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decision making by a nurse

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Introduction

Analysing a decision made by a nurse in the practice setting We are going to analyse the decision taken by a nurse to use compression bandages therapy onto a patient who had a venous leg ulcer. This decision was taken using guidelines and suggested methods, along with their ability to critically question practice in an organise manner, consequently developing the process of decision making (Lipman et al, 1997). Using these and prior knowledge and understanding of the areas we work, an evidence and knowledge based decision can be made, giving the patient options so that they can decide what care they wish to receive. Many studies show that most patients prefer to be involved in decision making, sharing information and decicions with the patient usually means a satisfied patient. It is important to maintain an effective holistic care management and assertive behaviour to create accurate decisions based on all facts and opinions of both parties (Nursing times, 2004). It is essential to have ethical principles in order to provide and maximise the effectiveness of the care provided (Doh, 2006) and ensure that the patient can lead the best possible life that they wish to, for as long as possible. The patient being cared for is a fifty-three year old man who had various wounds in his right leg. The patient suffers from type II diabetes and is obese; his past medical history is arthritis, bronchitis and leg ulcers. He has decreased mobility and is not able to go to the treatment room at the health centre; therefore he has been referred to the district nurses team. ...read more.

Middle

Following the RCN Guidelines (1998) where treatment with long-strech elastic bandages for patients with an ABPI of 0.8-1.3 is recommended, the nurse applied the four layer system to the patient with evidence and knowledge that this will result in an effective outcome for both parties. However, the nurse's experience in Doppler assessment wasn't too extensive, this explains why she preferred to stick to guidelines and policies rather than her own intuition (Field, 2004). She also asked for advice from the specialist nurse in order to make the best decision, assessing the patient with all the possible information. Although the nurse made her decision based on a rational approach, Moore(1996) affirms that it is not possible for nurses in practice to make a rational decision based on all opportunities and possible outcomes. He also states that a decision is limited by the decision-makers intellectual capacity, level of knowledge and experience about the particular situation. This would suggest that all nurses need a degree of intuition to successfully use a rational approach when making any kind of clinical decision. In this particular case the nurse was able to combine the two approaches to increase the reliability of the decision. According to Benner's (1984) 'novice to expert theory' there are five stages of clinical competence in which professionals make a transitional period throught each one as their education and experience increases. Benner suggests that a beginner has had no sufficient knowledge and experience of the situations in which they are expected to perform and that they can not be expected to make a rational or phenomenological decision effectively or competently. ...read more.

Conclusion

Ethics is about achieving the best for your patient and preventing them from harm (Tschudin, 1994). She goes on to state that strict ethical principles must apply to all people in oder to maintain a stable society. Ethics are provided in all health and social care settings to protect the patients and practitioners from harm and to reduce any moral and value differences creating an equal opportunity for everyone. To conclude, we can state that without knowledge, experience and some kind of intuition, nurses wouldn't be able to make accurate decisions or provide such knowledge that the patient can make a precise decision giving informed consent. In this particular case the patient needed a solution for his ongoing leg ulcers problem which was making him isolated and had decreased his quality of life. Using her experience, the nurse was able to make a rational decision in conjunction with some intuition to stop the patient getting in a worse condition and to, in a longer term, improve his quality of life. Knowing that reflection upon your own knowledge and experience and how you connected the two, within practice, enables professionals to progress from 'novice to expert' (Benner,1984) and provides the basis for decisions to be more accurate and precise. Using rational and phenomenological perspectives together will lead to better decisions and this will help nurses to improve their ability to work in partnership with patients. Considering both approaches nurses can use tools given in both process to avoid poor quality decisions and increase knowledge and experience. Good decision making also helps the relationship between professionals, leading to better multidisciplinary working. Nurses always intend to benefit their patients, they must ensure throughout the whole decision making process that they make the best possible decision. ...read more.

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