Clinical Decision Making in Nursing

Clinical decision making can be defined as, the collection of relevant patient information and accurate assessment, which results in an action being taken in the delivery of nursing care to the patient (Clark 1996). This definition is identical to the nursing process as described by (ref ewles & simnett?) however, this has been disparaged by some for not being critical in its stages (assesment, planning, implementation and evaluation) leading to standardized care plans and the reduction in decision making based on the individual patient (Benner et al 1996). Therefore, a definition by Standing (2005) which goes on to say that decisions should also be evidence based, critically thought out and within the realms of that nurses capabilities, is more applicable. The NMC (2004) state that the capacity to exhibit ‘sound clinical-decision making,’ is an essential requirement for pre-registration nurses. This alongside the NMC Code (2008) which stipulates evidence based practice must underpin actions and/or ommissions leading to accountability of care highlights the need for the ability of nurses to make and carry out clinical decisions. Dreyfus and Dreyfus (1986) argued that expert nurses make decisions based on intuition. However, intuition is not in keeping with the aim of evidenced based care stipulated in the DOH (1998) paper, A First Class Service, which aspires to raise the standard of care throughout the NHS. Conversly, it is unrealistic to have a guideline for every clinical decision, therefore nurses must be able to make decisions by referring to policy/guidelines, drawing on their own knowledge and experience whilst also taking into account clinical observation of the patient, their wants and needs (Bakalis & Watson 2005).

For the purpose of this essay the example of decision making is observed from a student nurse perspective. The decision was whether or not a staff nurse would challenge a doctor about his choice to re-canulate a child. In brief the