Essentials of Nursing Practice
Student Resources
Chapter 19: Clinical decision-making
1. What does holistic care mean?
Answer: A patient centred approach to care delivery that embraces physical, emotional, psychosocial, spiritual and cultural health needs.
2. What factors may facilitate effective communication in the clinical decision making process?
Answer: Open, honest relationship that fosters rapport and trust, self-awareness, awareness of verbal and non-verbal skills such as active listening, open questioning, eye contact and clear documentation.
3. How can patient’s ‘self’ advocacy be enabled during clinical decision making?
Answer: Adequate information given to make informed choices. Develop partnership in care that reflects mutuality and reciprocity between the patient and practitioner.
4. How can practice be improved in clinical decision making?
Answer: Critical reflection, clinical judgement, mentorship and integration of evidence based practice.
5. Describe ways patients might be involved to improve healthcare service delivery?
Answer: Expert patient programme, patient representatives on education and clinical programs and working in partnership with voluntary organisations, patient feedback such as satisfaction surveys, focus groups.
6. What factors should be considered in ethical decision making?
Answer: Beneficence, non-maleficence and patient’s autonomy
7. How can nurses ensure that ensure that patients are empowered to make decision on their health?
Answer: Information giving, open communication, facilitative support network, multi-professional teamwork, promoting and organisational culture that empowers staff, e.g. championing, continuous professional development.
8. How can reflection on action be developed?
Answer: Clinical supervision, reflective journal, models of reflection could offer some guidance, peer review.
9. What can be described as intuitive knowledge?
Answer: Pattern recognition, salience, common-sense understanding, ‘hunch’.
10. What does accountability mean?
Answer: Accountability – answerable to those in authority; there is a legal obligation between the practitioner and those in authority. It can be argued that one is accountable to oneself – moral perspective that may be associated with a sense of ownership; values embedded in the profession that could involve altruistic acts.
11. What does health literacy mean in clinical decision making?
Answer: The patient is provided with the necessary information and tools, in a way they can understand and make informed choices about their health. It requires patient empowerment so that they are actively involved in the decision making process.
12. Describe ways in which the care given can be evaluated?
Answer: Patient feedback, critical reflection, audit and clinical governance, case reviews, multi-professional team meetings, peer reviews.
13. Hypothetico-deductive reasoning involves a structured, analytical process of utilising scientific information such as guidelines to support decisions made. In addition to scientific knowledge, what other ways of knowing can be used to enhance the decision making process?
Answer: Personal knowledge – requires self-awareness, ethics that facilitates judgement and aesthetics that acknowledges the art of nursing such as intuition to be incorporated in decisions.
14. How can emotional labour be demonstrated in clinical decision making?
Answer: Embedding the 6 C’s, ensuring professional values underpin practice, upholding the code (NMC, 2015).
15. What factors could enable an integrated approach to health and social care decision making?
Answer: Collaboration, inter-professional team working, clear documentation, framework for joint assessments, understanding roles and responsibilities, care pathways.