Week 1: Clinical Decision Making and Clinical Reasoning

Question 1

What are the reasons for adverse patient outcomes during deterioration?

Answer 1

Failure in cognition/synthesis and acting on clinical information:

Failure to properly diagnose
Failure to institute appropriate treatment (confidence)
Inappropriate management complications

Question 2

What is critical thinking?

Answer 2

A disciplined, intellectual process which requires individuals to consistently examine their beliefs, knowledge ad attitudes in the light of evidence. It means analysing, synthesising and evaluating information, as well as considering underlying values and assumptions

Question 3

What are the characteristics of a critical thinker?

Answer 3

Open minded
Inquisitive
Truth seeking
Analytical
Systematic
Self confident
Ability to reflect

Question 4

What are the characteristics of critical thinking in nursing?

Answer 4

Essential part of clinical reasoning in contemporary healthcare
Conscious
Outcome oriented
Purposeful
Intentional
Needs to be fostered and practised

Question 5

What is clinical reasoning?

Answer 5

The process by which nurses collect cues, process and interpret the information, make a judgement about a patient problem or situation, come to a decision, plan and implement interventions, evaluate outcomes, and reflect and learn from the process

Question 6

Add questions about the clinical reasoning cycle

Answer 6

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Question 7

What are barriers to clinical reasoning?

Answer 7

Interruptions
Workplace culture
Values
Power dynamics
Knowledge and the ability to integrate theory ad practice

Question 8

What are different types of problem solving?

Answer 8

Trial and error: N/A healthcare
Scientific problem solving: clinical reasoning cycle and pattern recognition
Intuitive problem solving: tacit knowledge from years of experience

Question 9

What is the role of the nurse in assessing deterioration?

Answer 9

Surveillance
Accurate patient assessment: need to go beyond standard vitals
Clinical reasoning
Instigating action

Question 10

What is the context of patient deterioration?

Answer 10

Ageing population
More co-morbidities
Increased patient acuity
Hospital length of stay decreasing
Complex surgery performed on patients previously considered too high risk for surgery
Increasingly complex clinical loads

Question 11

What are afferent and efferent limbs of RRSs?

Answer 11

Afferent limb: systems to detect patient deterioration

Efferent limb: triggered response to detected patient deterioration

Question 12

What are examples of afferent and efferent limbs?

Answer 12

MEWS
PART
MET
Between the Flags

Question 13

What are the purposes of Between the Flags?

Answer 13

Improve compliance with vital sign recording
Assist staff in identifying patient deterioration
Reduce number of different charts in use and increase familiarity

Question 14

What is the role of effective communication in detecting and managing deteriorating patients?

Answer 14

Critical element, needs improvement
Can be improved through systems and tools for structured communication
ISBAR

Question 15

What does ISBAR stand for?

Answer 15

Introduction
Situation
Background
Assessment
Recommendations

Question 16

Do systems implemented to detect and respond to patient deterioration diminish critical thinking?

Answer 16

They can, but they should not:

Focus on data and trends
Know your patient
Understand anatomy, physiology and pathophysiology
Analyse clinical data
Predict patient problems
Think in action
Reflect

Question 17

What are the two types of reflection nurses should conduct?

Answer 17

Reflection in action:
Ability to read the situation
How is the patient responding to the care and interventions?

Reflection on action:
Opportunity for clinical learning
Requires courage and sense of responsibility

Question 18

What is an initial assessment?

Answer 18

Process of assessment beginning as soon as the nurse sights the patient
Immediate, subjective impression of visible manifestations of pathology or distress, including:
Facial expression or affect
Skin colour and texture
Deformity
Gait
General appearance

Question 19

What is a primary survey?

Answer 19

Airway and assessing for cervical spine injury
Breathing:rate, depth, chest expansion, accessory muscles, auscultation of breath sounds, palpation for crepitus
Circulation: pulse, BP, skin colour
Disability: LOC, pupillary response, gross sensory motor function
Exposure: life threatening injuries, haemorrhage, etc
Fluids
Glucose

Question 20

What is crepitus or subcutaneous emphysema?

Answer 20

Air bubbles underneath the skin

Question 21

What is a secondary survey?

Answer 21

Head to toe assessment:
Face
Neck
Chest: respiratory assessment
Cardiac assessment
Limbs
Abdominal assessment
Neurovascular assessment
Urine

Question 22

Include patient positioning

Answer 22

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