Clinical Decision Making in Nursing Process

INTRODUCTION

Nursing process was something that common used for independent nursing in their action, which can prevent, resolved and reduced to identify patient /client health issues. In term, it was a process to serve an organizational a framework to practice of nursing. The care of patient need assessment, nursing diagnosis, planning, implementation and evaluation to reconciliation of perception in term for the patient, relatives and the nurses itself. Nursing process was one-step earlier to diagnose the appeared symptom from patient to plan, concurrent with assessment, completion, action and goal. It will allow recurrent evaluation of the process repeatedly until success. It also must come from data collection to response for potential health problems or life processes. It provides the basis for selection of nursing intervention to achieve outcomes for which the nurse is accountable - (Nanda, 1990).

Decision-making was something broad to explained, it might be difference definition in difference persons. Somehow in nursing it something options or choice that must been make prior to a course of action .It doesn't involved for nurses itself but nurse manager especially ,managing and delivering care that engaging in planned change. There are many theory in decision-making and depend to situation itself to applied it. However, in decision-making there are processes for it, from expert of identifying the problem to evaluate the outcome of the problem.

The paradoxically nursing process was coming from effective decision-making tool. The quality decision-making was involved every sage of assessment, diagnosis, planning, implementation evaluation of patient needs and their demand on those day. This also involved personal competency and environment itself by decision they make according to the event or incident happen or dealing with patient case by case.

By that explicitly decision -making was needed in every nursing process was make intention the intervention and the result of it become more clear and the objective or outcome was good. The main thing the patient will succeed the treatment and care generally.

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CLINICAL DECISION -MAKING

In view of decision making as explained in the first page. But it something essential skill of leader prior needed in every nurses know it either lead by example, mentor -mentee, learn by mistake or learn base from experience and related it to situation come. How it learns to make timely, well considered the decision and lead the team to well deserved success. It depending how nurses deal it on the time, poor decision-making, will be poor or worse result outcome, if good decision-making was make, it will better result deserved as for it.

Decision -making was complex process that had many definitions however decision making need critical thinking one of the process .Besides scientific reasoning, the nursing process and problem solving added. The cognitive skills attributed to the critical thinking process included divergent thinking, reasoning, reflection, creativity, clarification and basic support (Green, 2000).There're few theories can be use in decision -making prior to the situation happen example as below;-

THEORY KEY IDEA APPICATION TO PRACTICE

Normative or prescriptive -Information was objective and routine decision involved to structure of the problem. -Options are known and predictable -situation can be used by the agency policy, standard operation procedures and analytical tool.

Descriptive or behavioral -Information was subjective, non-routine and unstructured.

-option unknown and unpredictable -It can best handled by gathering more date, used past experience, creativity approaches or follow by group processes.

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THEORY KEY IDEA APPICATION TO PRACTICE

Satisfying Decision-maker minimally meets the objectives or standards of decision .It more conservative. -The process most expedient and most appropriate when time is an issues.

Optimizing Decision-maker maximally meets the objectives or standards of decision. The process need pros and cons option, also listed the benefit and cost for each option needed following the goal selected. -The results was a better decision with prolong time needed.

There are two factors affected the decision-making to be make .External factor that was an environment situation, time and resources to influence decision-maker .Internal factor was physical and emotion state from decision maker itself.

It showed the personal changes could be measures from aspects philosophy, biases, values, interests, experiences, and knowledge and attitudes .All of it able to be adapted and benefit in team, department or organization. It should able to recognize to subtle cues of how's others feeling and thinking. Some of nurses should have decision-making and problem solving in a time. Nevertheless, it depends on how they do about it. Certain of them had stress and short of time in encounter a new problem or delivered new decision, they need to apply to react to situation of it. Even they had stacked or often forget to follow the rational approached .Rather the list of guideline was given and they learn about it but it does not intimidated by the length.

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Before continue with the processes of decision-making let substitute to view a problem as an opportunity;-

1. Define the problem.

Most of ours nurses was struggle when there are problems occurred. Even they think they can react with it. Define the problem it how we find the input in others and ourselves. They should question ourselves a few question like below;-

i)How it happen?

ii) Where is happen?

iii) What the causes make of the problem?

iv) Why it happen?

v) Who or whom involved in the problem.

vi) When it happen?

It seems five Wives and one Husband question, with this question will able define the causes but don't jump to conclusion cause it

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