- Why it is difficult to distinguish between clinical-decision making errors solely due to intuitive judgment or analytical judgment?
Decisions made will depend on both intuitive and analytical judgment. Intuitive judgment mainly comes from the experience of the nurse. According to Bjork and Hamilton (2011), intuition develops from experience in managing patients in the nursing field. In this case, the nurse does not need to refer to analytical principles since the continuous exposure to these similar scenarios has led them to develop cues on how to assess different clinical situations. On the other hand, where the nurse does not have the experience, it is required for him, or her to make reference to analytical principles. Thus, intuition can be viewed as the application of analytical principles without having to make any reference to the principles themselves.
Consequently, a situation where a nursing practitioner makes direct reference to analytical principles and one where the practitioner applies the analytical principles based on experience is the same. Thus, any clinical errors cannot be solely be because of intuitive judgment alone or intuitive judgment alone. According to Parsonage (2010), assessment of a patient will involve both intuitive judgments and analytical judgments hence errors that develop may not clearly be said to be from intuitive judgment or analytical judgment. Combination of analytical and intuitive judgments is aimed at enhancing credibility when errors arise.
- Current literature points to a debate surrounding the reliability of intuitive clinical reasoning in comparison to the analytical, hypothetico-deductive, process of reasoning. Discuss and debate current findings
The credibility of intuition reasoning is highly debated in health care mainly because of the biases and inaccurate judgments it may cause. Despite clinicians using intuitive reasoning, they find it hard to admit publically that their decisions were based on their own intuition (Buetow and Mintoft, 2011).
Some practitioners recognize the need to have intuition reasoning in developing evidence-based medicine. Intuition reasoning becomes valuable in the integration of different clinical circumstances, patient references and actions, and research evidence (Buetow and Mintoft, 2011). Further, intuition reasoning becomes helpful to the clinician when dealing with patient conditions that have limited evidence-based literature. Additionally, clinical situations develop, which do not have any evidence-based practices. Moreover, the presence of evidence-based practices and literature may become problematic when translating it to an individual patient. Some clinicians argue that confirming to hypothetico-deductive reasoning when assessing a patient’s condition can be limiting. In this case, intuitive reasoning may cause the clinician to ask additional questions that may assist in developing a diagnosis for the patient.
According to Higgs (2008), hypothetico-deductive reasoning also can be viewed to not being more adequate than intuitive reasoning. In the implementation of a diagnosis, the success level depends on the level of mastery of the content that is expertise, rather than the technique that is used (Higgs, 2008). Further, intuitive reasoning cannot be dismissed because certain clinical situations will not require hypothetico-deductive reasoning.
The increase in the use of hypothetico-deductive reasoning is based on its safety and reliability. According to Atkinson, Coutts, and Hassenkamp (2005), hypothetico-deductive reasoning involves backward reasoning, which involves the hypotheses that are generated from thorough collection of objective and subjective data. This is used especially when no recognizable patterns exist. The downside to hypothetico-deductive reasoning is the time factor. Most experts will opt to use intuitive reasoning because it is more time sensitive. Hypothetico-deductive reasoning is time consuming and is suited to conditions that are not life threatening and less time sensitive.
Evidenced based practices tend to confirm to most of the nursing practices. Hypothetico-deductive reasoning is normally based on the idea of evidenced based practices. Increasing ethical cases and concerns has made the increase in the use of evidenced based practice. This relates directly to hypothetico-deductive reasoning as it is based on data that have been thoroughly researched and collected on different scenarios. For the new practicing clinicians, hypothetico-deductive becomes critical in assessing patients. This will require the use of evidence-based practices.
- Why is clinical reasoning a ‘bounded’ process
Bounded indicates that clinical reasoning is limited by certain information, resources, time, and cognitive abilities of the human mind. In health care, new and different clinical situations develop. These situations may be critical or time sensitive. For instance, if a certain clinical situation is not addressed in time it may develop to a more complicated situation. In developing new findings and conducting researches, time plays a significant role especially where there is a situation that has become rampant and is affecting large populations of people. Further, errors may develop due to time limit in making decisions. Paramedics are normally faced with tough decisions when called at an accident scene. They have to make the right choice quickly in order to save a patient’s life.
The nursing governing bodies provide standardized procedures for clinicians and nurses. In the process of clinical reasoning, the practitioners have to take into account these standard procedures. In the reasoning process, while trying to come up with a decision, they have to be certain that whatever they decide to do is within the standardized procedures. Using procedures that are not standardized creates serious ethical issues despite the reality that it may have been the right thing to do. Ethical misconduct usually has serious consequences. Incorporation of ethics in clinical reasoning provides justifications in problematic clinical situations (Kaldjian, Weir, and Duffy, 2005).
The extent and quality of the clinical reasoning is governed by the cognitive ability of the human mind. Thus, the knowledge and expertise of a nurse or a clinician plays a significant role in determining the outcome of the clinical reasoning. Experts in this field will find it easier to develop diagnosis based on certain cues and patterns that they have encountered before. For the new practitioner, the mind will be aided by analytical published materials that address different situations.
Clinical reasoning also influences certain resources in the health care setting. For instance, finances have a large effect on the operations of the organization (Schell, and Schell, 2007). Therefore, in the clinical reasoning process the nurse or physician has to ensure that cases where multiple interventions are possible that he or she chooses the one that will benefit both the health care institution financially and the patient health wise. Furthermore, issues such as space for treating patients in case of numerous patients and the availability of equipment to be used in the treatment procedure of certain interventions also influence the clinical reasoning process.
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