Week 1: Clinical Decision Making and Clinical Reasoning Flashcards
What are the reasons for adverse patient outcomes during deterioration?
Failure in cognition/synthesis and acting on clinical information:
Failure to properly diagnose
Failure to institute appropriate treatment (confidence)
Inappropriate management complications
What is critical thinking?
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
What are the characteristics of a critical thinker?
Open minded Inquisitive Truth seeking Analytical Systematic Self confident Ability to reflect
What are the characteristics of critical thinking in nursing?
Essential part of clinical reasoning in contemporary healthcare Conscious Outcome oriented Purposeful Intentional Needs to be fostered and practised
What is clinical reasoning?
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
Add questions about the clinical reasoning cycle
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What are barriers to clinical reasoning?
Interruptions Workplace culture Values Power dynamics Knowledge and the ability to integrate theory ad practice
What are different types of problem solving?
Trial and error: N/A healthcare
Scientific problem solving: clinical reasoning cycle and pattern recognition
Intuitive problem solving: tacit knowledge from years of experience
What is the role of the nurse in assessing deterioration?
Surveillance
Accurate patient assessment: need to go beyond standard vitals
Clinical reasoning
Instigating action
What is the context of patient deterioration?
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
What are afferent and efferent limbs of RRSs?
Afferent limb: systems to detect patient deterioration
Efferent limb: triggered response to detected patient deterioration
What are examples of afferent and efferent limbs?
MEWS
PART
MET
Between the Flags
What are the purposes of Between the Flags?
Improve compliance with vital sign recording
Assist staff in identifying patient deterioration
Reduce number of different charts in use and increase familiarity
What is the role of effective communication in detecting and managing deteriorating patients?
Critical element, needs improvement
Can be improved through systems and tools for structured communication
ISBAR
What does ISBAR stand for?
Introduction Situation Background Assessment Recommendations
Do systems implemented to detect and respond to patient deterioration diminish critical thinking?
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
What are the two types of reflection nurses should conduct?
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
What is an initial assessment?
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
What is a primary survey?
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
What is crepitus or subcutaneous emphysema?
Air bubbles underneath the skin
What is a secondary survey?
Head to toe assessment: Face Neck Chest: respiratory assessment Cardiac assessment Limbs Abdominal assessment Neurovascular assessment Urine
Include patient positioning
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