Clinical decision making can be defined as, the collection of relevant patient information and accurate assessment, which results in an action being taken in the delivery of nursing care to the patient (Clark 1996). This definition is identical to the nursing process as described by (ref less & sentiment? ) however, this has been disparaged by some for not being critical in its stages (assessment, planning, implementation and evaluation) leading to standardized care plans and the reduction in decision making based on the individual patient (Banner et al 1996).
Therefore, a definition by Standing (2005) which goes on to say that decisions should also be evidence based, critically thought out and within the realms of that nurses capabilities, is more applicable. The NC (2004) state that the capacity to exhibit ‘sound clinical-decision making,’ is an essential requirement for pre-registration nurses. This alongside the NC Code (2008) which stipulates evidence based practice must underpin actions and/or omissions leading to accountability of care highlights the need for the ability of nurses to make and carry out clinical decisions.
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Dresses and Dresses (1986) argued that expert nurses make decisions based on intuition. However, intuition is not in keeping with the aim of evidenced based care stipulated in the DOD (1998) paper, A First Class Service, which aspires to raise the standard of care throughout the NASH. Conversely, it is unrealistic to have a guideline for every clinical decision, therefore nurses must be able to make decisions by referring to policy/guidelines, drawing on their own knowledge and experience whilst also taking into account clinical observation of the patient, their wants and needs Basalts & Watson 2005).
For the purpose of this essay the example of decision making is observed from a student nurse perspective. The decision was whether or not a staff nurse would challenge a doctor about his choice to re-cumulate a child. In brief the situation was as follows; a female child of eighteen months on an .NET ward was on her final dose of IV antibiotics for an mayhem. The child pulled out her canella, the nurse was not aware of this until she was about to administer the medication at ten pm. The child was asleep and due to commence oral antibiotics the next morning.
The Senior House Officer (SHOO) on call was a cardiac thoracic specialist who was also aware of the patients history and wanted to re-accentuate the child. The patients named nurse was an experienced member of staff who had worked on the ward for twenty years and was practiced at nursing children with emphysema. Acting as an advocate for the child she believed that it was not in the child’s best interests to recalculate and challenged the doctor to reconsider his decision.