Citically evaluate a decision made by a qualified nurse during a clinical placement

Topics: Nursing, Decision making, Decision theory Pages: 19 (4981 words) Published: September 21, 2004
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Decision making essay

Decision making is important to nurses in today's society, ( Thompson et al 2002) as a number of policy and professional imperatives mean that nurses have to worry about the decisions they make and the way in which they make them. The government has produced several policy initiatives (DOH 1989, 1993a, 1993b 1913c,1994, 1995, 1996a, 1996b,1997, 2000, 2000) which have led to the creation of an evidence based health care culture ( Mulhall & Le May 1999). Thompson et al (2002) believe that poor decision making will no longer be acceptable, the government aim to examine professional performances and the outcome of clinical decision making for the first time. Evidence based practice will no longer be an optional extra but a requirement of all health care professionals.

The aim of this essay is to analyse and evaluate a decision made by a nurse in a community practice. The author will highlight why she chooses the particular issue and how it is important to nursing. The author will provide an overview of two general approaches to decision making, rational and phenomenological, by evaluating and analyzing them. The author will consider decision making theories, and try to apply them to the decision making process witnessed in her community placement. She then aims to show, how they should or could have been used as an aid in effective decision making. She will also consider influencing factors that effected the decision making process. A pseudonym is used throughout the essay to protect the patient's identity, as stated in NMC (2002) code of professional conduct section 5.

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The patient chosen for the purpose of this essay will be referred to as Jo. Jo is 53 year old women who suffer with rheumatoid arthritis. This also resulted in Jo having bilateral hip replacements. Jo is on steroid treatment, which leads to thinning of the skin and susceptibility to trauma (Mallet and Dougherty 2001). Jo lives with her husband and two grown up sons. Jo was refereed to the district nurse on her discharge from hospital following her second hip replacement. The initial referral was to check the surgical wound. However on arrival it was pointed out by Jo that she had a skin tear on her left shin that wasn't healing. The district nurse performed an assessment and concluded the wound was a venous leg ulcer as it had been present for 6 weeks. The district nurses used Sorbisan and Telfa to dress the wound. Twice weekly visits were carried out to Joe for a further 4 weeks, and it became obvious that the ulcer was not improving. The district nurse had to make a decision on what care to provide. The decision was to try another dressing Aticoat which is impregnated with silver, and not to refer the patient to the leg ulcer clinic at the local hospital. The district nurse involved with Jo's care was a G grade nurse and in charge of a community practice that had 3 other nurses working in it.

The author decided to focus on this particular decision, as she was influenced by the amount of evidence based research available on the issue, and how the district nurse chose to ignore the evidence, and made a decision on the basis of personal knowledge. The author visited a leg ulcer clinic while on her community placement, and asked the expert nurses running the clinical at what stage they would like to see patients referred to them. She was told if a wound wasn't healing after 4 weeks the patient should be referred, this information was passed on to the district nurse and ignored.

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The district nurses felt that if he referred all his patients after 4 weeks the leg ulcer clinic at the hospital wouldn't be able to cope. In doing this he chooses to ignore the expert advice. I found this very frustrating and interesting, and as Scott (2004) said we ought to promote good and not cause harm, in Jo's case, the action of not referring her to the appropriate expert nurse could be seen as prolonging...

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