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
Alongside with NEWS scoring I used an ABCDE assessment to recognise and treat
problems (Resuscitation Council (UK),
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. Therefore, I and my mentor concluded with a decision of
escalating Mr Gill to medical team based on NEWS score.
This decision of mine and my
mentor was based upon a 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. In this scenario, the behaviour of Mr Gill has been
observed under the assumption that these behaviours are reflected due to some
abnormalities. 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. This is supported by 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).However, the
accuracy of my scoring system might not be right and might vary between different
health care professionals (HCP) on how they score based on their knowledge and
experience or human factors (University of York, 2018). The inaccurate
scoring can lead to inaccurate and delay in care being provided to patient
which might cause more health issues for a patient. The use of an electronic
system to calculate NEWS score compared to hand written documentation is less
time consuming and shows more accuracy with scoring for patient (Mohammed, et al., 2009). Therefore, the
method of using paper to calculate NEWS score might be unreliable which could
lead to an inaccurate judgement and decision making.
In this scenario, the decision
making could be affected by the human factors such as stress and fatigue at
work due to heavy workload, long hours of shift and lack of staffing, leading
to inattentive towards the patient presenting cues. This could cause delay in
performing observation and affect the analysis of NEWS score and therefore the
decision to escalate could be affected.
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.
Mohammed, M. A. et al., 2009. Improving accuracy and
efficiency of early warning scores in acute care. British Journal of
Nursing, 18(1), pp. 18-24.
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.
Resuscitation Council (UK), 2008. Resuscitation
Council UK. Online
Available at: file:///C:/Users/asmit/Downloads/EmergencyTreatmentOfAnaphylacticReactions.pdf
Accessed 18 December 2017.
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Available at: https://www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news-2
Accessed 18 December 2017.
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D., 1987. Diagnostic reasoning strategies of nurses and nursing students. Nursing
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Traynor, M., Boland, M. & Buss, N., 2010.
Autonomy, evidence and intuition: nurses and decision-making. Journal of
Advanced Nursing, 66(7), pp. 1584-1591.
University of York, 2018. Impact of early warning
systems on patient outcomes. Online
Available at: https://www.york.ac.uk/crd/publications/effectiveness-matters/early-warning-systems/
Accessed December 29 2017.