Applying Clinical Decision Making in Adult Nursing

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Applying Clinical Decision Making In Adult Nursing

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This assignment will critically analyse and justify the decisions based around a fictitious patient using a clinical decision making framework highlighting its importance to nursing practice. The chosen model will demonstrate clinical decision making skills in the care planning process. The patient’s condition will be discussed in-depth explaining the pathophysiology, social, cultural and ethical issues where appropriate in the care planning and decision making process. Any vulnerability that the patient may experience will be discussed and dealt with in the care planning and decision making process. The supporting evidence based literature will be analysed and interpreted throughout the assignment.

Frank Noble is a 57 year old. He is obese; smokes, drinks alcohol daily and does not eat particularly healthy food. Two years ago Frank was diagnosed with hypertension and hyper cholesterol from his doctor. Frank set off too work early, forgetting to take his medication for his conditions. Once at work he noticed he was suffering with a bad headache which he thought was unusual as he doesn’t normally suffer from them. He continues to work for a few hours then realises his right hand is not working and he can’t concentrate. Franks face appears to be drooped down one side and his speech appears to be slurred. He tried to stand up but his right arm gives way and he falls over. Franks assistant rings 999 for an ambulance immediately. On admission to hospital Frank is diagnosed with Cerebrovascular Accident (CVA).

According to Gillen (2010) a CVA is the rapid loss of brain functions due to disturbance in the blood supply to the brain. There are two main types of CVA’s, Haemorrhagic and Ischemia. Frank has been diagnosed with an Ischemic CVA which is the most common type accounting for more than 80% of all CVA combined. When blood flow to a particular part of the brain is cut off by a blockage (clot) inside a blood vessel, the result is an Ischemic CVA. Stroke remains the leading cause of adult disability in the UK (Department of Health (DH), 2008). Frank is experiencing the most common signs and symptoms of stroke which include hemiparesis, dysphasia and urinary incontinence (Mathews and Mitchell 2010, p37). The symptom’s Frank is experiencing have reduced Frank’s independence, which has made him vulnerable as he requires assistance mobilising, eating, going to the toilet and dressing himself. The shift from independence to dependence is a crucial point, in particular, when an illness or disability makes them housebound. When this happens, autonomy, sense of identity and relationships with others should be reviewed. An assessment for depression should be carried out. (McKevitt et al, 2005).

Evidence based practice is defined by Sacett (1996) as “The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” This statement suggests that the health care team decide very carefully about the evidenced used for individual patients.

Pritchard (2006, p128-130) states that clinical decision making is to sort through information and make decisions, then appropriately implement these decisions in a clinical environment. Pritchard (2006, p128-130) also understands that this is a skill that is gradually learnt by nurses over time. Marquis et al (2009, p794) has a similar view of clinical decision making in that it is often a complex, cognitive process which is defined by choosing the most appropriate course of action.

Thompson and Dowding (2002, p4) express their understanding of clinical decision making being so important in nursing as it is vital that nurses follow the various policies and guidelines whilst making decisions about patients. The NMC code of conduct (2008 [Online]) clearly identifies professional responsibility by stating nurses are accountable for the decisions...
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