Nursing Theory Essay

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The framework The Situated Clinical Decision-Making Framework incorporates context, foundational knowledge, decision-making processes and thinking processes. A schematic representation of the framework is provided in Figure 1. Discussion of the framework components follows. Context The vast array of contextual factors that influence clinical decision-making come into focus when context is viewed as including micro (e.g. nurse and patient in relationship), meso (e.g. nursing unit or department; health care agency or institution), and macro (e.g. society, government and profession) levels. Each level potentially includes social, cultural, political, ideological, economic, historical, temporal and physical factors. Situating clinical decision-making within this layered context has three implications: First, it highlights the relational matrix within which nurses make their decisions and, in turn, emphasizes the importance of effective communication and the possibility of collaboration within clinical decision-making. Second, it draws attention to the relational nature of nursing practice and, correspondingly, the ethical dimension inherent in all clinical decisions. Finally, it recognises the unique and contextual nature of clinical decision-making in nursing practice. Foundational knowledge The ‘house’ in the conceptual schematic represents the foundational knowledge that informs nurses’ clinical decision-making processes. This knowledge arises from various dimensions: the nursing profession, self, and general and specific aspects of the patient situation. These dimensions of knowledge are defined in Figure 2. Effective clinical decision-making requires the nurse to do more than simply have knowledge: it entails active acquisition of new knowledge pertinent to the specific patient and situation, along with thoughtful selection and use of existing knowledge. In

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