Clinical decision-making in nursing

Clinical thinking is a skill that all nurses should have, to deliver quality services. The nurse’s clinical decision-making usually influences the patient’s outcomes. As a nursing student, you will have the opportunity to learn different clinical decision-making theories they implement throughout your career.

A slew of advantages accrues when you are given the responsibility to make clinical decision-making in nursing that adheres to best practices. When patients enjoy better results, nurses are more satisfied with their jobs, and the medical institution also benefits by increasing patient care metrics and lowering their risk levels. With the help of different clinical decision-making models, nursing students can acquire the necessary skills and deliver quality nursing care.

Our experts have taken this opportunity to take you through the clinical decision-making process. Let’s begin by defining what clinical decision-making entails and its roots.

What is clinical decision-making?

Nurses are professionals when it comes to delivering patient care services. They grasp a patient’s current situation better than doctors and hospital practitioners. They are the first to notice when a patient is in pain or worsening their condition. Nurses must be problem solvers and decision-makers when determining patient outcomes.

Clinical decision-making in nursing is an active method of evaluating a patient’s status and making a clinical judgment based on the evidence. It’s a team effort, with a group of healthcare professionals weighing in and deciding on the best approach. Patients and families are also included in the clinical decision-making process, which sees patients as their greatest advocates and specialists on their physical and emotional health issues.

Critical thinking abilities, cooperation, communication, engagement, and awareness of quality standards require clinical decision-making models. Nurses, colleagues, and patients maintain open channels of communication. This ensures everyone is on the same page regarding the decisions made and care for patients based on evidence.

Examples of clinical decision-making in nursing

1.      COVID-19 initiatives

During a pandemic, the health of hospitalized COVID-19-infected victims could lead to severe problems. Experienced nurses used their understanding of patient care and an assessment of COVID-19 patients they’d previously treated to select patients most likely to require immediate treatment. Nurses primarily relied on their healthcare facilities and experience rather than rules-based decision-making, enabling them to react to complicated and constantly changing information faster.

2.      Diseases related to catheter

From research conducted by various scholars, Boston Medical Center recognized Foley catheters as the source of 9% of hospital-acquired diseases in its patients. A task force was formed by the medical center, which included nurse managers, nurse educators, urologists, and other practitioners in the organization. This group discovered the problems and implemented infection-prevention education initiatives. Between 2013 and 2017, the campaign resulted in an 83% decrease in catheter-related infections.

3.      Patient falls

Inpatient injuries are frequently caused by falls. Researchers investigate the efficacy of a data analytics application for fall prevention among the elderly and other patients. This is well highlighted in a 2021 study context in the Journal of Medical Internet Research. The findings displayed that using the data analytics tool raised nurses’ understanding of fall risk and reduced the overall number of falls. Such findings contribute to the body of evidence that supports clinical decision-making.

Why is clinical decision-making essential for nursing students?

Clinical decision-making provides numerous benefits to hospitals, patients, and nurses. The approach is founded on the methodology of science (hypothesis, test, repeat). Instead of following a set procedure or checklist, nurses can utilize their medical skills, education, and professional expertise in patient care. Considering nurses are clinicians, they should make medical judgments. Healthcare institutions in the following methods support nursing judgment and critical thinking:

·         Best patient results

The examples above demonstrate how clinical judgment and decision-making can enhance patient outcomes. Nurses evaluate patients, collaborate with colleagues, connect with patients and their families, and evaluate patient health needs. They can make decisions based on research and facts. They can employ critical thinking to determine when a patient’s treatment should be changed. According to the research, clinical decision-making by nurses can increase the quality of care delivered and patient satisfaction.

·         Hospital benefits

Patient outcome measurements are becoming more relevant as healthcare payment systems shift from fee-for-service to value-based treatment. This is because medical institutions and practitioners will soon be compensated mostly based on the quality of treatment they deliver rather than the process. Medicare penalizes hospitals based on statistics like hospital-acquired infections, falls, and readmissions. Enabling nurses to apply clinical judgment can aid in increasing hospital income.

·         Full job satisfaction

Nurse turnover has drastically increased as a result of COVID-19. Nurses claim that when their superiors grant them clinical decision-making power, they are more likely to feel satisfied with their careers. They may be less prone to fatigue and more likely to continue providing nursing services. Employers who treat nurses as clinicians are more likely to maintain personnel, which can help relieve the healthcare system’s statewide nursing deficit.

The two common clinical decision-making models

Clinical decision-making can be considered a multidisciplinary process. It can be used at the patient level since it considers the perspectives of all experts participating in a patient’s treatment plan. It is also applicable at the organizational level, as executives can use all clinical and administrative staff members’ experience and expertise when formulating operational decisions.

·         Coordinated healthcare decision-making

The coordinated care approach is a cornerstone of clinical decision-making at the patient level. It connects healthcare professionals (doctors, nurses, and support workers). It ensures that everyone interacts at different levels, including when patients are transferred to health practitioners or other caregivers or for the duration of their medical problem.

·         Organizational decision-making

Nurses, health practitioners, clinicians, executives, top-level nurses, and chief medical leaders are all involved in the clinical decision-making process at the organizational level. This proved extremely useful during the pandemic. The American Association of Critical Care Nurses reports that patient care nurses, nursing executives, and organizational leaders banded together to enhance clinical care best practices at all levels, beginning with the nursing process.

Best practices regarding clinical judgment and decision making for nursing students

·         Create safe opportunities that test critical thinking abilities while reassuring them that they are appreciated

In the healthcare setting, patient health conditions, and actual and perceived data can come at you easily and fast. Two methods for incorporating critical analysis into the curriculum include case studies in the educational environment and interactive simulation or skills lab beyond repeated demonstrations. Frequent and repeated chances to make mistakes outside the hospital might boost student confidence as they observe themselves effectively negotiating challenging settings.

·         Provide an opportunity for reflective feedback

Enabling students to communicate what went well and, more crucially, what went wrong in a safe atmosphere can significantly boost student confidence. This self-esteem greatly impacts clinical judgment and decision-making for nursing students. It gives you time to interact, debate with each other and solve problems as scholars before seeking your professor’s opinion.

·         Don’t be afraid to push yourself beyond your comfort zone

Your professor will assign you different nursing assignments to complete. It will help them  identify the students who constantly want to monitor or choose the “safe patient.”

·         Preparation is essential

Ensure that students are oriented to a team and, if possible, that they are introduced to their instructor or other professional nurses operating during the clinical training. This can be accomplished during a casual meet-and-greet. Set up a day and space before the clinical assignment for students to assemble in a break or meeting room and ask nurses to engage with students over the cafeteria or field. After investing time on the ground with students, use a treasure hunt to find essential items and regions. All of this helps to lessen ecological fears of the unknown.

·         Pre-clinical evaluation of students

Preparations are critical since students inevitably want to “hit the deck,” often without understanding what they do not yet comprehend or are not prepared for. Students should be able to describe the patient’s diagnosis, predict the presentation, collect data prioritization, and conduct treatments. “What if” scenarios can be an effective pre-clinical conference tactic. Educate students about short-patient situations they must use in the clinical decision-making process.

·         Make yourself known in the clinical context

Students must understand that they have a prominent figure supporting them and that you are available to them when they need your input.

·         Do not undervalue the importance of the post-clinical meeting

This should be the safest area for students to express what was effective and what was not. Work to establish a setting where students may express their difficulties and evaluate their strengths and flaws. Motivate students to find solutions among themselves before you step in to address the situation. You are promoting their potential to understand one another in this way. This boosts student confidence and, as a result, clinical judgment and decision-making.

In summary

From the above article, it is evident how crucial clinical decision-making skill is in the nursing profession. This guide is superb for professors and students to help them understand the clinical decision-making process. As a professor, you can use it to pepper your students with vast knowledge; as a student, it can help you navigate your career.

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