- Why it is difficult to distinguish between clinical-decision making errors solely due to intuitive judgment or analytical judgment?
Clinical decision-making is based on the situation nurses face at hand. These situations may require the application of expertise or intuition in addressing it. Errors may result from either applying the right analytical procedures to a scenario or using traditional ritualistic reasoning. According to Hughes (2008), using intuitive judgment in most cases results to improving the standard nursing practices. Intuitive judgment assists in developing new standards reducing the use of wrong and outdated approaches to health care, and increasing prevention of illnesses using new evidence. This has contributed to the inclusion of intuition in clinical reasoning. Thus, when an error results from intuitive judgment, a nurse can argue on the basis that following the standard practices was not bearing any results, which then necessitated the need to approach the scenario differently.
On the other hand, the application of analytical judgment is core to nursing practice. Decisions need to be made based on certain standards. However, since nursing may not be an exact science, errors arise. Application of old standards may create a situation where nurses have become accustomed to them such that it comes naturally to them. According to Hogarth (2002), both analytical and intuitive judgments introduce some form of biases, which makes it difficult when clinical 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
Intuitive clinical reasoning becomes an issue because of the lack of the ability to communicate the approaches that result to hypothetico-deductive decision making. Explaining the basis of intuitive judgment is quite a challenge. The recent increase in the application of evidence-based practice limits the application of intuitive reasoning. The nursing practice is emphasizing the use of evidence-based practice to improve on its delivery of service to patients (Pearson, Vaughan, and Fitzgerald, 2005).
Certain nursing intuitive decision-making may be not permitted in nursing. Nurses are bound to provide valid and accountable reasons why they choose to apply certain decisions. Thus, ethical issues may arise based on the application of certain decisions. However, since research on evidence-based practice has not been exhausted, situations in nursing may arise where the nursing practitioner will be required to make a decision. Such situations will require intuition. Further, evidenced based practice that is outdated may not assist in improving the patient’s outcome, which then makes the nursing practitioner to use alternative means by applying intuitive reasoning. When conditions of the patients are life threatening, intuitive reasoning has proved to be of valuable help. Experts use this reasoning in making decisions about a patient’s condition (Parsonage, 2010). This process is usually faster. Challenge will arise when the decision is made differing to the patient’s conditions, and this will create ethical issues.
An essential element of intuitive reasoning is critical reflection. To most experts, the process of critical reflection helps to increase the understanding in making clinical decisions. Parsonage (2010) notes that nurses may over rely on the hypothetico-deductive reasoning. In some situations, data may be of no use in assessing a patient’s condition. Thus, hypothetico-deductive reasoning becomes more effective when used in conjunction with intuitive reasoning.
Hypothetico-deductive reasoning is highly being encouraged in the nursing practice. Using this approach provides evidence that can be scrutinized in cases where complications arise. Further, compared to intuitive reasoning, most researchers consider intuitive reasoning creates numerous clinical errors. However, in terms of time effectiveness intuitive reasoning is much more effective. This is because hypo-deductive reasoning may require the need to refer to researches and accepted methodologies, which may not help the patient’s condition. Hypothetico-deductive reasoning becomes significant when trying to breakdown the elements of a patient’s condition. This becomes critical when a nurse does not have sufficient knowledge on a particular condition or symptoms that may be affecting a patient. Additionally, hypothetico-deductive reasoning assists in selecting an appropriate form of intervention to a patient’s condition when there are myriad of possible diagnoses.
- Why is clinical reasoning a ‘bounded’ process
A practitioner cannot just apply his or her own methodologies during clinical reasoning. Clinical reasoning is a bound process because in determining and assessing a patient’s condition to obtain information; several procedures have to be followed. Standards in the nursing practice have to be used in clinical reasoning. These standards help in resolving ethical situations that may arise in the nursing practice. Without these standards, many resources may be used in mitigating lawsuits. Further, current health care environments necessitate the need to have accountability (Simmons, Lanuza, Fonteyn, Hicks, and Holm, 2003). Therefore, assessment of the decisions made will be based on the results that are attained in the treatment of the patient.
Different patient conditions are time dependent. That is certain conditions will require immediate time attention than others. Failure to take into consideration patient’s time line may result to serious issues. Thus, reasoning needs to ensure that experience plays a significant role in arriving at a solution fast. If a nurse does not have experience, then he or she is bound to rely solely on scientific evidence and published procedures to make clinical judgments.
Clinical reasoning also embraces a social aspect. The application of evidenced-based practice clearly shows this concept. Nurses will use evidence-based practice that has been carried out by other researchers in this field. According to Higgs (2008), clinical reasoning also is a social process in that to make the best decisions there is the need to involve other individuals. A person’s own assumptions are not always accurate. This will aid in reducing chances of errors unlike when decisions are solely made by one individual.
Both experienced and new nurses need to use clinical reasoning strategies rapidly with fewer resources. Certain clinical decisions may significantly influence the finances of a health care institution. Practitioners need to ensure that when making decisions they take into consideration the financial implications their decisions may have on the organization. According to Schell, and Schell (2007), finances highly influence the clinical reasoning process. A wrong clinical decision may create wastage of resources. Medicines that may be applied in the treatment of a patient may be costly, thus if the clinical reasoning develops a wrong intervention, additional finances need to be used to ensure the right medication is purchased. The medication used in the first intervention is wasted in the process. Furthermore, availability of equipment and space also needs to be taken into consideration in clinical reasoning.
Bibliography
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Pearson, A., Vaughan, B., & Fitzgerald, M. 2005. Nursing models for practice (3rd Ed.).
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Schell, B. A., & Schell, J. W. 2008.Clinical and professional reasoning in occupational
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