutelage. According to Standing, M. (2011), accountability in finale making is beingness answerable to patients, the public, employers, NMC and the law for the consequences of our actions and having to explain, prune, and defend our findings.The Nursing and Midwifery Council (NMC, 2008) states that nurses are personally accountable for their actions during work out and whence they must(prenominal) be able to justify their terminations at all ti me. Nurses have to balance a number of elements onward they make a decision, however the patients best interest is their main priority. last making involves valuateing available options and their effectiveness. It applies judgement regarding our reasons for doing or not doing things. As nurses, we commit different cultivation sources to support our judgement and decision making.Nursing is the white plague of clinical judgement in the provision of conduct to enable lot to improve, maintain, or recover health, to cope with health problems, and to achieve the best accomplishable quality of life whatever their disease or impediment, until death. (Royal College of Nursing, 2003)Decision making requires thinking skills to exercise judgement in assessing the benefits of available options and choosing a pet option that is then acted upon. Judgement is not decision making only is closely related. Decision making links judgement to utilization by acting on it in choosing from the options available. There are different models of decision making in nursing developed to facilitate nurses make their decision on all aspects of nursing safekeeping and I decided to localize on guess analysis and management and differentiate based decision making.Clinical work is often pertain with fortune reduction and with the develop trend in health forethought litigation, there is a big accent on risk management for both the patients and health dispense staffs. Clinical risk management will fundamentally happen through the description and application of agreed single care plans. The development of a super and separate care plan will relate to the broad figure of effective treatment, rehabilitation and support services provided at the current take of clinical k out chastenledge (Morgan, S., 1998).Risk discernment is a process of identifying and study factors associated with the increased probability of specified risk occurring. It is an examination of the con text and exposit of past risk incidents in the light of current circumstances. It is as well concerned with the patterns of circumstances in which these factors may arise.A nurse may assess a patient as at risk of developing nip sores, and then implement measures to try and reduced the likelihood of this event occurring by providing equipment such as specialist mattress.Risk judgment is a invariable process in which nurses gather study from multiple sources and other health care professionals with the focus of identifying the factors that is associated with the increased probability of risk happening. It is the foundation on which decisions are made and risks plans are then formulated through available national and local policies and procedures (Morgan, S.,1998). According to Lipsedge (1995), good practice in risk assessment requires nurses to translate their knowledge into a cl previous(predicate) distinct conceptualisation of the risks. The formulation should ideally reflec t aspects of each individual, context and systems that may fix the potential for risks.The primary aim of pull ulcer risk assessment in like mannerl is to help nurses identify individuals at risk of hale ulcers and bound the degree of risk (Shakespeare 1994).Formal press ulcer risk assessment involves the intention of a tool that assists in identifying those patients likely to develop a pressure ulcer.According to Guy, H. (2007), risk assessment on pressure ulcer requires multifactorial consideration. Risk-assessment tools are a useful signpost to risk factors alone must not be used in isolation to identify risk. It is valuable to carry out a care plan once the patient is identified to be at risk of developing a pressure sore so that occurrence of pressure damage prat be prevented.Most nurses are familiar with the use of pressure sore risk assessment tools such as the Braden or Waterlow scales. These tools collect info regarding various factors thought to be associated w ith the development of pressure sores. There is normally most form of scoring system which shows the probability of the pressure sore occurring. For example, if a patient arrive ats 15 or over on the Waterlow scale, the individual may be considered at risk of developing pressure sores and therefore the nurses will have to maintain a pressure ulcer legal community (PUP) bundle in ordination to keep track of the patients condition. According to Waterlow (1985), recommended care interventions are available with each recommendation corresponding to the risk score parameters of the Waterlow scale.The Waterlow scale is mostly used in adult field of nursing. It bottom of the inning also be used with hospitalised mental health and learning disability patients. However, the Waterlow scale is specifically designed for adults and therefore it is not appropriate to be use on children. Paediatrics use a different pressure ulcer risk assessment tool called the Glamorgan scale (Willock, J. et al, 2007).No risk assessment tool can be 100% accurate. The key retort in examining risk assessment tools is how good they are at distinguishing those at risk from those who are not and if they are better or much accurate than simply relying on professional judgement (Thompson, C. Dowding, D., 2002). When considering risk assessment and risk reduction, it is valuable that the initial assessment of risk is accurate.Evidence refers to knowledge that is used to support particular beliefs, decisions and actions. Evidence-based decision making is a prescriptive approach to making choices based on ideas of how research and theory can be used to improve decision making in regards to tar and quality of patient care. According to Nursing and Midwifery Council (2008a, p.7), nurses are now required to use evidence based practice. For example, nurses must deliver care based on the best available evidence or practice and must ensure any advice given to patients are evidence based.Sackett el al (1996) defines evidence base practice as the conscientious, explicit and clear-sighted use of current best evidence in making decisions roughly the care of the individual patient by incorporating individual clinical expertise with the best available external clinical evidence from a organized research. This center that one solution will not be the uniform for all clinical scenarios and it is the nurses role to identify the research that best fits the clinical situation.According to McKibbon (1998)Evidence based practice is an approach to health care wherein health professionals use the best evidence possible, i.e. the most appropriate information available to make clinical decisions for individual patients. Evidence based practice values, enhances and builds on clinical expertise, knowledge of disease mechanisms, and pathophysiology. It involves complex and conscientious decision making based not only on the available evidence but also on patient characteristics, situat ions and preferences. It blots that health care is individualised and ever changing and involves uncertainties and probabilities. Ultimately, Evidence base practice is the formalisation of the care process that the best clinicians have practiced for generations.McKibbon (1998) recognises the importance of the patient when making decisions about their own care. According to Reigle, Steven, Belcher et al (2008) and Talsma, Grady, Feetham, et al (2008), the reason why evidence based practice is consistently implemented is because it leads to the highest quality of care and best patient outcomes. It involves combining the knowledge of an expert, patient preferences and research evidence within the context of available resources. Also, studies by McGuinty and Anderson (2008) and Williams (2004) showed that evidence based practice has reduced healthcare prices and geographic variation in saving of care.Integrating research evidence into decision making involves forming a pore clinical question in response to a recognised information need, searching for the most appropriate evidence to meet that need, critically appraise the retrieved evidence, incorporating the evidence into a strategy for action, and evaluating the effects of any decisions and actions taken. Thompson et al (2004) oneness of the tools used in evidence based practice is the use of the early warning score system (EWS). EWS were developed to assist health care professionals detect if patients are deteriorating. It is based on physiological parameters taken when transcription patient observation e.g. the patients heart rate, respiratory rate, temperature, oxygen saturations and systolic crosscurrent pressure. The EWS is designed for adults and can also be use with mental health and learning disability patients. However, referable to children and adults different physiological responses, EWS is inappropriate to use on children. Alternatively, Paediatric Early Warning Scores (PEWS) is use for chil dren, to infix observations and is use to assess the childs condition i.e. If the childs score is high then this means he/she is at risk of deteriorating, this gives nurses an early indication that an action has to be done.The use of early warning score (EWS) is the best practice for clinical observations (Department of Health, 2000), and this is backed up by NCEPOD (2005) who emphasised that every in-patient should have a EWS recorded. Accurate and timely observations and adherence to EWS is essential in order to recognise patients who are at risk of deterioration.According to NICE (2007), nurses caring for patients in acute hospital settings should be skilled in monitoring, measuring, and interpreting data and have prompt response to the acutely ill patient and they should be assessed in order to demonstrate their competency. Early intervention can help prevent patients condition from deteriorating which then helps avoid the need to transfer the patient to a higher level of care. However, despite the good outcome of victimization evidence based practice in decision making with regards to patient care, there are issues such as nurses do not evermore make their decision based on available evidence due to lack of skills i.e. poor IT skills, lack of research skills and literature. There are also misconceptions that traditional ways is the best way, or that gathering evidence is too difficult and time consuming. Becoming skilled in clinical decision making requires the application of a range of evidence regarding patient concern, animal(prenominal) and human resources within healthcare contexts, understanding health and illnesses, developing expertise in applying therapeutic approaches, a commitment to enhance the wellbeing of those in your care and fulfilling the requirements of the relevant professional body.Overall, as nurses, it is important to have a basis when we make a decision regarding patient care. Risk is intrinsic to nursing and the assessment of r isk is one of the most common judgements nurses make. for each one decision making model requires certain set of skills in order to be put on proper use and get the right results. Nurses are expected to use valid evidence to support their decisions when deciding what care to provide each patient. It is also important that nurses use their resources cost effectively by ensuring that resources and equipment are used correctly by the patient. sometimes it is difficult for the nurse to come to a decision that will match clients and co-workers and they also may be challenged at any time, however the important thing is that the nurse takes full responsibility and is able to justify his/her decision. Making the wrong clinical decision is not only harmful to patients but can also damage a nurses career. Learning about developing and applying effective clinical decision making skills is vital for the wellbeing of patients and nurses cleverness to demonstrate that decisions are justified.