Nurses come across various
situations in practices where a decision has to be made following a judgement (Traynor, et al., 2010). Therefore, nurses’
decision making and judgement contributes to safety and quality of patient care
which can arise the challenges. The effective decision should be made for
patients who are incapable of processing the information and those who have capacity
should be involved in the decision of their own care (Nursing and Midwifery
council (NMC), 2015). In this assignment I will be using a
specific scenario of a patient whose name will be given a pseudonym to maintain
the confidentiality as stated by NMC code. The scenario will be used to discuss
about the decision undertaken in practice along with my allocated mentor by
analysing it in depth explaining the appropriate decision made regarding
patient safety. In addition, I will also be using a theory and evidence to show
how these strengthened my decisions and how this may influence my decisions
making in the future practice. Throughout this assignment, I will be further
exploring the ethical principles, protocols, guidelines and policies that
hospital uses to guide a healthcare professionals to conclude a decision to
deliver high standard of care and provide patient safety.
During a placement in medical
ward, I came across a patient named Mr. Gill who was a 38 years old man admitted
to the ward after post-operative chest drain inserted for pneumothorax. Mr Gill
presented with signs such as redness, itchiness, swollen tongue and difficulty
in swallowing, signs of allergic reaction for an antibiotic name doxycycline (Allergy UK, 2018). Mr Gill had a
social history of living with wife and a child and was an independent man. In
this scenario my decision was to carry out a set of observation using the
national early warning score (NEWS) which scores on the physiological
parameters of an individual (Royal college of
On the repetition of the set of observation Mr. Gill was scoring of 5 on
tachypnea, hyperthermia and tachycardia. The Royal college of Physicians states
that NEWS score with 5 or more, medical team caring for the patient should be
urgently informed. The study conducted in Buckinghamshire NHS Trust shows that
carrying out a NEWS helps with the case to be reviewed by a doctor of
appropriate seniority, improving the quality of care given at the hospital (Spiers, et al., 2015). Therefore, I and my
mentor concluded with a decision of escalating Mr Gill to medical team. However,
the accuracy of my scoring system might not be right
This decision of mine and my
mentor was based upon descriptive theory. The descriptive theory contributed
with our decision to escalate Mr Gill to medical team. The descriptive theory
is associated with the studies that observe, describe and analyse how decisions
are made by professionals. The one of the most common descriptive theory is hypothetic-deductive
theory and therefore my decision on the scenario will be based on this theory.
The hypothetic-deductive theory is a scientific approach which involves four
stages: cue recognition, hypothesis generation, cue interpretation and hypothesis
evaluation (Tanner, et al., 1987). The first stage is
cue recognition stage, at this stage I was able to collect clinical information
about Mr Gill, such as observing the changes in Mr Gill’s physical appearance.
This was followed by hypothesis generation, where I was able to develop a
hypothesis specifically about the cause of Mr Gill’s allergic reaction to any
form of medication administration. Hypothesis generation is followed by cue
interpretation where the interpretation of cues are generated from the first
finding and therefore focuses on to confirming the cues to contribute onto
original hypothesis. The cue such as Mr Gill itching constantly and complaining
about a swollen tongue and feverish feeling lead to confirming the original
hypothesis. At the final stage, the hypothesis was evaluated by carrying out
the NEWS score to confirm the changes in pathophysiological and therefore the
decision of escalating Mr Gill was taken.
Ethics is an unavoidable part
of nursing practice and therefore numbers of guidelines and codes have been
introduced. In this scenario, Mr Gill had a full capacity to understand the
information and provide consent. Therefore he was involved into a decision
about his own care as stated by a policy introduced by NHS- no decision about
me, without me. He was provided with all the information regarding the care and
the explanation about the reasons for the care being delivered. Before carrying
out any procedure, the informed consent was taken.
Intuition- body language
suggested something was wrong
Previous experience: Benner
novice to expert
Clinical judgement in nursing: (Standing, 2017)
Allergy UK, 2018. Allergy
Available at: https://www.allergyuk.org/information-and-advice/conditions-and-symptoms/34-drug-allergy
Accessed 22 December 2017.
Nursing and Midwifery council (NMC), 2015. Nursing and
Midwifery council. Online
Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf
Accessed 28 November 2017.
Royal college of Physicians, 2017. National Early
Warning Score. Online
Available at: https://www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news-2
Accessed 18 December 2017.
Spiers, L. et al., 2015. Recognition of the deteriorating
patient. BMJ Open Quality, Volume 4.
Standing, M., 2017. Clinical Judgement and Decision
making in Nursing. 3rd ed. London: Seige.
Tanner, C., Padrick, K., Westfall, U. & Putzier, D.,
1987. Diagnostic reasoning strategies of nurses and nursing students. Nursing
Research, Volume 36, pp. 358-363.
Traynor, M., Boland, M. & Buss, N., 2010. Autonomy,
evidence and intuition: nurses and decision-making. Journal of Advanced
Nursing, 66(7), pp. 1584-1591.