Clinical Judgment and Decision Making
Assessment Information
Assessment:Critical self-evaluation based on a simulated patient assessment drawn from a variety of conditions and environments.
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Learning Outcomes for the module. At the end of this module, students will be able to:
Knowledge 1) Examine the principles of shared decision making in healthcare delivery to ensure an individual’s human rights, values, customs and spiritual beliefs are respected. 2) Critically evaluate the needs and evidenced base care for individuals with a variety of conditions and in a range of environments including the home care setting. 3) Appraise different models of clinical decision making for application to practice.
Subject-based practical skills
4) Through simulation, rehearse the assessment and management of a range of clinical situations and within the context of multiprofessional working. Thinking skills
5) Critically reflect upon individual clinical judgement and decision making, informed by local and national policies and guidelines.
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FAQs
- What is a critical self-evaluation?
You need to show that you have reflected on your chosen scenario and patient assessment and down this critically. To do this you will need to use a decision making or clinical judgement framework or theory to base your analysis of the patient assessment and decisions the nurse will make.
You will also need to draw on the literature from a framework or theory that you have learnt about as part of the module.
As a guide this assignment should be styled as a report with sub-headings and include the following:
What is the format for the assignment?
- Writing in third person (The Nurse) and in present tense.
- Use a clinical decision-making model, some models listed below
Introduction / Outline of the assignment:
- Explain the aim of the assignment 250 words
Overview of the scenario chosen:
- Add scenario as an appendix
- Reason to why specifically this scenario is chosen
- Pathology explanation of illness (gallstones) 500 words
Critical reflection on the scenario: 800 words
- What is happening, what is wrong with the patient, vital signs? Pathology, what’s the issue?
- What assessments will be carried out, eg- A-E assessment, Holistic, systematic and comprehensive
- assessment and why. (Using Nice guidelines)
- Using a decision-making model to critically reflect on the assessment
- Decisions the nurse will take for the patient issues and what interventions will be carried out and the reasons behind the decisions made. (Evidence based).
- Must consider any signs of actual or potential deterioration of physical and or mental health, consider human rights.
- Consider what MDTs (multidisciplinary team) needed and why they make the decisions they will make, what they will do for the patient. (Evidence based)
Identification and analysis of the decision-making issues: 800 words
- Using the decision making and principles model
- The strengths / weaknesses from the decision-making process, what went well. Why where the decisions made? E.g., save life, prevent hypovolemic shock? Infection control?
Summary of the implications for your learning:
400 words
- what the nurse learnt from the decision-making process, if there were any implication’s that occurred.
- What can be carried over into the future.
Conclusion: 250 words
- Summarise the main point of this assignment. Pulling out the main points from your essay.
- Identify any implications for practice and/or identification where more evidence (research) is required to inform best practice.
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This is a guide only and not a prescriptive breakdown of the number of
words required in each section or of the section heading themselves. 3000 words
Scenario 1 Post-Operative Nursing Care
Masthan is a banker who was previously a football player of a local team. He lives with his wife; Jackie and they
have a daughter who lives about 100 miles away with her husband and two children. Masthan has an active life
and is the chair of his local school governance and treasurer for an amateur dramatics group. Masthan has never smoked, enjoys cooking and eating out in restaurants, drinks whisky occasionally, and is overweight (weight:
100kg, BMI = 32).
Masthan is allergic to penicillin (rash). He is treated for hypertension with antihypertensive medication which maintains his blood pressure around 130/80. He has no other medical history and describes himself as ‘enjoying exceptional good health’.
Masthan was admitted following recent reoccurring episodes of severe right upper abdominal pain which was
worse after eating and did not resolve with analgesia. An ultrasound scan confirmed acute cholecystitis due to gallstones and an urgent admission for cholecystectomy surgery was arranged. His operation today was
uneventful, and he returned to the ward two hours ago
Mr Masthan Ali is a 68-year-old man who underwent a laparoscopic cholecystectomy under a general anaesthetic today. Masthan is on the post-operative ward and has been experiencing acute pain. In the last 30 minutes
Masthan has deteriorated, he is hypotensive, tachycardic and his NEWS score is 9
Airway – Patent, able to talk
Breathing – Respiratory Rate: 24 per min, SpO2 94% on 2 litres oxygen, shallow breathing
Circulation – Pulse rate: 125 per min and regular, Blood Pressure: 95/60mmHg, Urine: 25 mls/hr, Capillary refill time 4 seconds, appears pale and has cold and clammy skin
Disability – Alert but drowsy, Blood glucose 5.6 mmol
Exposure – Temperature: 36.8 centigrade, Tender over wound site with blood-soaked dressing, Pain score 8/10,
IV cannula in forearm, has vomited once. Masthan is anxious and asking for Jackie
Masthan is showing signs of physiological shock. Review by surgeon confirms hypovolaemic shock due to blood
loss. Masthan is to be prepared for emergency surgery to investigate possible internal haemorrhage.
Amlodipine, Dalteparin, Metronidazole, Gentamicin, Paracetamol, Morphine, Cyclizine, Metoclopramide,
Sodium Chloride 0.9% intravenous solution, Packed Red Blood Cells (Cross matched blood for IV transfusion), Oxygen (via face mask)
Issues from scenario – lifestyles- overweight,
- Gall stone removal
- Pain
- Low blood pressure- can be caused by bleeding must look at blood volume, fluid charts, how much has
- been lost- can relate to level of competence (benner model)
- Grade 4- hypovolemic shock.
- No cannula
- High respiratory-24
- Raised heart rate- 125
- Oxygen- 94%
- Tender wound site & Blood soaked dressing
- Vomited once
- Alert but drowsy
LIST OF MODELS TO CHOOSE ONE
- The Cognitive Continuum Model
- The Humanistic Intuitive Model
- The Information- Processing Model
- Benner’s model
