Clinical decision-making in nursing

To provide quality services, all nurses should have clinical reasoning skills. Clinical decisions made by the nurse typically affect the patient’s outcome. As a nursing student, you will have the opportunity to study various clinical decision-making theories.

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A multitude of benefits accrue when you are entrusted with making clinical decisions in nursing that adhere to best practices. When patients experience improved outcomes, nurses are more satisfied with their jobs, and the medical institution also benefits by improving patient care metrics and reducing risk. With the aid of various clinical decision-making models, nursing students can acquire the required competencies and provide quality nursing care.

Our specialists have utilized this opportunity to explain the clinical decision-making process. Let’s start by defining clinical decision-making and its origins.

What is the definition of clinical decision-making?

Professionals when it comes to providing patient care services, nurses are nurses. They have a greater understanding of a patient’s current condition than doctors and hospital practitioners. They are the first to detect a patient’s distress or deteriorating condition. When determining patient outcomes, nurses must be capable problem-solvers and decision-makers.

Clinical decision-making in nursing is the process of actively evaluating a patient’s condition and making an evidence-based clinical judgment. It is a collaborative endeavor, with a group of healthcare professionals weighing in and determining the best course of action. Patients and their families are also involved in the clinical decision-making process, which recognizes patients as their greatest advocates and experts on physical and emotional health issues.

Clinical decision-making models necessitate critical thinking skills, cooperation, communication, engagement, and awareness of quality standards. Communication channels between nurses, coworkers, and patients remain open. This ensures that everyone is on the same page regarding evidence-based decisions and patient care.

Examples of nursing clinical decision-making

1. COVID-19 initiatives

During a pandemic, the health of COVID-19-infected hospitalized patients could cause severe problems. Experienced nurses selected patients most likely to require immediate treatment based on their knowledge of patient care and an assessment of COVID-19 patients they had previously cared for. In lieu of rule-based decision-making, nurses predominantly relied on their healthcare facilities and experience, allowing them to respond more quickly to complex and ever-changing information.

2. infections caused by catheters

The Boston Medical Center identified Foley catheters as the source of 9 percent of hospital-acquired diseases among its patients based on research conducted by multiple academicians. The medical center formed a task force with the participation of nurse supervisors, nurse educators, urologists, and other practitioners. This group identified the issues and instituted infection-prevention education programs. Between 2013 and 2017, the campaign decreased catheter-related infections by 83%.

3. Patient collapses

Falls are a common cause of inpatient injuries. Researchers examine the effectiveness of a data analytics application for preventing falls in the geriatric and other patients. This is emphasized in the Journal of Medical Internet Research in a 2021 study context. The results demonstrated that the use of the data analytics tool increased nurses’ awareness of fall risk and decreased the total number of falls. These findings add to the body of evidence that supports clinical decision-making.

Why is clinical decision-making an important skill for nursing students?

Clinical decision-making provides hospitals, patients, and nurses with numerous benefits. The approach is based on the scientific method (hypothesis, verify, repeat). Instead of following a set procedure or protocol, nurses can use their medical knowledge, education, and professional experience to provide patient care. Since nurses are clinicians, they must make medical decisions. In the following ways, healthcare institutions support nursing judgment and critical thinking:

· Best patient results

The preceding examples illustrate how clinical judgment and decision-making can improve patient outcomes. Nurses evaluate patients, collaborate with colleagues, establish rapport with patients and their families, and assess the health requirements of patients. They are able to make decisions based on facts and investigation. They are capable of using critical thought to determine when a patient’s treatment should be altered. Clinical decision-making by nurses can improve the quality of care provided and patient satisfaction, according to the research.

· Hospital privileges

As healthcare payment systems transition from fee-for-service to value-based care, the importance of measuring patient outcomes grows. In the near future, medical institutions and practitioners will be compensated primarily based on the quality of care they provide, as opposed to the procedure. Medicare penalizes hospitals based on statistics such as infections acquired in hospitals, accidents, and readmissions. Allowing nurses to exercise clinical judgment can help increase hospital revenue.

· Full job satisfaction

As a consequence of COVID-19, the turnover rate among nurses has skyrocketed. When their superiors delegate clinical decision-making authority to them, nurses claim they are more contented with their careers. They may be less susceptible to fatigue and more likely to continue to provide nursing care. Employers who regard nurses as clinicians are more likely to retain personnel, which can help alleviate the statewide nursing shortage in the healthcare system.

The two prevalent models of clinical decision-making

One can consider clinical decision-making a multidisciplinary process. It is applicable at the patient level because it incorporates the opinions of all specialists involved in a patient’s treatment plan. It is also pertinent at the organizational level, as executives can utilize the experience and knowledge of all clinical and administrative staff members when formulating operational decisions.

Coordination of healthcare decision-making

The coordinated care approach is fundamental to patient-level clinical decision-making. It facilitates communication between healthcare professionals (doctors, nurses, and support staff). It ensures that everyone interacts at various levels, such as when patients are transferred to health practitioners or other caregivers or throughout the duration of their medical problem.

· Organizational decision-making

At the organizational level, nurses, health practitioners, clinicians, executives, top-level nurses, and principal medical leaders are all involved in the clinical decision-making process. This was incredibly helpful during the pandemic. Patient care nurses, nursing executives, and organizational leaders joined forces, according to the American Association of Critical Care Nurses, to improve clinical care best practices at all levels, commencing with the nursing process.

Best practices for nursing students’ clinical judgment and decision-making Create risk-free opportunities to assess critical thinking while assuring students of their value.

Patient health conditions, as well as actual and perceived data, can arrive rapidly and readily in the healthcare setting. In addition to repeated demonstrations, case studies in the educational environment and interactive simulation or skills lab are two methods for incorporating critical analysis into the curriculum. Frequent and repeated opportunities to make errors outside of the hospital may bolster students’ confidence as they observe themselves successfully navigating challenging environments.

Facilitate the opportunity for reflective feedback

Permitting students to communicate in a safe environment what went well and, more importantly, what went awry can significantly boost student confidence. This self-esteem has a significant impact on nursing students’ clinical discernment and decision-making. It allows you to interact, debate, and solve problems as scholars prior to pursuing your professor’s opinion.

Don’t be hesitant to challenge yourself beyond your comfort zone.

Your professor will designate you various nursing-related tasks to complete. It will assist them in identifying the students who continually monitor or select the “safe patient.”

Preparation is indispensable

Ensure that students are oriented to a team, and if possible, introduce them to their instructor or other professional nurses operating during clinical training. This can be accomplished during an informal encounter. Set up a time and location before the clinical assignment for students to gather in a break room or meeting room and ask nurses to interact with them in the cafeteria or on the field. After spending time on the ground with students, use a treasure search to identify important objects and regions. This reduces ecological apprehensions of the unknown.

Pre-clinical evaluation of medical students

Preparations are crucial because students invariably want to “hit the deck” without comprehending or being prepared for what they do not yet comprehend. Students must be capable of describing the patient’s diagnosis, predicting the presentation, prioritizing data collection, and administering treatments. The use of “what-if” scenarios at pre-clinical conferences can be an effective strategy. Educate students on short-patient situations for which they must make clinical decisions.

Identify yourself within the clinical context

Students must realize that they have the support of a prominent figure and that you are accessible to them if they need guidance.

Do not underestimate the significance of the post-clinical meeting

This should be the safest place for students to discuss what was and was not effective. Establish a setting in which students can discuss their difficulties and assess their strengths and weaknesses. Encourage students to discover solutions amongst themselves prior to your intervention. You are thereby increasing their capacity to comprehend one another. This enhances pupil confidence and, consequently, clinical reasoning and decision-making.

In summation

Evident from the preceding article is the importance of clinical decision-making skills in the nursing profession. This guide is exceptional for helping professors and students comprehend the clinical decision-making process. As a professor, you can use it to impart extensive knowledge to your students; as a student, it can assist you in navigating your career.

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