Clinical Decision Making

Lilik S

PRINCIPLES of PATIENT CARE

Decisions making Evidence based nursing Practice guidelines Assessing the outcome of care Delivering cost-effective & benefit medical care Accountability Continued learning Research and teaching

Decision-making
is solving a problem using a systematic approach of sequenced steps, selecting an alternative approach, and putting the approach into action.

An organizational decision
relates to organizational purpose: futurity,impact, philosophy or ethics, uniqueness.

A personal decision
relates to professional autonomy.

Manager behavior

Applies decision-making theory and the problem-solving process in achieving the mission of the nursing agency.

Pitfalls of decision making

Inadequate fact finding Time constraints Poor communication Failure to follow decision-making steps

Steps in problem-solving

Systematically collect, organize, and analyze data related to a specific problem or need. Make a plan of action. Implement the plan. Evaluate the results.

Normative model
1. Define and analyze the problem 2. Identify all available alternatives 3. Evaluate the pros and cons of each alternative 4. Rank the alternatives 5. Select the alternative that maximizes satisfaction 6. Implement 7. Follow up

PARADIGMA PROSES DIAGNOSIS

MEMPELAJARI PENDERITA DATA DASAR inducto MANIFESTASI MASALAH KELAINAN
STRUKTUR & FUNGSI

verivicative

hypotetico

SINTESIS DIGNOSIS
PERUBAHAN
MORFOLOGI, SELULER & KIMIA

VERIFIKASI
Diagnosis Planning, etc

PATOANATOMI PATOFISIOLOGI deducto PATOGENESIS ETIOLOGI DATA DASAR MEMPELAJARI PENYAKIT

Scientific Problem Solving Approach

S.P.S.A. PROBLEM IDENTIFICATION EVALUATION DATA COLLECTION CLINICAL PROCESS HEALTH PROBLEM FOLLOW-UP ANAMNESA/ P.D./ LAB. / MED-RECORD DATA & INFORMATION ANALYSIS

IMPLEMENTATION

DATA ANALYSIS

IMPLEMENTATION

PRIORITY SETTING

HYPOTHESIS FORMULATION HYPOTHESIS TESTING

TREATMENT PRIORITY SETTING

DIAGNOSIS SYNTHESIS

PROBLEM SOLVING ALTERNATIVE

TREATMENT ALTERNATIVES

DIAGNOSIS PLANNING

Making critical decisions requires critical judgment the use of knowledge and experience to diagnose patients and plan their treatment.

Critical Decision Making

The ability to anticipate The ability to prioritize The ability to problem-solve Relies heavily on knowledge base An ability to learn from past mistakes

Critical thinking is not an action but a way of life.

Bledsoe et al., Essentials of Paramedic Care: Division 1I 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Acuity

The severity or acuteness of your patients condition

Protocol

A standard that includes general and specific principles for managing certain patient conditions

Standing Orders

Treatments you can perform before contacting the medical direction physician for permission

Algorithm

Schematic flow chart that outlines appropriate care for specific signs and symptoms

Paramedics Critical Thinking Skills (1 of 2)

Knowing anatomy, physiology, and pathophysiology Focusing on large amounts of data Organizing information Identifying and dealing with medical ambiguity

Paramedics Critical Thinking Skills (2 of 2)

Differentiating between relevant and irrelevant data Analyzing and comparing similar situations Explaining decisions and constructing logical arguments

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