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Clinical Decision Making - Essay Example

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Fever frequently affects patients with haematological malignancies such as leukaemias, either as a part of the disease process itself or because of the chemotherapeutic drugs used in the treatment. To diagnose the cause, blood culture is mostly required for identification of causative bacteria or fungus. A nurse caring for a patient with acute leukaemia is many a time confronted with the clinical scenarios where he or she is required to make clinical decision to take blood culture from a febrile patient. The nurse may herself make the decision to obtain a blood sample for culture on suspicion of an infection or may act on the orders of a physician. In an autonomous decision, the complexity and the nature of the decision task affect the approach taken towards problem solving (Thompson, Kirkness & Mitchell 2007). The decision taken by the nurse can be analysed for the application of evidence based medicine in routine clinical situations. Analysis and clinical reasoning of the decision Decision analysis allows to share a decision with seniors and colleagues and to evaluate its advantages and disadvantages (Bucknall 2003). Nurse uses the domains of prior knowledge about the patient and his circumstances, ethical knowledge and specific knowledge. This knowledge is accessed and applied by the means of pattern recognition and heuristics (Bohinc & Gradisar 2003). First of all, the component of problem recognition requires the nurse to identify the ‘cues’ or clinical symptoms such as fever in this case. The recall of these cues leads to formulation of a hypothesis of a problem (Jenks 1993). Once the problem has been recognised, the decision maker proceeds on to the next step of assessment in which the data is gathered, assimilated and analysed (Klein 2005). The nurse records the temperature, maintains a temperature chart and records associated symptoms such as chills, sweating, cough and pattern of fever etc. as a part of data collection. To be able to form a judgement, it is imperative to evaluate and make a choice (Higgs et al 2008; Connolly, Arkes & Hammond 2000). The nurse evaluates the data and infers about what should be done (Thompson & Dowding 2004). The judgement can be of a bacteremia as the cause of fever. To make an operational decision, in the scenario of management of a febrile patient with acute leukaemia, the nurse compares the requirement of a blood sample for blood culture with the alternative of not taking a sample using a clinical decision analysis. To be able to reach a decision, nurse has to explore and compare the advantages and disadvantages of this diagnostic tool in this patient (Standing 2009). Decision making is the process whereby knowledge is converted into action. The more accurate the knowledge, the more relevant and accurate a decision is likely to be (Randall et al 2009). This impacts the clinical practice of the nurse. The knowledge base about the complex associations between infections, signs and symptoms of infection such as fever, scenario of an immunocompromised and/or neutropenic patient, is acquired as a part of nursing training, with the experience of dealing with such patients and the usual protocols and guidelines followed in a setup. Clinical reasoning in this case, is most likely a combination of knowledge base, experience and intuition (Tanner et al, 1987). Also, if the nurse’s actions are analysed using a rational model, the objective of the decision is to find out whether ...Show more
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Name of the of the Professor Nursing 3 June, 2012 Clinical decision making Introduction: Decision to take blood culture from patient with acute leukaemia In a hypothetical case scenario, a nurse encounters a patient of acute leukaemia with fever…
Clinical Decision Making
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