Nurses come across varioussituations in practices where a decision has to be made following a judgement (Traynor, et al.
, 2010). Therefore, nurses’decision making and judgement contributes to safety and quality of patient carewhich can arise the challenges. The effective decision should be made forpatients who are incapable of processing the information and those who have capacityshould be involved in the decision of their own care (Nursing and Midwifery council (NMC), 2015). In this assignment I will be using aspecific scenario of a patient whose name will be given a pseudonym to maintainthe confidentiality as stated by NMC code. The scenario will be used to discussabout the decision undertaken in practice along with my allocated mentor byanalysing it in depth explaining the appropriate decision made regardingpatient safety. In addition, I will also be using a theory and evidence to showhow these strengthened my decisions and how this may influence my decisionsmaking in the future practice.
Throughout this assignment, I will be furtherexploring the ethical principles, protocols, guidelines and policies thathospital uses to guide a healthcare professionals to conclude a decision todeliver high standard of care and provide patient safety. During a placement in medicalward, I came across a patient named Mr. Gill who was a 38 years old man admittedto the ward after post-operative chest drain inserted for pneumothorax. Mr Gillpresented with signs such as redness, itchiness, swollen tongue and difficultyin swallowing, signs of allergic reaction for an antibiotic name doxycycline (Allergy UK, 2018). Mr Gill had asocial history of living with wife and a child and was an independent man. Inthis scenario my decision was to carry out a set of observation using thenational early warning score (NEWS) which scores on the physiologicalparameters of an individual (Royal college of Physicians, 2017).
Alongside with NEWS scoring I used an ABCDE assessment to recognise and treatproblems (Resuscitation Council (UK), 2008).On the repetition of the set of observation Mr. Gill was scoring of 5 ontachypnea, hyperthermia and tachycardia. The Royal college of Physicians statesthat NEWS score with 5 or more, medical team caring for the patient should beurgently informed.
Therefore, I and my mentor concluded with a decision ofescalating Mr Gill to medical team based on NEWS score. This decision of mine and mymentor was based upon a descriptive theory. The descriptive theory contributedwith our decision to escalate Mr Gill to medical team. The descriptive theoryis associated with the studies that observe, describe and analyse how decisionsare made by professionals. In this scenario, the behaviour of Mr Gill has beenobserved under the assumption that these behaviours are reflected due to someabnormalities.
The one of the most common descriptive theory ishypothetic-deductive theory and therefore my decision on the scenario will bebased on this theory. The hypothetic-deductive theory is a scientific approachwhich involves four stages: cue recognition, hypothesis generation, cueinterpretation and hypothesis evaluation (Tanner, et al., 1987). The first stage iscue recognition stage, at this stage I was able to collect clinical informationabout Mr Gill, such as observing the changes in Mr Gill’s physical appearance.This was followed by hypothesis generation, where I was able to develop ahypothesis specifically about the cause of Mr Gill’s allergic reaction to anyform of medication administration.
Hypothesis generation is followed by cueinterpretation where the interpretation of cues are generated from the firstfinding and therefore focuses on to confirming the cues to contribute ontooriginal hypothesis. The cue such as Mr Gill itching constantly and complainingabout a swollen tongue and feverish feeling lead to confirming the originalhypothesis. At the final stage, the hypothesis was evaluated by carrying outthe NEWS score to confirm the changes in pathophysiological and therefore thedecision of escalating Mr Gill was taken. This is supported by the studyconducted in Buckinghamshire NHS Trust shows that carrying out a NEWS helps withthe case to be reviewed by a doctor of appropriate seniority, improving thequality of care given at the hospital (Spiers, et al.
, 2015).However, theaccuracy of my scoring system might not be right and might vary between differenthealth care professionals (HCP) on how they score based on their knowledge andexperience or human factors (University of York, 2018). The inaccuratescoring can lead to inaccurate and delay in care being provided to patientwhich might cause more health issues for a patient. The use of an electronicsystem to calculate NEWS score compared to hand written documentation is lesstime consuming and shows more accuracy with scoring for patient (Mohammed, et al., 2009). Therefore, themethod of using paper to calculate NEWS score might be unreliable which couldlead to an inaccurate judgement and decision making.
In this scenario, the decisionmaking could be affected by the human factors such as stress and fatigue atwork due to heavy workload, long hours of shift and lack of staffing, leadingto inattentive towards the patient presenting cues. This could cause delay inperforming observation and affect the analysis of NEWS score and therefore thedecision to escalate could be affected. Ethics is an unavoidable partof nursing practice and therefore numbers of guidelines and codes have beenintroduced. In this scenario, Mr Gill had a full capacity to understand theinformation and provide consent. Therefore he was involved into a decisionabout his own care as stated by a policy introduced by NHS- no decision aboutme, without me.
He was provided with all the information regarding the care andthe explanation about the reasons for the care being delivered. Before carryingout any procedure, the informed consent was taken.NudgingIntuition- body languagesuggested something was wrongPrevious experience: Bennernovice to expert Clinical judgement in nursing: (Standing, 2017) Bibliography Allergy UK, 2018. Allergy UK. Online Available at: https://www.
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