NAD007-3 Enhanced Assessment Skills And Decision Making In Adult Nursing Essay

NAD007-3 Enhanced Assessment Skills And Decision Making In Adult Nursing Essay

This assignment will highlight an event from clinical practice where it was essential to make a collaborative care decision and will analyse the decision-making process. A collaborative care decision is where there are joint decisions made between more than one person by working together to achieve an agreed care plan or treatment (Standing, 2017 a). Throughout this assignment you as the reader will understand the process of decision making and the related models. Team working, leadership and leadership styles and the ethical issue autonomy will be considered and identified within the chosen scenario.In accordance with the guidance from the Nursing Midwifery Council [NMC] (2015 a), confidentiality will be maintained, therefore any names of people and places have been changed. NAD007-3 Enhanced Assessment Skills And Decision Making In Adult Nursing Essay

ORDER A PLAGIARISM-FREE PAPER NOW

The scenario from practice is an 82-year-old man called Alan, he was admitted to an elderly medical ward due to a fall. The fall happened at home, with no loss of consciousness, and no head injuries. An ambulance was called because Annette was not able to get Alan up, off the floor. The Paramedics thought it best to have Alan checked over at the hospital. Alan has been well supported at home by his wife Anne. Anne supports Alan with all his care needs at home and is happy in doing so however, she has come in looking tired and expressing she is struggling with the progression of his dementia and anger. Up till now there has been no previous care packages or support at home, other than Annette. Alan has a medical history of bilateral hearing loss, Parkinson’s disease and Lewy body dementia [LBD] secondary to the Parkinson’s. Parkinson’s disease is a progressive neurological disorder which affects the brain and the loss of dopamine cells. These cells that are affected release chemicals to send signals to other nerve cells. Those who have Parkinson’s suffer with tremors, stiffness, impaired balance and co-ordination which can affect mobility, (National Institute of Neurological Disorders and Stroke, 2018). Lewy body dementia [LBD] is a progressive dementia, that involves tiny deposits appearing in nerve cells in the brain, they lower levels of other important chemicals involved in carrying messages between nerve cells, and the loss of connection makes the cells die. The dementia affects movement and changes mental abilities, (Alzheimer’s Society, 2018 a). Current treatment is intravenous fluids due to hypotension and physio assessing and supporting mobility. The collaborative care decision that will be analysed throughout this assignment is whether to support Anne at home with her husband or refer to a nursing home. This decision needs to be made due to his care needs, mental capacity and Anne needing support to care for her husband.NAD007-3 Enhanced Assessment Skills And Decision Making In Adult Nursing Essay

The Mental Capacity Act Code of Practice (2005) refers to capacity as someone who is unable to make decisions or actions for themselves at the time of the decision or when action needs to be taken. Alan lacks capacity because he is unable to understand information specific to the decision, retain the information, weigh up the information available or communicate the decision, (Alzheimer’s Society, 2018 b). All healthcare professionals should assess Alan with his best interests in mind, so it is important to include and encourage him to contribute to decisions and consider his past and present wishes and beliefs, (Social Care Institute for Excellence [SCIE] 2015 a). The best interest’s principles are defined in the Mental Capacity Act [MCA] (2005 a), the act has regulations that are required when any action or decision is made on behalf of someone who lacks capacity.

The collaborative care decision that was being discussed was; should Alan return home with support in place or should there be a referral to a nursing home. This collaborative care decision took place in a discharge planning meeting. Pellet (2016) states the purpose of a discharge planning meeting is to reduce the length of stay in hospital and to prevent further unplanned hospital admissions. Discharge planning is a process that facilitates the transition of care and should begin on admission, (Noseworthy, Sevigny, Laziner, Houle and Riccia, 2014). The discharge planning meeting was arranged by the nursing staff on the ward and involved a multi-disciplinary team and the patients family; consultant, nurse, occupational and physio therapist, district nurse, discharge co-ordinator, Alan and Annette. Collaboration of the different professionals is important because it allows them all to communicate and share views, share responsibility and problem solve to make decisions to carry out care, (O’Daniel and Rosenstein 2008 a). The SCIE (2010) agrees, collaboration is important because it improves transparency of decision making and organisational structure. A collaborative decision is made up of three parts; consultation to communicate concerns, negotiation to agree and identify a plan and co-operation to work together to achieve the shared solution, (Standing 2017 b). This discharge planning meeting was held in a room on the ward, for privacy. Discharge planning is known as shared decision making because it involves the clinicians and the family. The process provides the person with dementia and their family opportunities to be involved and express their preferences about decisions, (Miller, Whitlatch and Lyons 2014). NAD007-3 Enhanced Assessment Skills And Decision Making In Adult Nursing Essay

Shared decision making is a three-step process; choice talk, option talk and decision talk. The model rests on supporting and understanding a process of deliberation and respecting what matters most to the patient, which in turn will allow them to make informed preferences, (Elwyn et al 2012). Similarly, Legare et al (2011) and Groen van de Ven et al (2017 a) suggests the decision consists of clinicians, patients and families communicating the decisions and considering the implications, therefore including the person with dementia and any informal carers. Within the meeting it was important to respect what Alan wanted, which was to go home. Annette was unsure of the support she would get looking after Alan but is worried about him going to a care home, due to visiting and being apart. Annette is happy to continue supporting Alan at home with support, the nurses on the ward support her decision, however the consultant wants Annette to explore her options before making a choice. The consultant explored the option of a nursing home due to Alan’s capacity and anger and expressed a nursing home would be able to meet his nursing needs. This is where the process of deliberation started to happen, the consultant wanted the option explored, as Alan’s needs could be met, however, this was not respecting what mattered most to Alan and his family. The consultant was not behaving as a collaborative team decision-maker because he was not working together to co-operate and achieve a shared solution, suggested by Standing (2017 c). O’Daniel and Rosenstein (2008 b) concur, collaboration is working together, problem solving and making decisions to carry out a shared plan.However, it could be argued that the consultant was exploring other options, so Annette had all the information to enable her to make an informed choice for Alan’s care needs, which is the basis of shared decision making. Shared decision making is enabling a collaborative care decision to be made by discussing the health care options and facilitating the patient and family to express their views and develop informed preferences, (Groen van de Ven et al 2017 b). To enable an informed preference, all options need to be explored so Alan and Annette have all the information.NAD007-3 Enhanced Assessment Skills And Decision Making In Adult Nursing Essay

The nurses on the ward supported Annette and agreed that a package of care at home would be beneficial. The nurses worked together to provide a detailed report of Alan’s care needs to be able to assess funding criteria for carers and equipment. After this, the consultant was happy to continue the discharge planning process for Alan to be supported at home. The consultant is showing good characteristics of collaborative working because he was able to combine and balance negotiation, co-operation and adjust his outlook when presented with evidence, (Standing 2007 d).

However, it could be argued that a different decision-making model was used, clinical decision making. Clinical decision making uses clinical judgement to select the best possible and evidence-based option to ensure the best quality care, (Tiffen, Corbridge and Slimmer, 2014). It is evident the nurses used their intuition and experience to assess Alan, by working together to produce a report of information on Alan’s care needs. Stokes (2009) agrees clinical decision making is a process of gathering information and analysing assessment information, so the team can collaborate with the patient and their family. The nurses provided the reports through clinical judgement and everyone involved was able to come to an agreed decision.

Democratic leadership was used, this is also known as participative or shared leadership. Lewin (1993 a); Frandsen (2014); and Cherry (2018) suggests democratic leadership allows everyone to participate in decision making, but the democratic leader is there to guide and control. The leader encourages communication and staff participation in decisions. During the discharge planning meeting and working together to decide whether Alan goes home, the consultant actively listened to other members of the team. He respected their participation and looked at the evidence they provided about Alan’s care and he made the final decision. There are various team members involved in Alan’s discharge planning, a democratic leadership allows for the decision to be shared and values each member contribution. Democratic leadership can work well within multi-disciplinary teams, e.g. discharge planning allowing the shared decision model to be used. Lewin (1993 b) found democratic leadership enhanced inclusion and decision making through sharing ideas and collaborating as a team. However, Goleman, Boyatzis and McKee (2002) argues a big disadvantage from democratic leadership is the loss of speed in decision-making because it requires everyone’s input therefore making decisions timely as meetings need to be arranged and discussions had. Therefore, democratic leadership could enhance shared decision making as it allows collaborative working.NAD007-3 Enhanced Assessment Skills And Decision Making In Adult Nursing Essay

However, Bass and Riggio (2008) suggest transformational leadership could have worked well because it has ability to inspire and motivate others to act. This type of leadership focuses on building relationships and encouraging one another which builds moral and motivation. Within the multidisciplinary team it was important to ensure everyone was motivated to deliver the care Alan needed. It was also important to build a relationship with both Annette and Alan, so decisions could be made. Transformational leadership is considered the most influential theory as it’s the highest one considered in studies, (West et al 2015). Cummings et al (2008); McFadden, Henagan and Gowen (2009); Apekey et al (2011); and Wong, Cummings and Ducharme (2013) found evidence that transformational leadership has positive outcomes to nursing care, patient safety and patient satisfaction.

Under the NMC (2015 b) there are ethical principles that nurses must follow, the principles promote patient choice and to do no harm. Beauchamp and Childress (2001 a) standardised framework in which to analyse ethical situations. The four principles are; Autonomy, the right to make your own choice and that choice be respected whilst enabling informed choices, Beneficence, acting in the best interest of someone, Non-maleficence, to do no harm and Justice, fairness and equality. Alan’s autonomy is important, (Beauchamp and Childress 2001 b) suggests Alan’s choice of going home should be considered and respected, even if the decision is not the ‘correct’ decision. An autonomous decision should be one that is informed. Mulley, Trimble and Elwyn (2012) suggest, patients who are well informed of options and decision can better articulate their preferences. Although Alan lacks capacity because of his dementia, it should be assumed all adults are able to make their own decisions, to have capacity information should be understood, processed, retained and information should be weighed up, (MCA, 2005 b). The SCIE, (2015 b) suggests a person can lack capacity on big decisions but still have capacity to make small ones. Therefore, Alan can make decisions and voice that he would like to go home because the Human Rights act (1998); the MCA, (2005 c), and the ethical principle of autonomy underpin the multi-disciplinary team’s actions. Alan should be included in decision making, Department of Health [DH] (2012) “no decision about me, without me” gives patients more opportunities to make informed choices. Alan was included in the discharge planning meeting and was asked at different times of the day where he would like to go to ensure that he had opportunities to express his opinions. Alan’s choice of going home was respected and taken into consideration by the multi-disciplinary team. The option was explored and identified as a safe option, therefore causing no harm. Whilst respecting Alan’s autonomy, his lack of capacity enables Annette and the multi-disciplinary team to respect his beneficence. To do so, the decisions should be least restrictive to Alan’s rights and freedom, enhancing fairness. The team worked well and respected Alan’s ethical principles whilst working alongside Annette to provide information that allowed Annette to act in Alan’s best interest with informed choices.NAD007-3 Enhanced Assessment Skills And Decision Making In Adult Nursing Essay

However, at first the consultant was pressing for a nursing home to be the place of discharge. The consultant was not supporting Alan or taking his preferences into consideration. At this time the consultant was not working ethically as the emphasis should have been on respecting the persons with dementia autonomy and involving the person in decision-making, (Nuffield Council on Bioethics 2009). The consultant needed to approach the decision-making process through person-centred care. Thornton (2011), person-centred care looks at care ethically and values the person and not their cognitive status. Perhaps the consultant was looking at the decision through Alan’s cognitive status rather than basing decisions holistically.NAD007-3 Enhanced Assessment Skills And Decision Making In Adult Nursing Essay

In conclusion, decision-making is required in health care, all professionals need to in different environments and with complex health needs.Shared decision making, and clinical judgment were used in the scenario and they worked well with Alan and his complex health needs. Evidence suggests that combining shared decision making and clinical judgement enhanced the quality care, Alan’s autonomy and the multi-disciplinary team were able to agree on a suitable outcome that benefited Alan. Graham, James and Spertus (2018) agree, decision support models provide and facilitate clinical decision making which delivers personalised care. Overall the team worked well, with the consultant adopting a democratic leadership, although evidence suggests a transformational leadership would have worked also.

Through learning about the decision-making models and identifying them when they are used and how it is relevant to clinical decisions, future practice can be adapted to use different models to engage patient participation and enhance quality care. Education studies alongside clinical judgment for student nurses help them to engage with patients, understand moral reasoning and enhance quality care, (Tanner, 2006). This enhances future practice as a nurse as these specific skills are attained, understood and reflected upon whilst recognising any failures.NAD007-3 Enhanced Assessment Skills And Decision Making In Adult Nursing Essay

References

Alzheimer’s Society. (2018 a). Decision-Making and Mental Capacity. [online] available at https://www.alzheimers.org.uk/get-support/legal-financial/decision-making-and-mental-capacity#content-start
Alzheimer’s Society. (2018 b). Dementia with Lewy bodies: What is it and What Causes it? [online] available at https://www.alzheimers.org.uk/about-dementia/types-dementia/dementia-with-lewy-bodies
Apekey, T. and McSorley, G. and Tilling, M. and Siriwardena, A.N. (2011) ‘Room for Improvement? Leadership, Innovation Culture and Uptake of Quality Improvement Methods in General Practice.’ Journal of Evaluation in Clinical Practice. 17 (2), pp. 311-318. NAD007-3 Enhanced Assessment Skills And Decision Making In Adult Nursing Essay
Bass, M and Riggio, R.E.(2008) Transformational Leadership. New Jersey: Lawrence Erlbuam Associates.
Beauchamp, T. and Childress, J. (2001 a and b) Principles of Biomedical Ethics. 5^th edn. Oxford University Press.
Cherry, K. (2018) What is Democratic Leadership? Characteristics, Benefits, drawbacks and Famous examples. [online] available at https://www.verywellmind.com/what-is-democratic-leadership-2795315
Cummings, G. and Lee, H. and MacGregor, T. and Paul, L. and Stafford, E. and Davey, M. and Wong, C. (2008) ‘Factors Contributing to Nursing Leadership: A Systematic Review,’ Journal of Health Services Research and Policy. 13 (4) pp. 240-248.
Department of Health [DH]. (2012) Leading the NHS: No Decision about me Without me. Government Response. [online] available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/216980/Liberating-the-NHS-No-decision-about-me-without-me-Government-response.pdf
Elwyn, G. and Frosch, D. and Thomson, R. and Joseph-Williams, N. and Lloyd, A. and Kinnersley, P. and Cording, E. and Tomson, D. and Dodd, C. and Rollnick, S. and Edwards, A. and Barry, M. (2012) ‘Shared Decision Making: A Model for Clinical Practice’ Journal of General Internal Medicine Vol 27 (10) pp. 1361-1367.
Frandsen, B. (2014) Nursing Leadership: Management and Leadership Style. [online] available at https://www.aanac.org/docs/white-papers/2013-nursing-leadership—management-leadership-styles.pdf?sfvrsn=4
Goleman, D, Boyatzis, R. and McKee, A. (2002) Primal Leadership: Realizing the Power of Emotional Intelligence. Harvard Business Review Press.NAD007-3 Enhanced Assessment Skills And Decision Making In Adult Nursing Essay
Graham, M. and James, M. and Spretus, J. (2018) ‘Decision Support Tools: Realizing the Potential to Improve Quality of Care.’ Canadian Journal of Cardiology. 34 (7) pp. 821-826.
Groen van de Ven, L. and Smits, C. and Elwyn, G. and Span, M. and Jukema, J. and Eefsting, J. and Vernooij-Dassen, M. (2017) ‘Recognising Decision Needs: First Step for Collaborative Deliberation in Dementia Care Networks.’ Journal of Patient Education and Counselling Vol 100 (7) pp. 1329-1337.
Human Rights Act. (1998) Legislation [online] available at http://www.legislation.gov.uk/ukpga/1998/42/contents
Légaré, F., Stacey, D., Gagnon, S., Dunn, S., Pluye, P., Frosch, D., Kryworuchko, J., Elwyn, G., Gagnon, M. and Graham, I. (2011) Validating a conceptual model for an inter-professional approach to shared decision making: a mixed methods study. Journal of Evaluation in Clinical Practice. 17, p.554–564.
Lewin, K, Liippit, R and White, R.K. (1993 a and b). ‘Patterns of Aggressive Behaviour in Experimenttally created Social Climates.’ Journal of Social Psychology, (10) pp 271-301.
McFadden, K. L. and Henagan, S. C. and Gowen, C. R. (2009) ’The Patient Safety Chain: Transformational Leadership’s Effect on Patient Safety Culture, Initiatives and Outcomes.’ Journal of Operations Management. 27 (5) pp. 390-404.
Mental Capacity Act (2005 a and b and c) The Principles [online] available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/497253/Mental-capacity-act-code-of-practice.pdf
Mental Capacity Act. (2005) Code of Practice. [online] available at http://www.legislation.gov.uk/ukpga/2005/9/section/1
Miller, L. and Whitlatch, C. and Lyons, K. (2014) ‘Shared Decision-Making in Dementia: A Review of patient and family Carer Involvement’ Journal of Dementia. Vol 15 (5) pp 1141-1157.
Mulley, A. and Trimble, C. and Elwyn G. (2012) ‘Stop the Silent Misdiagnosis: Patients’ Preferences Matter.’ https://doi.org/10.1136/bmj.e6572
National Institute of Neurological Disorders and Stroke. (2018) Parkinson’s Disease Information Page. [online] available at https://www.ninds.nih.gov/Disorders/All-Disorders/Parkinsons-Disease-Information-Page
Noseworthy, A. and Sevigny, E. and Laziner, A. and Houle, C. and Riccia, P. (2014) ‘Mental Health Care Professionals’ Experiences with the Discharge Planning Process and Transitioning Patients Attending Outpatient Clinics into Community Care.’ Archives of Psychiatric Nursing. Vol 28 (4) pp. 263-271.NAD007-3 Enhanced Assessment Skills And Decision Making In Adult Nursing Essay
Nuffield Council on Bioethics. (2009) Dementia Ethical Issues. Nuffield Council on Bioethics London.
Nursing Midwifery Council [NMC] (2015 a and b) The Code. [online] available at https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf
O’Daniel, M. and Rosenstein, H. (2008 a and b) ‘Patient Safety and Quality: An Evidence-Based Handbook for Nurses’ Rockville: MD, Agency for Healthcare Research and Quality.
Pellet, C. (2016) Discharge Planning: Best Practice in Transitions of Care. The Queens Nursing Institute, [accessed online] https://www.qni.org.uk/wp-content/uploads/2016/09/discharge_planning_report_2015.pdf
Social Care Institute for Excellence (2010) Practice Development: Collaborative Working in Social Care. [online] available at https://www.scie.org.uk/publications/guides/guide34/background/whyuse.asp
Social Care Institute for Excellence (2015 a and b) Making Decisions in a Person’s Best Interests. [online] available at https://www.scie.org.uk/dementia/supporting-people-with-dementia/decisions/best-interest.asp
Standing, M. (2017 a and b and c and d) Clinical Judgement and Decision Making in Nursing. 3^rd edn. Los Angeles: Sage/ Learning Matters.
Stokes, M. (2009) Pocketbook of Neurological Physiotherapy. 1^st edition. Churchill Livingstone.
Tanner, C. (2006) ‘Thinking Like a Nurse: A Research-Based Model of Clinical Judgement in Nursing.’ Journal of Nursing Education. 45 (6) pp.204-211.
Thornton, L. (2011). ‘Person-Centred Dementia Care: An Essential Component of Ethical Nursing Care.’ Journal of Canadian Nursing Home. 22 (3) pp. 10-14.
Tiffen, J. and Corbridge, SJ. And Slimmer, L. (2014) ‘Journal of Professional Nursing’ Enhancing Clinical Decision Making: Development of a Contiguous Definition and Conceptual Framework. 30 (5) pp. 399-405.
West, M. and Loewenthal, K. and Eckert, R. and West, T. and Lee, A. (2015) ‘Leadership and Leadership Development in Health Care: The Evidence Base.’ The Faculty of Medical Leadership and Management with The King’s Fund and the Centre for Creative Leadership. [accessed online] https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/leadership-leadership-development-health-care-feb-2015.pdf
Wong, C. A. and Cummings, G. G. and Ducharme, L. (2013) ‘The Relationship between Nursing Leadership and Patient Outcomes: A Systematic Review Update.’ Journal of Nursing Management. 21 (5) pp 709-24.NAD007-3 Enhanced Assessment Skills And Decision Making In Adult Nursing Essay

Clinical decision making in nursing involves applying critical thinking skills to select the best available evidence based option to control risks and address patients’ needs in the provision of high quality care that nurses are accountable for. – Standing, M. (2011)

Nurses are accountable for the quality, safety and effectiveness of their clinical decision making. We are accountable to the patients, clients and service users to whom we owe a duty of care. According to Standing, M. (2011), accountability in decision making is being answerable to patients, the public, employers, NMC and the law for the consequences of our actions and having to explain, justify, and defend our decisions.

The Nursing and Midwifery Council (NMC, 2008) states that nurses are personally accountable for their actions during practice and therefore they must be able to justify their decisions at all time. Nurses have to balance a number of elements before they make a decision, however the patient’s best interest is their main priority.

Decision making involves assessing available options and their effectiveness. It applies judgement regarding our reasons for doing or not doing things. As nurses, we use different information sources to support our judgement and decision making.

Nursing is the use of clinical judgement in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life whatever their disease or disability, until death. (Royal College of Nursing, 2003)

Decision making requires thinking skills to exercise judgement in assessing the benefits of available options and choosing a preferred option that is then acted upon. Judgement is not decision making but is closely related. Decision making links judgement to practice by acting on it in choosing from the options available. There are different models of decision making in nursing developed to help nurses make their decision on all aspects of nursing care and I decided to focus on risk analysis and management and evidence based decision making.NAD007-3 Enhanced Assessment Skills And Decision Making In Adult Nursing Essay

Clinical practice is often concerned with risk reduction and with the developing trend in healthcare litigation, there is a big emphasis on risk management for both the patients and health care staffs. Clinical risk management will fundamentally happen through the interpretation and application of agreed individual care plans. The development of a comprehensive and individualised care plan will relate to the broad range of effective treatment, rehabilitation and support services provided at the current level of clinical knowledge (Morgan, S., 1998).

Risk assessment is a process of identifying and investigating factors associated with the increased probability of specified risk occurring. It is an examination of the context and details of past risk incidents in the light of current circumstances. It is also concerned with the patterns of circumstances in which these factors may arise.

A nurse may assess a patient as at risk of developing pressure sores, and then implement measures to try and reduced the likelihood of this event occurring by providing equipment such as specialist mattress.

Risk assessment is a continuous process in which nurses gather information from multiple sources and other health care professionals with the focus of identifying the factors that is associated with the increased probability of risk happening. It is the foundation on which decisions are made and risks plans are then formulated through available national and local policies and procedures (Morgan, S.,1998). According to Lipsedge (1995), good practice in risk assessment requires nurses to translate their knowledge into a clearly distinct formulation of the risks. The formulation should ideally reflect aspects of each individual, context and systems that may influence the potential for risks.

The primary aim of pressure ulcer risk assessment tool is to help nurses identify individuals at risk of pressure ulcers and determine the degree of risk (Shakespeare 1994).Formal pressure ulcer risk assessment involves the use of a tool that assists in identifying those patients likely to develop a pressure ulcer.NAD007-3 Enhanced Assessment Skills And Decision Making In Adult Nursing Essay

According to Guy, H. (2007), risk assessment on pressure ulcer requires multifactorial consideration. Risk-assessment tools are a useful signpost to risk factors but must not be used in isolation to identify risk. It is important to carry out a care plan once the patient is identified to be at risk of developing a pressure sore so that occurrence of pressure damage can be prevented.

Most nurses are familiar with the use of pressure sore risk assessment tools such as the Braden or Waterlow scales. These tools collect data regarding various factors thought to be associated with the development of pressure sores. There is normally some form of scoring system which shows the probability of the pressure sore occurring. For example, if a patient scores 15 or over on the Waterlow scale, the individual may be considered at risk of developing pressure sores and therefore the nurses will have to maintain a pressure ulcer prevention (PUP) bundle in order to keep track of the patient’s condition. According to Waterlow (1985), recommended care interventions are available with each recommendation corresponding to the risk score parameters of the Waterlow scale.

The Waterlow scale is mostly used in adult field of nursing. It can also be used with hospitalised mental health and learning disability patients. However, the Waterlow scale is specifically designed for adults and therefore it is not appropriate to be use on children. Paediatrics use a different pressure ulcer risk assessment tool called the Glamorgan scale (Willock, J. et al, 2007).

No risk assessment tool can be 100% accurate. The key issue in examining risk assessment tools is how good they are at distinguishing those at risk from those who are not and if they are better or more accurate than simply relying on professional judgement (Thompson, C. & Dowding, D., 2002). When considering risk assessment and risk reduction, it is important that the initial assessment of risk is accurate.NAD007-3 Enhanced Assessment Skills And Decision Making In Adult Nursing Essay

Evidence refers to information that is used to support particular beliefs, decisions and actions. Evidence-based decision making is a prescriptive approach to making choices based on ideas of how research and theory can be used to improve decision making in regards to delivery and quality of patient care. According to Nursing and Midwifery Council (2008a, p.7), nurses are now required to use evidence based practice. For example, nurses must deliver care based on the best available evidence or practice and must ensure any advice given to patients are evidence based.

Sackett el al (1996) defines evidence base practice as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient by incorporating individual clinical expertise with the best available external clinical evidence from a systematic research.” This means that one solution will not be the same for all clinical scenarios and it is the nurse’s role to identify the research that best fits the clinical situation.

According to McKibbon (1998):

“Evidence based practice is an approach to health care wherein health professionals use the best evidence possible, i.e. the most appropriate information available to make clinical decisions for individual patients. Evidence based practice values, enhances and builds on clinical expertise, knowledge of disease mechanisms, and pathophysiology. It involves complex and conscientious decision making based not only on the available evidence but also on patient characteristics, situations and preferences. It recognises that health care is individualised and ever changing and involves uncertainties and probabilities. Ultimately, Evidence base practice is the formalisation of the care process that the best clinicians have practiced for generations.”

McKibbon (1998) recognises the importance of the patient when making decisions about their own care. According to Reigle, Steven, Belcher et al (2008) and Talsma, Grady, Feetham, et al (2008), the reason why evidence based practice is consistently implemented is because it leads to the highest quality of care and best patient outcomes. It involves combining the knowledge of an expert, patient preferences and research evidence within the context of available resources. Also, studies by McGuinty and Anderson (2008) and Williams (2004) showed that evidence based practice has reduced healthcare costs and geographic variation in delivery of care.

“Integrating research evidence into decision making involves forming a focused clinical question in response to a recognised information need, searching for the most appropriate evidence to meet that need, critically appraising the retrieved evidence, incorporating the evidence into a strategy for action, and evaluating the effects of any decisions and actions taken.” – Thompson et al (2004). NAD007-3 Enhanced Assessment Skills And Decision Making In Adult Nursing Essay

One of the tools used in evidence based practice is the use of the early warning score system (EWS). EWS were developed to assist health care professionals detect if patients are deteriorating. It is based on physiological parameters taken when recording patient observation e.g. the patient’s heart rate, respiratory rate, temperature, oxygen saturations and systolic blood pressure. The EWS is designed for adults and can also be use with mental health and learning disability patients. However, due to children and adults different physiological responses, EWS is inappropriate to use on children. Alternatively, Paediatric Early Warning Scores (PEWS) is use for children, to record observations and is use to assess the child’s condition i.e. If the child’s score is high then this means he/she is at risk of deteriorating, this gives nurses an early indication that an action has to be done.

The use of early warning score (EWS) is the best practice for clinical observations (Department of Health, 2000), and this is backed up by NCEPOD (2005) who emphasised that every in-patient should have a EWS recorded. Accurate and timely observations and adherence to EWS is essential in order to recognise patients who are at risk of deterioration.

According to NICE (2007), nurses caring for patients in acute hospital settings should be skilled in monitoring, measuring, and interpreting data and have prompt response to the acutely ill patient and they should be assessed in order to demonstrate their competency. Early intervention can help prevent patient’s condition from deteriorating which then helps avoid the need to transfer the patient to a higher level of care.NAD007-3 Enhanced Assessment Skills And Decision Making In Adult Nursing Essay

However, despite the good outcome of using evidence based practice in decision making with regards to patient care, there are issues such as nurses do not always make their decision based on available evidence due to lack of skills i.e. poor IT skills, lack of research skills and literature. There are also misconceptions that traditional ways is the best way, or that gathering evidence is too difficult and time consuming. Becoming skilled in clinical decision making requires the application of a range of evidence regarding patient concern, physical and human resources within healthcare contexts, understanding health and illnesses, developing expertise in applying therapeutic approaches, a commitment to enhance the wellbeing of those in your care and fulfilling the requirements of the relevant professional body.

ORDER NOW

Overall, as nurses, it is important to have a basis when we make a decision regarding patient care. Risk is integral to nursing and the assessment of risk is one of the most common judgements nurses make. Each decision making model requires certain set of skills in order to be put on proper use and get the right results. Nurses are expected to use valid evidence to support their decisions when deciding what care to provide each patient. It is also important that nurses use their resources cost effectively by ensuring that resources and equipment are used correctly by the patient. Sometimes it is difficult for the nurse to come to a decision that will satisfy clients and co-workers and they also may be challenged at any time, however the important thing is that the nurse takes full responsibility and is able to justify his/her decision. Making the wrong clinical decision is not only harmful to patients but can also damage a nurse’s career. Learning about developing and applying effective clinical decision making skills is vital for the wellbeing of patients and nurses’ capacity to demonstrate that decisions are justified. NAD007-3 Enhanced Assessment Skills And Decision Making In Adult Nursing Essay