Clinical Decision-Making in Nursing

Clinical Decision-Making in Nursing

Clinical thinking is an essential skill for all nurses, as it plays a pivotal role in delivering high-quality healthcare services. The ability to make clinical decisions has a direct impact on patient outcomes. As nursing students, you’ll have the opportunity to explore various clinical decision-making theories that you can apply throughout your nursing career.

There are numerous advantages to taking on the responsibility of making clinical decisions in nursing following best practices. When patients experience better outcomes, nurses find greater job satisfaction, and healthcare institutions benefit by improving patient care metrics and reducing risk levels. With the guidance of diverse clinical decision-making models, nursing students can acquire the necessary skills to provide exceptional nursing care.

Evidence-Based Project, Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews

Our experts are here to guide you through the clinical decision-making process, starting with a definition of what clinical decision-making entails and its foundations.

What Is Clinical Decision-Making?

Nurses are the front-line professionals when it comes to delivering patient care services. They often have a deeper understanding of a patient’s current condition compared to doctors and other healthcare practitioners. Nurses are typically the first to detect when a patient is in pain or their condition is deteriorating. This underscores the importance of nurses being skilled problem solvers and decision-makers when it comes to determining patient outcomes.

Clinical decision-making in nursing is an active process that involves assessing a patient’s status and making clinical judgments based on available evidence. It’s a collaborative effort, with a team of healthcare professionals coming together to decide on the best course of action. Patients and their families are also integral parts of the clinical decision-making process, as they are viewed as advocates and experts regarding their physical and emotional health issues.

Critical thinking skills, collaboration, communication, engagement, and adherence to quality standards are essential components of clinical decision-making models. Nurses, colleagues, and patients maintain open lines of communication to ensure that everyone is aligned with the decisions made and that patient care is evidence-based.

Examples of Clinical Decision-Making in Nursing

1. COVID-19 Initiatives

During the COVID-19 pandemic, the health of hospitalized COVID-19 patients was at significant risk. Experienced nurses relied on their knowledge of patient care and their previous experiences with COVID-19 patients to identify those in urgent need of treatment. These nurses primarily used their expertise and the unique circumstances they faced, rather than rigid rule-based decision-making, enabling them to respond rapidly to complex and constantly changing information.

2. Catheter-Related Diseases

Research conducted by various scholars revealed that Foley catheters were responsible for 9% of hospital-acquired diseases among patients at Boston Medical Center. To address this issue, a task force was formed at the medical center, consisting of nurse managers, nurse educators, urologists, and other practitioners. This collaborative group identified the problems and implemented educational initiatives focused on infection prevention. Between 2013 and 2017, this effort led to an impressive 83% decrease in catheter-related infections.

3. Patient Falls

Falls among inpatients are a common cause of injuries. Researchers conducted studies to assess the effectiveness of a data analytics tool for preventing falls among the elderly and other patients. This was prominently featured in a 2021 study published in the Journal of Medical Internet Research. The findings demonstrated that the use of this data analytics tool increased nurses’ awareness of fall risks and reduced the overall number of falls. Such research contributes to the growing body of evidence supporting the importance of clinical decision-making.

Why Is Clinical Decision-Making Essential for Nursing Students?

Clinical decision-making offers numerous benefits to hospitals, patients, and nurses alike. This approach is rooted in the scientific method (hypothesis, testing, repetition). Instead of relying on rigid protocols or checklists, nurses can leverage their medical knowledge, education, and professional expertise in patient care. Given that nurses are clinical professionals, they should be actively involved in making clinical judgments. Healthcare institutions support nursing judgment and critical thinking in the following ways:

1. Improved Patient Outcomes

The examples cited earlier illustrate how clinical judgment and decision-making can lead to better patient outcomes. Nurses assess patients, collaborate with colleagues, engage with patients and their families, and evaluate patient healthcare needs. They make decisions based on research and evidence, using critical thinking to determine when treatment plans need adjustment. Research indicates that clinical decision-making by nurses can enhance the quality of care provided and increase patient satisfaction.

2. Hospital Benefits

Patient outcome metrics are becoming increasingly important as healthcare payment systems shift from fee-for-service to value-based care. Hospitals and healthcare providers will soon be reimbursed based largely on the quality of care they deliver rather than the quantity. Medicare, for instance, penalizes hospitals based on statistics such as hospital-acquired infections, falls, and readmissions. Empowering nurses to exercise clinical judgment can help improve hospital revenue.

3. Enhanced Job Satisfaction

The COVID-19 pandemic has led to a significant increase in nurse turnover. Nurses report higher job satisfaction when they are granted the authority to make clinical decisions. They are less likely to experience burnout and more likely to continue providing nursing services. Employers who recognize nurses as clinical decision-makers are more likely to retain staff, which can help alleviate the nursing shortage crisis.

The Two Common Clinical Decision-Making Models

Clinical decision-making is a multidisciplinary process that can be applied at both the patient and organizational levels. It takes into account the perspectives of all experts involved in a patient’s care plan and can be extended to organizational decision-making.

1. Coordinated Healthcare Decision-Making

Coordinated care is a fundamental aspect of clinical decision-making at the patient level. It involves the collaboration of healthcare professionals, including doctors, nurses, and support staff. Coordinated care ensures that everyone works together at various levels, from the moment patients are admitted to healthcare facilities to their transfer between practitioners or caregivers, and throughout their medical journey.

2. Organizational Decision-Making

Clinical decision-making at the organizational level involves nurses, healthcare practitioners, clinicians, executives, senior nurses, and chief medical leaders. This approach proved highly effective during the pandemic. The American Association of Critical Care Nurses reports that patient care nurses, nursing executives, and organizational leaders joined forces to enhance best practices in clinical care at all levels, starting with the nursing process.

Best Practices for Clinical Judgment and Decision-Making for Nursing Students

1. Create Safe Opportunities for Testing Critical Thinking Skills

In a healthcare setting, patient conditions and data, both actual and perceived, can change rapidly. Incorporating critical analysis into the curriculum can be achieved through methods such as case studies in educational environments and interactive simulations or skills labs. Providing students with frequent and repeated opportunities to make decisions in a risk-free setting can boost their confidence as they learn to navigate challenging situations effectively.

2. Encourage Reflective Feedback

Allowing students to discuss what went well and, more importantly, what went wrong in a safe environment can significantly boost their confidence. This self-assessment has a profound impact on clinical judgment and decision-making for nursing students. It creates opportunities for students to interact, engage in discussions, and problem-solve among themselves before seeking input from their professors.

3. Challenge Students Beyond Their Comfort Zones

Professors should assign nursing tasks that require students to think critically and not always choose the “safe patient” option. This pushes students to expand their capabilities and develop confidence in tackling a wide range of clinical scenarios.

4. Emphasize Preparedness

Ensure that students are well-oriented to their teams and, whenever possible, introduce them to their instructor or other professional nurses they’ll be working with during clinical training. Pre-clinical meetings or informal gatherings can

help establish rapport. Allocate a day and space before the clinical assignment for students to gather in a break or meeting room, allowing nurses to engage with students informally over lunch or in the field. These efforts help alleviate students’ fears of the unknown.

5. Pre-Clinical Evaluation of Students

Preparation is key, as students may sometimes rush into situations without fully comprehending what they don’t yet know or aren’t adequately prepared for. Students should be capable of explaining the patient’s diagnosis, predicting presentation, prioritizing data collection, and conducting treatments. Employing “what if” scenarios can be an effective pre-clinical conference strategy. Educate students about short-patient scenarios that they may encounter during the clinical decision-making process.

6. Establish Your Presence in the Clinical Context

It’s essential for students to know that they have a supportive figure they can turn to when they need guidance. Let them be aware that you’re available to assist them when they require input.

7. Recognize the Value of Post-Clinical Meetings

Post-clinical meetings should be a safe space for students to share what went well and what didn’t. Create an environment where students can voice their challenges and assess their strengths and weaknesses. Encourage students to collaborate and find solutions among themselves before you step in to address issues. This fosters their ability to understand one another and boosts their confidence, ultimately enhancing clinical judgment and decision-making.

In Conclusion

From the information presented above, it’s clear that clinical decision-making skills are of utmost importance in the nursing profession. This guide serves as a valuable resource for both professors and students, helping them gain a deeper understanding of the clinical decision-making process. As a professor, you can use this knowledge to enrich your students’ learning experiences, while students can use it to navigate their nursing careers.

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