24/05/23

 

Clinical judgment is the accumulation of knowledge and skills over time, which contributes to the nurse’s ability to analyze and synthesize the patient presentation, objective, and subjective data, and to provide evidence base nursing interventions to improve patient outcomes.

It involves assessing the potential consequences (risk and benefits) of possible alternative actions before committing oneself or the other (decision making).

Shared decision is the process through which a clinical support of a patient is reach to a decision making about their treatment.  ASPIRE (Assess, Systematic nursing diagnosis, Plan, Implement, Recheck and Evaluate) is the method used to assessing patient.

The health professionals and patients working together to make decisions about treatment plan for the patient.

There are different choices available to discussed with the patient along with their risk and benefits.

Support the patient to understand and express what they want to achieve from their treatment or support.

Some benefits of shared decision making.

Health care professionals and the patient can gain understanding of what’s important to the other person.

The patient feels supported and empowered to make informed choices and reach a shared decision.

Health and social care professionals can tailor the care or treatment to the needs of the individual.

It enables the patient to be in control of their own care. This result in better and more cost -effective outcomes.

Involvement in care may lead to reduced hospital admission rates.

 

The importance of working in partnership enables shared decision making a relationship between the health care professional and the patient must be a partnership.

It is a relationship in which healthcare professionals and the patient work together to:

• Understand what is important to the person.
• make decision about their care and treatment.
• Identify and achieve their goals.
• Normally there will be choices to make about your healthcare.

Ensure these questions are answered:

“What are the options?”

“What are the pros and cons of each option for me?”

“How do I get support to help me make a decision that is right for me?”

The patient must be fully informed about the options they face.

They must be provided with reliable evidence-based information on the likely benefits and harms of interventions or actions.

This involves:

• Providing reliable, balanced, evidence-based information outlining treatment, care or support options, benefits, risks, and outcomes.
• Decision support counselling with a clinician or health coach to clarify options and preferences.
• System for recording, communicating, and implementing the patient’s preferences.

In decision support, clinicians need to assess what patients need to decide and provide them with appropriate resources to support this process.

Support can be given in clinical consultations or through other sources such as counselling provided by trained health coaches.

Decision support resources aim to help people to develop the knowledge, skills, and confidence to manage their own health and make treatment decisions and/or lifestyle changes accordingly.

Decision aids can be provided that the patient can review and absorb at home, before returning to discuss their preferences and decide how to treat or manage their condition.

Decision aids are designed to inform patient and help them think about what the different options might mean for them helping them to reach an informed preference.

The patient decision aids take a variety of forms, for example:

One-page sheets outlining the choices,

Detailed leaflets,

Computer programs,

Interactive websites.

 

Some of the impacts of using decision aids in practice:

Decision can:

• Improve on the patient knowledge of the options.
• Helps the patient feel more informed.
• Ensure the patient has accurate expectations of the possible benefits and harm associated with their options.
• Encourage more participation in decision making.
• Facilitate discussion between the patient and the practitioner.

In recording, decisions must be documented in the patient’s notes or electronic medical record.

Document if the patient has used a decision aid.

The record of decisions or the care plan should be accessible to the patient as well as health professionals.

This document can be used for several different purposes:

• as a legal record of the shared decision-making process.
• To help coordinate care.
• As a personally held record that can be continually updated to support behavior change.
• To inform commissioning strategies.

Barriers to shared decision- making:

• Time
• Standardized approach to practice.
• Lack of decision aids.
• Patients not wanting to be involved.
• Patient unable to be involved.
• Decision making capacity.

I learnt about the decision-making capacity:

• Some patients can provide a history but lack the ability to make decisions.
• The need to determine whether a patient has a “decision making capacity” which is the ability to understand information related to health, weigh clothes and their consequences, reason through the options, and communicate a choice.
• A patient who is quite ill may be unable to make decisions about care but can regain capacity with clinical improvement.
• A patient who may be unable to make a complex decision but still able to make simple decisions.
• Even if the patient lack capacity for certain decisions, but still important to seek their input, as they may have definite options about their care.

The following are the elements of decision-making capacity. Patient must have the ability to:

• Understand the relevant information about proposed diagnosis test or treatment.
• Appreciate their situation (including their underlying values and current clinical situation)
• Use reason to decide.
• Communicate their choice.

 

 

 

 

 

 

 

 

 

 

KSB ADDRESSED.

 

 

 

KNOWLEDGE:

K1: Understand the code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC 2018), and how to fulfil all registration requirements.

K4: Understand the principles of research and how research findings are used to inform evidence-based practice.

 

K5: Understand the meaning of resilience and emotional intelligence, and their influence on an individual’s ability to provide care.

 

K6: Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice.

 

K7: Understand the importance of courage and transparency and apply the Duty of Candour.

K8: Understand how discriminatory behaviour is exhibited.

K9: Understand the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people.

K10: Understand the principles of epidemiology, demography, and genomics and how these may influence health and well-being outcomes.

K11: Understand the principles of epidemiology, demography, and genomics and how these may influence health and well-being outcomes.

K12: Understand the importance of early years and childhood experiences and the possible impact on life choices, mental, physical, and behavioural health, and well-being.

K13: Understand the contribution of social influences, health literacy, individual circumstances, behaviours, and lifestyle choices to mental, physical, and behavioural health outcomes.

 

K15: Understand human development from conception to death, to enable delivery of person-centred safe and effective care.

K16: Understand body systems and homeostasis, human anatomy and physiology, biology, genomics, pharmacology, social and behavioural sciences as applied to delivery of care.

K17: Understand commonly encountered mental, physical, behavioural, and cognitive health conditions as applied to delivery of care.

 

K18:  Understand and apply the principles and processes for making reasonable adjustments.

K19: Know how and when to escalate to the appropriate professional for expert help and advice.

K20: Know how people’s needs for safety, dignity, privacy, comfort, and sleep can be met.

 

K21: Understand co-morbidities and the demands of meeting people’s holistic needs when prioritising care.

 

K22: Know how to meet people’s needs related to nutrition, hydration and bladder and bowel health.

K23: Know how to meet people’s needs related to mobility, hygiene, oral care, wound care, and skin integrity.

K24:  Know how to support people with commonly encountered symptoms including anxiety, confusion, discomfort, and pain.

K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life.

 

K26: Understand where and how to seek guidance and support from others to ensure that the best interests of those receiving care are upheld.

 

K27: Understand the principles of safe and effective administration and optimisation of medicines in accordance with local and national policies.

K28: Understand the effects of medicines, allergies, drug sensitivity, side effects, contraindications, and adverse reactions.

K29: Understand the different ways by which medicines can be prescribed.

 

K30: Understand the principles of health and safety legislation and regulations and maintain safe work and care environments.

 

K33: Understand when to seek appropriate advice to manage a risk and avoid compromising quality of care and health outcomes.

 

K36: Understand the roles of the different providers of health and care.

K39: Understand the principles and processes involved in supporting people and families with a range of care needs to maintain optimal independence and avoid unnecessary interventions and disruptions to their lives.

K40: Understand own role and contribution when involved in the care of a person who is undergoing discharge or a transition of care between professionals, settings, or services.

 

K41: Know the roles, responsibilities, and scope of practice of different members of the nursing and interdisciplinary team, and own role within it.

 

 

SKILLS:

 

S1: Act in accordance with the Code: Professional standards of practice and behaviour for nurses, midwives, and nursing associates (NMC, 2018), and fulfil all registration requirements.

S2: Keep complete, clear, accurate and timely records.

S5: Safely demonstrate evidence-based practice in all skills and procedures required for entry to the register: Standards of proficiency for nursing associates Annex A & B (NMC 2018).

 

S17: Safely demonstrate evidence-based practice in all skills and procedures required for entry to the register: Standards of proficiency for nursing associates Annex A & B (NMC 2018).

 

S18: Recognise when capacity has changed recognise and how a person’s capacity affects their ability to make decisions about their own care and to give or withhold consent.

 

S21: Monitor the effectiveness of care in partnership with people, families and carers, documenting progress, and reporting outcomes.

 

S23: Work in partnership with people, to encourage shared decision making, to support individuals, their families, and carers to manage their own care when appropriate.

S25: Meet people’s needs for safety, dignity, privacy, comfort, and sleep.

S26: Meet people’s needs related to nutrition, hydration and bladder and bowel health.

 

S27: Meet people’s needs related to mobility, hygiene, oral care, wound care, and skin integrity.

 

S28: Support people with commonly encountered symptoms including anxiety, confusion, discomfort, and pain.

 

S30:  when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings, and escalating as needed.

 

S32: Work collaboratively and in partnership with professionals from different agencies in interdisciplinary teams.

 

S35: Accurately undertake risk assessments, using contemporary assessment tools.

 

 

 

 

 

BEHAVIOUR:

B1: Treat people with dignity, respecting individual’s diversity, beliefs, culture, needs, values, privacy, and preferences.

B2: Show respect and empathy for those you work with, have the courage to challenge areas of concern and work to evidence based best practice.

B3: Be adaptable, reliable, and consistent, show discretion, resilience, and self-awareness.