Clinical Decision Management Essay

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CRITICAL REFLECTION ON FACTORS INFLUENCING A CLINCAL DECISION. The purpose of this assignment is to critically reflect on factors influencing a clinical decision based on one of the experiences I have witnessed during my clinical placement. The clinical decision will be focusing on the care of a client and involves a nursing input. The episode of care I will be examining what happened in a recovery theatre following orthopaedic surgery for the removal of screws to the left ankle. The clinical decision which I witnessed involves bringing pain under control by administration of 1mg of midazolam intravenously to a 12year old patient who said she was in crucial pain after administration of 10mg Morphine. Confidentiality will be maintained in compliance with the NMC (2004) professional code of conduct, and so the name of the setting, name of the client and members of the multidisciplinary team will not be disclosed. Tomey (2004) defines decision making as a process of selecting one cause of action from alternative. She further describes decision making as the process of choosing a course of action for dealing with a problem or opportunity. Barrows & Pickell, (1991), on the other hand see Clinical decision-making (CDM) as the formulation and revision of hypotheses throughout a patient encounter. It is a dynamic activity in which the nurse practitioner (NP) builds a case in which hypotheses are accepted or rejected based on collected data. Flagler (2000) identifies a number of different processes that are used in CDM, such as searching, reasoning, prioritising and recognising patterns. They can test several hypotheses simultaneously and follow-up clues or hypotheses. Experts are able to frame or structure the problem in a way that allows a solution strategy to be initiated. They have knowledge in long-term memory, and they have a set of rules that specify what

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