Clinical Decision making and the Nursing Process

Clinical Decision devising and the breast feeding ProcessInternal and external vari fitteds such(prenominal) as the nourishs personal experience, experience, inventive thinking ability, education, self concept, as meshed with the think ofs working environment, and situational stressors all base work to enhance or inhibit effective clinical determination making for a fellate. (OReilly, 1993) Clinical decision-making is defined as the ability to sieve and synthesize information, make decisions, and appropriately implement those decisions within a clinical reach. Practicing defys must effectively target and solve the problems of patient diagnosing and give-and-take by using such a model. One means of doing so, paradoxically, is to identify the barriers to decision making so they batch be overcome by the hire of more than effective decision-making tools. The breast feeding process itself involves the need for feel decision-making at every sage of assessment, diagnosis, fancyning, implementation, and evaluation of patient needs and demands. ( nursing process, 2006, Wikipedia) Thus, both processes be interrelated as to be a good nurse a nurse must be a good decision-maker. run along Patricia Benners stages of clinical judgmentAccording to the nursing theorist Patricia Benner (2004), the novice nurse has little experience, and must essentially proceed by rote to prevail as an effective nurse in the clinical displace, such as a first year nursing student who needs invariable guidance from other hospital staff members. A recent alumnus nurse or advanced beginner possesses some minimal clinical practice and sight grasp attributes but not aspects of the clinical setting without constant assistance. In contrast, a efficient nurse has a imbueing device of experience to know what to ignore and what to assimilate in the clinical setting, base upon greater levels of experience than the advanced beginner nurse. A proficient nurse has made the leap be yond basic competence into a more holistic assessment of understanding of patient needs. Finally, the intellectual nurse no longer relies upon clearly articulated analytical rules of judgment regarding patient diagnosis and treatment at all, but can proceed to judgment on a more transcendental, but still rational level. The expert can deploy both creative thinking and rational thinking concurrently and effectively in the clinical environment.Discuss the ways in which the nursing process contributes to effective clinical decision-makingThe nursing process of assessment, diagnosis, externalizening, implementation, and evaluation are dependant upon both the nurses personal qualities as well as upon the setting of the assessment. (Quan, 2006) For example, during the assessment, augmentd knowledge on the part of the nurse practitioner leads to greater clinical accuracy in judgment. The more experienced nurse knows what to blunter for, based upon clinical knowledge and personal exp erience, and can drop that observed and filtered knowledge in making a more competent diagnosis. A more competent diagnosis leads to a better-planned and implemented course of treatment, and a better assessment of how and if the treatment is working. (OReilly, 1993)But treatment is not alone a checklist. Intuition is also said to be the hallmark of expert judgment, where intuitively on a subconscious level accumulated knowledge kicks in in helping the nurse understand what, if anything, in the patients invoke of health whitethorn be wrong. Creative thinking when assessing the patients psychological and forcible state, the ability to fuse emotion and reasoning in the mind of the season nurse, can lead to a better mental selection of consequential data and a more effective diagnostic conclusion. (OReilly, 1993)Also, self-concept, the empowered use with confidence of ones knowledge that comes with experience and the practice of years can increase the speed and efficacy of the pl anning of the treatment and its implementation and evaluation. However, it is important to phone that even in expert nurses, stresses such as less(prenominal) hence optimal staffing or undercutting confidence with interpersonal staff conflicts can increase anxiety, and can threaten the ability to make an effective diagnosis. A lack of sleep, an overwhelming patient load, or staff condescension, especially in less confident novice nurses can all inhibit the use of ones personal assessment tools and thus disrupt the process of effective nursing in the clinical environment. (OReilly, 1993)Provide examples of how planning for the provision of nursing foreboding might differ at each stage of clinical judgment.Nursing processes are thus always in a dialogue mingled with the nurses own personal competence (internal factors) and the external stressors of the environment. For example, take a passing contentious situation in the ER when a patient may come in, late at night, complaining of chest paints, agitated, and certain that he or she is suffering a heart attack. A novice nurse, in her process of assessment, diagnosis, planning, implementation, and evaluation might merely register the patients emotional put out and promptly call for a doctor specializing in cardiac care, accept the patients own assessment and diagnosis as if it were valid. The nurses lack of confidence and vexation of the possible consequences of an untreated attack might drive her to seek ready assistance to help in the planning and implementation of a plan to aid a heart attack victim.An advanced beginner nurse, less shaken by the emotion of patient, but proceeding by rote and by the knowledge given to her by professional mentors during her minimal preliminary clinical experience, might go down a checklist of evaluating the patients pain, such as where is the pain localized, when the pain began, then asking the patient to describe and regulate the pain, and based upon such an assessmen t, diagnosis the cause and severity of the case beforehand seeing assistance in planning and implementing a treatment plan either for a cardiac condition or for heart go up.A competent nurse might, by sight, be able to respect if the patients pain was nausea, as in heartburn, or if the clutching pain seemed to affect the patients breathing or numb the patients limbs as might be typical of an oncoming heart attack. A proficient nurse might be able to assess the immediate severity of the condition-even if the pain was heart-related, she or he might be able to toss a finer-tuned diagnosis and plan. For example, if the patents angina was life threatening and ask immediate care, or if the pain could be taken care of through a nitroglycerin tablet, for example, and patient rest, before a doctor was called for to evaluate the patients physical health and provide advice regarding future heart care.Finally, an expert nurse might be able to assess, having seen many heart attacks and heart burn patients go through the ER, might know what was needed almost by sight. The expert nurse would likely be also better hot in comforting the patient and thus lessening the trauma of the patients aerate to the ER and the final diagnosis.However, it is important to remember at all junctures of this decision-making process, that a crowded or understaffed ER can interfere with such holistic judgment, although the more experienced a nurse is in trenchant situations, the better able he or she will be to filter out such unnecessary environmental static such as an argument with a colleague, the lateness of the hour, or an uncooperative patient. Experience is not a panacea, but combined with an effective use of clinical decision making and the nursing process, experience combined with the simultaneous and effective deployment of rational and intuitive judgment is the best personal asset a nurse offer to a patient.