Paper Example on Clinical Decisions: Management Issues and Challenges

Introduction

Clinical decisions are critical as they determine the quality of service delivery of a health institution. Health officers are usually careful regarding this matter as the goal is to improve the patients' outcome. However, it is essential to note that this process is often not an easy one as it encounters many challenges. In this paper, I will be explaining three management issues regarding clinical decisions based on personal career experience.

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Notably, I encountered these problems during my internship as a nurse at the Peterson Centre in New York. My role at Peterson was not limited to handling patients, but also I was tasked with administration responsibilities. My encounter with patients was to take care of them to ensure the betterment of their health condition. For instance, I made sure that that they took their prescriptions as described. On the hand, my administrative role was to ensure that the hospital operations ran smoothly during my duty time. Importantly, the problems I discovered emerged from different situations during my stay at Peterson.

Issue #1: Problem Prioritization versus Patient Values

Background

It is a fundamental practice for all clinical to enhance patient values while making all decisions that concern the patients' welfare (Lee, Low & Ng, 2013). In this context, they help the patients to attain their right to good health by treating them with respect and humanely (Lee et al., 2013). Importantly, patient values are characterized by individual traits, status, beliefs together with desires such as gender, religion, socio-economic status and race (Lee et al.. 2013). It is also critical to note that clinical decisions also depend on the patient's medical situation. However, Lee and his colleagues (2013) explains that patient values are the most critical as they influence a patient's reaction towards the treatment. The challenge comes in when nurses prioritize the problem at hand instead of the patients' values when making decisions (Hoffman, Jansen & Glasziou, 2018).

Assessment

At Peterson, I noticed that the clinicians were not observant of the patient's values. The health staffs were only concerned of the bettering the patients' health conditions by making decisions based on the medical conditions excluding their (patients) standards. In my view, I saw that such practice portrayed an imbalance between medical conditions and patient values in decision making. As a result, the patients felt unappreciated even when they felt better after a decision was implemented. For instance, there was a case where a woman delivered through a C-Section whereby she had not consented. She later explained that she was hesitant about the procedure due to her socio-economic status that could not afford the service. As a result, she became stressed over her incapability to pay for the CS delivery service.

Recommendation

To rectify the issue, it is recommendable that patients' concerns to be favored in the process of making decisions (Lee et al., 20130. The clinical administrative should initiate survey exercises before service delivery to understand the personality, status, and needs of the patient. The knowledge of such history will enable a clinician to decide adequately considering both the standards and health conditions of the patient.

Significance

The issue of patient values in clinical decision making is necessary for nursing practice as it enables them to offer quality health services regarding social acceptance (Lee et al., 2013). Even though problem prioritization is vital in saving lives, patients have the right to consent and choose the clinical practices they desire (Lee et al., 2013). More so, prioritizing more on patients' needs and standards than tackling the condition promotes the relationship between the patients and the nurse which in turn aids proper service delivery (Lee et al., 2013).

Issue#2: Ethical Reasoning as a Clinical Expertise Challenge

Background

Clinicians' expertise plays an essential role in making decisions. Here, the health practitioners depend on their intellectuality to boost their confidence in their decisiveness actions (Hayness, Devereux & Guyatt, 2002). Notably, they rely on their attained experience education and skills in determining approaches or justifications that improve the patients' health (Hayness et al., 2002). However, their intellectuality blurs their reasoning regarding ethical standards while making justification or when partaking their responsibilities (Hayness et al., 2002). They become ignorant to their job requirement; thus, they make improper decisions. Ethics, in this context, refers to the set of guidelines that direct nurses on how to perform their duties (Hayness et al., 2002).

Assessment

During the period I was at Peterson, we, the students, did most of the work. As nursing students, we had less experience in most of the health cases we handled specifically the serious ones. As a result, we were unable to make substantial justifications on many occasions. In some critical situations, we had to wait upon the experienced doctors to give instructions, a move which we thought worsened the patients' conditions. Notably, there was a case where we lost a patient while waiting for the senior doctor to check on him. In my view, the unfortunate incidences could not have happened if the top doctors and nurses had observed their standards by doing their roles

Recommendation

As much as letting student health practitioners take over hospital duties is strategic to their knowledge increment, they should not be fully delegated the tasks. Experienced and skilled doctors and nurses should work hand in hand with the trainees to ensure that they gain more knowledge while at the same time they make justifiable decisions. Moreover, the health institutions in which the trainees are practicing should provide additional practical training where the trainees, as well as the experienced staff, will gain more expertise to be able to make wise decisions.

Significance

Notably, knowledge without morals is useless as it ends up offending people. O the same hand, clinical expertise is essential to nurses as it grants them confidence while practicing especially when deciding on necessary justifications regarding patient's wellbeing (Hayness et al., 2002). Therefore, a combination of ethics and expertise ensures quality decision making in nursing practice.

Issue#3: Inadequate Research-Based Evidence in Clinical Decisions

Background

Research enables clinicians to make decisions based on credible information. In this context, they use specific resources to draw conclusive evidence that will allow them to make correct justifications pertaining to the patient's condition being handled (Fontelo, Liu & Uy, 2015). It is important to note that this is the best medium of decision making as the health practitioners provide facts that back up their decisions (Fontelo et al., 2015). Clinicians mostly use this method to diagnose suspected medical conditions to craft a suitable treatment approach (Fontelo et al., 2015). Examples of research-based evidence include laboratory experiments, randomized control experiments and clinical research.

Assessment

The major problem with evidence-based decision making is that people view the process as time-consuming and tiring. As an administrator at Peterson, I noticed that most patients were being treated without being taken to the laborites to identify their sickness. The doctors were relied on their experience, skills, and education to make treatment decisions like prescribing medication. As a result, some of the patients were misdiagnosed; thus, their situation became worse.

Recommendation

The clinicians should be advised to depend on evidence-based information regardless of their experience range while making treatment decisions (Fontelo et al., 2015). Again, the outcomes of the research should be critically evaluated to come up with suitable choices that fit the patients' preferences (Fontelo et al., 2015).

Significance

Notably, research-evidence based is significant to practicing nursing as it removes uncertainty while making treatment justification (Fontelo et al., 2015). Importantly, unsureness reduces the chances of adverse implications on the patient's health. Moreover evidence-based provides room for adequate accountability that ensures quality services to bettering the patients' health (Fontelo et al. 2015).

References

Fontelo, P., Liu, F., & Uy, R. C. (2015). How does evidence affect clinical decision-making?. BMJ Evidence-Based Medicine, 20(5), 156-161. Retrieved from https://ebm.bmj.com/content/20/5/156.info

Haynes, R. B., Devereaux, P. J., & Guyatt, G. H. (2002). Clinical expertise in the era of evidence-based medicine and patient choice. BMJ Evidence-Based Medicine, 7(2), 36-38. Retrieved from https://ebm.bmj.com/content/ebmed/7/2/36.full.pdf

Hoffman T., Jansen J. & Glasziou P. (2018). The importance and challenges of shared decision making in older people with multimorbidity. PLoS Med.15(3). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5849298/

Lee, Y. K., Low, W. Y., & Ng, C. J. (2013). Exploring patient values in medical decision making: a qualitative study. PLoS One, 8(11). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24282518