Clinical Decision-Making Assessment: A report into the clinical decisions made for a clinical care scenario.
Writing your Clinical Care Scenario
You have to write a report on a clinical care scenario that involves clinical decision making.
Step 1: Reflect on your clinical placements that you have had since you started the course. This may be recent or from any placement that you have been on.
Consider: It needs to be simple and from a moment in time.
I was working with Mrs B who is a 76-year-old lady who has diabetes, hypertension and angina. She had been admitted to hospital due to an infected leg ulcer. She needed regular dressing changes but had been refusing to get it changed regularly as the pain was so severe. Me and my supervisor discussed how we could help Mrs B and she suggested that she took pain killers 30 minutes prior to the dressing change. Mrs B was keen to engage and as a result was more willing to commit to regular dressing changes.
For instance:
The report does not have to be about something good or bad occurring. It is about a moment of time and learning about what happened and the decision that were made.
Please avoid anything that may be personal, emotive, or considered poor practice and needs escalating. We are using this as an opportunity to learn why something happened in a particular way or why it may be best for it to be undertaken differently.
The clinical care scenario care will provide the framework for the report and the critical discussions and therefore ensure that it has sufficient content to be able to explore, and not too much that it is hard to cover.
What needs to be incorporated into my clinical care scenario?: The scenario needs to have the following elements:
It needs to have a clear decision-making process.
In the scenario above the decision was made in collaboration with the student nurse. However the decision was made by the practice supervisor.
The pathophysiology that could be discussed is: leg ulcer, infection, diabetes, hypertension and angina.
The most appropriate would probably be leg ulcer but infection and diabetes could also be a possibility.
You need to be able to discuss pathophysiology that is directly linked to the case study.
You need to discuss pharmacology that is directly linked to the case study.
The pharmacology that could be discussed: diabetes medication, pain control or dressing used.
The most appropriate is probably either pain medication or type of dressing.
Is the patient or care involved in the decision-making process? If not, should they have been? It maybe that they were not. That is fine. Discuss the importance of involving (or not) the patient in the decision-making process. Or look at it from a patient centred care perspective.
The issues for the patient was not about little concordance (agreement) (try to avoid the term compliance as it insinuates that the patient is deliberately not adhering to treatment) with treatment. Mrs B was concerned about the pain (patient factor) and this was preventing her agreeing to dressing changes as frequently as requested.
Is there any guidelines or policy that could guide management of the patient?
The guidelines could be regarding management of her leg ulcer, or it could be focussing on pain medication. For example:
Pressure ulcers: prevention and management. Clinical guideline [CG179]
However, there may be others. For instance, an international guidance https://www.epuap.org/wp-content/uploads/2016/10/quick-reference-guide-digital-npuap-epuap-pppia-jan2016.pdf
Will I be able to find evidence to back up the decision making process?
The evidence needs to be from research articles. Not www.nhs.uk or Healthline.
Question: Does your clinical care scenario meet the above requirements?
Yes: proceed to the next stage.
No: return to clinical care scenario and relook at how to incorporate the above.
Writing your report:
The decision-making process. Look at how you can explore the decisions made. It may be useful to draw out the stages and the influencing factors.
The aspects that we may want to include in this maybe:
The theoretical knowledge- We have been taught how to undertake dressings.
Working knowledge- the practical application of undertaking a dressing, this may include previous experience of a similar encounter.
We may explore the professional aspects that influence our decision to try to improve the patient experience and reduce pain (look at the NMC code of conduct).
Are our ethics influencing the management of the patient. If so how (does autonomy apply, beneficence, non-maleficence or justice). Rationalise why.
a. Pathophysiology.
The pathophysiology needs to be the linked to the case study. You may wish to include:
1. Aetiology (cause),
2. Risk factors
3. The physiology influenced by the disease or illness.
4. Signs and symptoms
Everyone will be different so they may not all require all of these elements. Read around the subject and look at various textbooks. Reference this. There does not need to be many but ensure that the source is identified. Use books from canvas and not Wikipedia or google.
2. b. Pharmacology
The pharmacology around how the drug works (this can include oxygen, dressings etc).
You can use the BNF for information but remember we need to know a little bit more about it. Go to Essentials of Pharmacology for Nurses https://go.exlibris.link/Fj2mYwdw
Reference this. There does not need to be many but ensure that the source is identified. Use books, articles from canvas, BNF etc and not Wikipedia or google.
Service user or patient centred care.
Consider the service user perspective. How does this differ from your perspective?
Consider your goal. What is the patient’s goal?
You may also consider patient centred care. For instance, a patient is receiving morphine. You are aware that constipation is caused from morphine. You enquire with the patient about their bowel habits and suggest that a laxative may be a useful adjunct to their stay (preventing harm).
Guidelines or policy
What is the difference between policy and guidelines? For your topic, what guidelines are out there? It is always useful to look at NICE. Are there any alternative guidelines? Consider professional bodies that may have their own specific guidance.
How does this differ to NICE? Is a policy best suited to your topic area? If so, why?
Be critical. Your evidence may sit alongside the guideline. If it does not say so and discuss.
Evidence
You can search through specific journals if you know the article you are looking for.
GO to Health subject toolkit.
Go to Specialist data bases
The evidence needs to be from research articles. Not www.nhs.uk or Healthline.
Tasks to undertake in order to write the report:
The report has to cover the following aspects
A brief summary of the clinical decisions made.
A discussion of the pathophysiology and pharmacology relevant to the episode of care
The importance of person-centred care and involving patients in their decisions around the planning and implementation of their care.
Discuss the relevance of health policy or guidelines in relation to the episode of care.
Critical discussion and evidence to support or refute the decisions that were made
Evaluating the effect of the decision
Included in the report there must be consideration towards:
Ethical issues and professionalism.
Systematic approaches to care, for instance the Nursing process.
There must be critical discussion and evidence to support your writing from a wide range of sources.
Word count 2500+/- 10% due on the 27th of April at 10.00am.
You will be offered the opportunity to undertake a formative to support you with your assignment.
The formative will consist of 500 words on section 2: Explore the relevant pathophysiology and pharmacology relevant to this clinical care scenario. Include in the appendix your clinical care scenario and an outline of your report (bullet points). 27th of March at 10.00
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Report into the clinical decisions made and the rationale and evidence supporting or refuting these clinical decisions. |
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| Date | |||||||
| Clinical care scenario concerning… (note all names, places of work have been changed to protect patient confidentiality) | |||||||
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This report is about the clinical care scenario found in appendix 1. Please refer to this for information regarding the nature and the issues discussed in the report. |
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| 1. | Identify the key clinical decisions made that are relevant to this clinical care scenario of care and will be explored further within this report. You may choose to frame this section in context of a suitable decision-making model. Include here any ethical or professional issues. | ||||||
| 2. | Explore the relevant pathophysiology and pharmacology relevant to this clinical care scenario | ||||||
| 3. 4. 5. | In this section. In relation to the clinical decisions made; critically discuss the evidence supporting or refuting these decisions, discuss the relevance of patient centred care and the importance (or not) of the patient’s involvement in their care and consider how relevant health policy shapes or guidelines informs decisions. | ||||||
| 6 | In respect of the findings in the report; evaluate the care given and how the evidence supporting or refuting the clinical decisions made will impact on future practice. | ||||||
Appendix 1: Clinical Care Scenario
Appendix 2: References and bibliography