CLINICAL DECISION MAKING

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CLINICAL DECISION MAKING THE NURSING PROCESS

• NRS 110

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Critical Thinking Revisited

• Knowledge
• Experience
• Reflection
• Intuition

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Components of Critical Thinking in Nursing

• Specific Knowledge Base
• Experience
• Critical Thinking Competencies
• Diagnostic Reasoning
• Clinical Decision Making
• Nursing Process
• Critical Thinking Attitudes
• Critical Thinking Standards
• Intellectual Standards
• Professional Standards

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Clinical Decision Making

• Critical thinking process for choosing the best
  actions to meet a desired goal
• To act or not to act, that is the question!
• Criteria used to make decisions
• Collaboration
• Problem Identification
• Who is responsible for making the decision?

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Level of Critical Thinking

• Basic
• Complex
• Commitment

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NURSING PROCESS

• Assessment
• Diagnosis
• Planning
• Implementation
• Evaluation

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The nursing process in action
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Step One Assessment

• Collect data (Types of data, Sources of data,
  Methods of data collection)
• Organize data
• Validate the data
• Record report

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Step 2 Diagnosis

• Analysis of assessment data leads to problem
  identification
• NANDA list
• Types of nursing dx.

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Anatomy of a Nursing Diagnosis

• Problem (Diagnostic label)
• Etiology (Related factors and Risk factors)
• Defining Characteristics
• Differentiating Nursing Diagnoses from Medical
  Diagnoses
• Differentiating Nursing Diagnoses from
  Collaborative Problems

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The Diagnostic Process

• Analyzing data Compare data against standards,
  cluster data, identify gaps and inconsistencies
  in data
• Identify health problems, determine problems and
  risks, determine strengths

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Formulating Diagnostic Statements
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Step 3 Planning

• Set priorities
• Apply standards
• Identify goals outcomes
• Select interventions
• Record the plan (nursing care plan)

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What are the priorities?
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Maslows Hierarchy of Basic Human Needs
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Guidelines for Writing Goal Statements

• Write goals in terms of client responses
• Be sure the desired outcomes are realistic and
  compatible with ordered therapies
• Make sure that each goal is derived from only one
  nursing diagnosis
• Use observable, measurable terms for outcomes
• Involve the client in the process

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CONCEPT MAP Ineffective Airway Clearance (Gas
Exchange)
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Step 4 Implementation

• Put your plan into action
• Perform the interventions
• Note patient response to interventions
• Record report

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Types of Interventions

• Independent (nurse initiated)
• Dependent (physician initiated)
• Collaborative

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Step 5 Evaluation

• Did the plan work?
• Was goal achieved?
• What was the outcome of the care provided.
• Stated in measurable terms.
• Its all about outcomes!

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Case Scenario

• A.A. is an 28 y.o. female who was admitted with
  pneumonia. She presents with complaint of cold x
  2 weeks, dyspnea on exertion, , orthopnea,
  decreased oral intake. Assessment of patient
  reveals
• T 103F, P 92, R 22 shallow, BP 122/80
• Dry mucous membranes, hot pale skin
• Decreased breath sounds, inspiratory crackles
• Ineffective cough-coughing up thick pink sputum
• Lethargic, c/o being weak

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Now lets write the plan down!
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Concept Map Steps

• Place your main issue/problem in the middle
• Determine key problems/concepts that have a
  direct relationship to the main problem
• Add clinical data to appropriate problem boxes
• Draw lines between related problems. Label with a
  nursing diagnosis
• Identify goals/outcomes
• Add interventions
• Evaluate patient response to interventions

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CONCEPT MAP Ineffective Airway Clearance (Gas
Exchange)