I always faced challenges with clinical decision-making as a new graduate. As an emergency department full-time nurse, making reasonable, logical, and precise clinical decisions is a top priority due to the complexity of different medical conditions exhibited by patients. However, to attain the competence of making reliable clinical decisions, I received exemplary support and guidelines from my instructors throughout my education until now as a graduate student. In general, clinical decision-making entails making inferences regarding a patient’s needs and health status and selecting an appropriate methodology to meet the identified patient’s needs (Tanner, 2016).
My instructors used a variety of techniques to build our clinical judgment competence. The instructors taught us that nurses utilize an array of combined reasoning patterns based on the demands of the clinical situation markets. These techniques entail using analytical processes such as the hypothetico-deductive procedures naturally present in diagnostic reasoning, narrative thinking frameworks, and intuition (Nibbelink & Brewer, 2018). These techniques have specific patterns that can be triggered in a given clinical situation and can be used as stand-alone methodologies or combined with other practices (Hutchison et al., 2019).
The analytical processes technique involves breaking a clinical situation into its constituent elements. This technique’s core attribute involves establishing different options against the patients’ clinical data or the probability of attaining outcomes (Tanner, 2016). The analytic processes technique is used in several contexts, especially by new nurses who lack fundamental knowledge regarding patient assessments. As such, the new nurses may undertake an in-depth evaluation of the patient and then infer from textbooks to compare the assessment information to the patient’s clinical signs and symptoms, as explained in the book. The analytic processes technique can further be utilized when there is an evident mismatch between the expected assessment outcomes and the actual occurrences in a given clinical situation. This involves diagnostic reasoning in which one evaluates a decision based on available alternatives. For instance, when various diagnosis alternatives are available or other appropriate interventions from which to select, a logical, analytic process technique is used, in which the available evidence that favors each clinical diagnosis or the merits and demerits of each intervention are compared against each other.
The intuition-based technique involves an immediate understanding of the present clinical situation. It is based on the provider’s experience with previous similar encounters (Price et al., 2017)—the concept of apprehension often relies on identifying a pattern in a patient’s clinical symptoms. The last technique is the narrative thinking approach. This approach is based on 1986 cognitive development studies by Jerome Bruner, a psychologist (Buckingham & Adams, 2017). Bruner argued that individuals think in a paradigmatic way (via propositional argument) and a narrative form (through describing and translating stories) (Ashley & Stamp, 2016). The narrative thinking approach encompasses an attempt to comprehend a specific case. It is perceived as the human core sensible way of understanding experiences via trans action of inherent individual concerns, intents, and objectives. The narrative thinking technique is based on the underpinning that appropriate care can only be provided based on described elements of a given medical condition, awareness of the meaning individuals attach to the state, understanding of the patients coping mechanisms, and their prospects.
Ashley, J., & Stamp, K. (2016). Learning to think like a nurse: The development of clinical judgment in nursing students. The Journal of Nursing Education, 53(9), 519–525. https://doi.org/10.3928/01484834-20140821-14
Buckingham, D., & Adams, A. (2017). Classifying clinical decision making: Interpreting nursing intuition, heuristics, and medical diagnosis. Journal of Advanced Nursing, 32(4), 990–998.
Hutchison, T., Lees, C., Lotto, R., White, A., & Harris, R. (2019). Clinical decision making and the challenges of responding to mental health needs. Journal of Paramedic Practice, 11(10), 434-439. https://doi.org/10.12968/jpar.2019.11.10.434
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