Module 5C Clinical Decision-Making PowerPoint PDF

Clinical Decision-Making NUR 211 Unit 5 Module 5C Jill Huffman, MSNed, RN Learning Outcomes • Discuss the use of critical thinking skills in nursing. • Distinguish between problem-solving and the nursing process. • Differentiate considerations related to clini...

Clinical Decision-Making NUR 211 Unit 5 Module 5C Jill Huffman, MSNed, RN Learning Outcomes • Discuss the use of critical thinking skills in nursing. • Distinguish between problem-solving and the nursing process. • Differentiate considerations related to clinical decision-making about patients throughout the lifespan. • Discuss the components of clinical decision-making. Learning Resources • Ignatavicus, D. (2021). Pp. 10-12 & 18-27. • ATI Fundamentals for Nursing 10.0 – Chapters 7 & 8. • ATI Engage Fundamentals: (Review) • Clinical Decision-Making – Clinical Judgement Process • Priority-Setting frameworks Patient-Centered Care ● A competency recognizing the patient as the source of control of his or her care. ● Includes nursing theories of caring compassion, and whole person care to respect the diverse preferences and needs of the patients and their families. ● All patients have the right to have their basic physical care and comfort needs met. ● Requires an interdisciplinary team approach to meet the individual needs of the patient. Critical Thinking ● The skill of using logic and reasoning to identify the strengths and weaknesses of alternative healthcare solutions, conclusions, or approaches to clinical or practice problems. ● Learning to analyzes and interpret data to solve a problem to achieve a desired outcome. ● Includes questioning, analysis, synthesis, interpretation, inference, reasoning, intuition, application, and creativity Critical Thinking ● Without critical thinking, safety lapses and errors occur that can lead to harm or death. ● Caring behavior best predicts a nurse’s willingness to use critical thinking. ● Fundamental elements of critical thinking: ○ Patient-Centered Care ○ Safety ○ Evidence-Based Practice ○ Informatics ○ Teamwork and Collaboration ○ Quality Improvement ● Based on logic, creativity, and intuition ● Driven by needs ● Focused on Safety and Quality ● Guided by Standards Critical Thinking ● Critical thinking involves questioning with meaning ● Examining personal thinking and the thinking of others ● Judgments are made on facts, not assumptions ● New ideas and alternatives are offered in a constructive way ● Willing to consider other ideas and recognizes that there may be more than one right way to do something Clinical Reasoning ● The process by which nurses collect cues, process the information, come to an understanding of a patient problem or situation, plan and implement interventions, evaluate outcomes, and reflect on and learn from the process. ● Includes: Anticipating consequences of actions, Interpreting data, Noticing cues, Setting priorities ● Takes place through a process known as ADPIE ○ A- Assessing ○ D- Diagnosing (Nursing not medical) ○ P- Planning ○ I- Implementing ○ E- Evaluating Five- Step RN Nursing Process ● Assessment - complete and analyze a comprehensive assessment of the patient ● Nursing Diagnosis - using assessment data gathered formulate individualized nursing diagnosis ● Planning - prioritize nursing diagnosis, interventions, and alternatives to be carried out ● Implementation - direct and carry out the plan of care. Collaborate and delegate to other team members as appropriate ● Evaluation - evaluate the patient’s progress and adjust the plan of care as needed to achieve goals Four-Step LPN Nursing Process ● Assessment - gather basic subjective and objective data ● Planning - understands the priorities and interventions identified in the plan of care ● Implementation - carry out specific interventions as directed by the RN ● E valuation - provides the RN with basic assessment data as directed by the plan of care Clinical Judgement ● The observable outcome of critical thinking and decision making ● A process that uses nursing knowledge to observe and assess presenting situations, identify a prioritized patient concern, and generate the best possible evidence-based solutions in order to deliver safe patient care. ● Includes being respectful of the patient’s and family’s culture and lifestyle choices. ● Outside influences such as environment of care can influence your decisions and affects clinical judgement. Clinical Judgement ● Based on layers of collected information and surrounding context ● Each time the nurse encounters a patient, assessment begins. ● Environment, time pressure, availability or content of electronic health records, resources, and individual nursing knowledge have a direct impact on clinical judgement. ● The foundation on which the nurse will form hypotheses, prioritize decision making, formulate solutions, and then implement nursing interventions. Six-Step Process to Clinical Judgement 1. Recognize Cues: elements of data that provide important information. What is important vs. what is not important. What is of immediate concern? What is relevant to the situation? 2. Analyze Cues: How do the cues connect to the patient’s condition or history? What is most relevant? 3. Prioritize Hypotheses: Consider all possibilities and determine their urgency and risk for the patient. What will happen? Which possible outcomes present the greatest concern? Six-Step Process to Clinical Judgement 4. Generate Solutions: Use the hypotheses to develop expected outcomes. Determine the desired outcome first to help decide which interventions are appropriate. What interventions will lead to the expected outcome? What interventions should be avoided or are potentially harmful? 5. Take Action: Use nursing interventions to address the highest priorities of care and indicate how these will be performed. Consider the need for any additional interventions such as additional assessment, health teaching, documentation, requested healthcare provider orders or prescriptions, nursing skills, interprofessional collaboration, etc. 6. Evaluate Outcomes: Consider patient outcomes in relation to expected outcome. What signs indicate an improvement, decline, or unchanged patient condition? NCSBN Clinical Judgement and Action Module Systems Thinking ● An approach to care that reinforces the nurse’s role in safety and quality improvement while expanding clinical judgement to include the patient’s place within the greater healthcare system in the context of care decisions. ● Encourages nurses to look beyond individual actions for additional or enhanced methods to promote safety and increase quality improvement. ● Analysis of data retrieved from systems thinking may lead to goals and policy changes that could then be enacted to improve patient outcomes. Health Care Concepts ● Influencers that guide care for the patient ● They can impact the nurse’s critical thinking, clinical reasoning, and decision making about a patient’s care. ● Includes: ○ Complexity of care ○ Interprofessional practice ○ Evidence-Based Practice (EBP) ○ Determinants of health ○ Population health ○ Emerging technology ○ Health policy Practice A 38-year-old mildly obese woman is brought to the emergency department by her older sister with a severe attack of her chronic asthma. The client has audible wheezes on inhalation and exhalation. Her admitting vital signs are B/P - 172/100, P - 114, RR - 24, T - 100.0 F, O2 sat - 78% on RA. When the nurse asks her if she took her medications today, she nods yes but is too breathless to speak. Her lips and nailbeds are cyanotic, and she has an anxious expression on her face. The nurse notes that the patient has a brace around her right knee. Her sister tells the nurse that the patient called her about 30 minutes ago and asked to be taken to the hospital because several doses of her reliever inhaler were not helping her asthma attack. The sister has all of the patient’s prescribed medications in her purse, which include albuterol inhaler, a salmeterol inhaler, and a fluticasone inhaler. When asked about the patient’s knee brace, the sister reports that the patient had chronic knee pain and has been taking both acetaminophen and an NSAID daily to manage the discomfort. 1. What assessment findings are most important? What other data do you need? 2. After analyzing all the data what nursing diagnosis(s) would be most appropriate for this patient? How would you prioritize them? 3. What is your nursing plan of action and goals for this patient? Is it individualized to the patient? 4. What actions need to be completed first? Who would implement the tasks? 5. How frequent do you plan to evaluate this patient? What indicates that the actions were effective? Do you need to adjust the plan of care?