Medical practice calls for a well-structured decision making in order to improve efficiency and quality of care. This applies to doctors and nurses alike. Nursing practitioners face a wide range of situations, which require emergent, urgent and informed decisions. On a day-to-day basis, nurses make decisions concerning the regularity of patient check-ups, charting of patient’s vital signs, drug administration and environmental modification through cleaning and changing of patient’s beddings. Apart from the clinical practice decisions, nurses also make decisions on health policies, ethical and nonclinical issues. A tie that binds all these together calls for different skills, knowledge and understanding depending on the decision. Benner, 1987 describes of the professional processes of development of expertise and knowledge of nursing care. Decision making in nursing highly depends on the level of the nurse according Benner’s seven domains.
Patricia Benner offers a description of nursing practice in her book From Novice to Expert after she had worked in merely all fields of nursing care including intensive and critical care, med surgical wards, maternal and pediatric care, to mention but a few. From her experience, Benner explains that nurses acquire knowledge and exactitude in abilities through practice. Brenner describes the five levels of nursing skill acquisition as a process that starts from one being a novice, then a beginner, to a competent nurse, who then turns to become a proficient practitioner and finally rises to the top rank of an expert. She also structures the nursing practice into seven domains.
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Aims of Analysis
Intuition is a rapid process in which a practitioner makes a decision by use of prior experiences and knowledge. Evidence-based practice has replaced the use of intuition as the core of decision support in medical practice. When intuition is applied, it allows a practitioner to view a patient in a holistic manner according the level of experience of the caregiver. This facilitates a focused form of care that limits errors of omission (Shirley et al, 2013). It is therefore important to emphasize the role that intuitive decision making plays although much of medical practice today employs informative evidence. The aim of this paper is to discuss the concept of intuition in making of clinical and non-clinical decisions as well increase knowledge in the field of nursing care. This paper will also discuss Brenner’s domains of nursing and the correlation between them decision-making in nursing.
Uses of the Concept
Intuitive nursing has been in use for a long period. The importance it plays in settings where there exists no supporting data regarding some of the clinical decisions is great. For instance, before the advent of evidence based medicine, decisions depended on the expertise of the medical practitioner. The more experienced the nurse, the more likely that the decisions that they made are of great importance and influence. Understanding the role that intuition plays in other non-clinical decisions such as development of nursing policies and ethical considerations is a crucial aspect of the concept. The paper will employ Walker and Avant’s outline to carry out an investigation on intuition using secondary data as the main source.
Walker and Avant’s framework describe the nursing practice as a composition of several steps in which overcoming is the main step of the intuitive process. For one to overcome a situation, a clear understanding of the circumstances of the situation guides the decision making process (Robert, Tilley & Petersen, 2014). In this, the nurse has to consider different aspects of the individual including the social setting, personal preferences of the patient, the prevailing health problem, whether physical or mental and then formulate a plan of catering for the specific needs of the patient (Cader, Campbell, & Watson, 2013). The aim of most of the procedures is to overcome the ailment completely, primarily by providing an environment that facilitates recovery.
Overcoming is a derivation of an English word ofercuman, with the meaning of attaining better, to undo or to overthrow. This precept has both an emotional will power and a physical characteristic in it. Meaning, for one to overcome, they have to determine psychologically that they would want to get over the situation and emergence victorious. Physical preparedness to handle the situation allows one to put in place the desired effort that would allow them to overturn the situation. Take for example, a poly-trauma patient who undergoes multiple limb salvaging surgeries has to have the will to overcome the psychological torture of a debilitating accident as well have the physical strength to undergo rehabilitative and adaptive procedures. The roles of a nurse in helping such a patient tranquil over the situation is invaluable (Cader, Campbell, & Watson, 2013).
Defining Attributes
Intuition is a composition of several aspects that co-exist for realization of nursing decision making. The first attribute is that it is an unconscious process, which does not require the use of the preexisting decision support systems. Experience is the main back up for intuition. The nurse recognizes situations as they have occurred before, how he or she dealt with the situation and the outcome of prior procedures on a similar situation. Although the concept of intuition is facing a decline in use, unconscious decision- making has played a major role in clinical practice.
The second component of intuition is holistic knowledge. This knowledge has no derivation from the classical data, information, and knowledge hierarchy but it is rather a product of information synthesis (Carper, 2015). Such allows use of prior experiences to determine what would be the next action in dealing with a situation. To overcome, the nurse does not necessarily need to evaluate all the data available regarding the procedure. More or the same, the use of prior knowledge is more important than the application of analytical data to determine outcomes. Since, intuition is outcome-oriented the nurse’s focus is usually on the main reward of restoration of the health of the patient rather than concentrate on the application of procedures and policies (Benner, 2012). However, this does not mean that the nurse does not uphold the desired standards of medical practice.
Model Case Study
The model case in this study is a 70-year-old African- American female admitted to the medical ward with a history of dyspnea and palpitations. Her accompanying relative reports that the patient has had progressive history of easy fatigability for one month and currently she cannot climb a flight of stairs. According to the relative, the patient has had a past medical history of hypertension, of which she has been non-compliant to medications. The patient has also been on treatment for diabetes mellitus and is on oral hypoglycemic agents including metformin, and glipizide. She cannot recall the names of other drugs she has been taking.
On enquiry of the family social history, the patient reveals that she has been taking moderate amounts of alcohol usually on Fridays and weekends when she does not go to work. She used to smoke but stopped, after advice from a doctor. She stays with her granddaughter in New Jersey, although the caretaker does not stay at home for most of the days since she is a flight attendant. The patient is a retired high school teacher.
Physical examination reveals a patient in respiratory distress, who is pale and centrally cyanosed. On evaluation of the capillary refill, it is adequate and the blood pressure is elevated at 180/ 110 mmHg. She is also febrile. The patient has pitting edema of the lower limbs up to the level of the knees. Heart sounds are audible and a systolic murmur that is louder on the left axillary region is auscultated. All other systems are essentially normal but for a mild headache in the left parietal region although the Glasgow Coma Score is 15/15.
Using intuition, the nurse I charge of the ward decides to restrict fluids to the patient as she supposes that the patient could be suffering from heart failure. The nurse starts the patient on 100% oxygen via mask. Fluid restriction is guided by the presence of the pitting edema of the lower limbs. The nurse also starts the patient on furosemide, to initiate dieresis. The main aim of this is to relieve the fluid overload. Use of intuition also guides the nurse to decide on initiating the patient on a warfarin to offer prophylaxis for deep venous thrombosis since the patient has been immobile for three days. The nurse recommends for the patient to receive investigations for hyperlipidemia, blood sugar levels, HbA1C, chest radiographs, an echocardiograph and an electrocardiograph. The nurse also decides to start the patient on labetalol to lower the high blood pressure. A fifteen-minute interval charting of the vital signs of the patient is also initiated.
Borderline or Contrary and Related Cases
A contrary or borderline case would be a 20-year-old male who is not obese and has no comorbidities presenting with a history of dyspnea and chest tightness. The patient has no history of hypertension or diabetes and on family social history points to no use of alcohol in a devoted Christian family. The patient is cyanosed and in respiratory distress, however, there is no edema of the lower limbs. The patient complains a mild dry cough that usually occurs in the morning. On auscultation, there are bilateral wheezes noted on the lower borders of the lung. The patient is also dehydrated.
Intuition would guide the nurse in this case to determine that the patient would require intravenous fluids to counter the dehydration. Contrary to the former case, this patient is more likely to be suffering from asthma although both patients presented with a similar history of breathlessness. Further exploration into the history exhibits the differences in these two cases, which require different plans of management ( Blais, 2015) . Given that the second case is of a 20-year old male, who has had no preexisting medical conditions, a diagnosis of heart failure is unlikely. However, a clear diagnosis may be apparent from laboratory and radiographic findings. The most important aspect here is for the nurse to use intuition to judge the situations and make a management plan even before obtaining all the results of the investigations. Determination that both patients have inadequate tissue perfusion as evidenced by cyanosed lingual surfaces allows the nurse to justify the use of supplemental oxygen. More or the same, there has to be some guide from the gut feeling of the nurse, which may not necessarily be supported by the available evidence.
A related case to the initial case would be for a 60-year-old male with a history of coronary heart disease who presents with a history of breathlessness and pain in the left side of the chest. The pain radiates to the inner side of the left upper limb and is aggravated by physical exercise. Intuitive decision-making is likely to guide the caregiver to this patient towards a diagnosis of a stable angina. The treatment goals for this patient are similar to those of the patient in the first case. However, a prophylaxis of cardiovascular accident by use of high dose aspirin and clopidogrel is essential in this patient than that of the first case.
Antecedents and Consequences
The antecedents are the circumstances and factors that need consideration before the designing of a specific concept. These are simply the guiding points towards a decision-making process.in clinical practice, antecedents help the practitioner to relate issues and draw meanings from them ( Simmons, 2010) . The correlations that exist between these factors allow nurses to decide on nursing care, including drug administration, monitoring of the vital signs and designing of appropriate investigations such as blood sugar levels
Reviewing the main case study of the 70-year-old African American female, the presenting history, the past medical history, family and socio-economic history help to guide the diagnosis. Correlating this history with appropriate physical examinations is crucial in determining the patient needs and devising the goals of treatment. Most of the actions would therefore gain justification from these antecedents ( Chism, 2015) . Demographic data such as age, sex and race of the patient are important in assessing the risk factors for the development of cardiovascular disease. They are also important aspects to consider in making a decision regarding drug administration for heart failure since research has shown that certain classes of diuretic drugs such as angiotensin receptor blockers are ineffective in people of the black race ( Ek & Svedlund, 2015) .
Comorbidities such as hypertension and high blood cholesterol in the setting of chronic alcohol use and a history of smoking are determinants of the decision making process. Apart from treatment for heart failure, the patient would require anti-hypertensive agents and anti-cholesterols such as rusuvastatin in order to reduce the hyperlipidemia, which increases the risks for heart disease. Advice on the need to keep a tight glycemic control and modification of risk factors such as cessation of alcohol use and exercises would also prove appropriate (Institute of Medicine, 2010).
The consequence of the use of intuition is that it decreases the need to keep referencing all the actions in the ward setting (Moore et al, 2015). It minimizes time wastage and increases the chances of survival for critically ill patients who need immediate interventions. Intuitive decision-making ensures prioritization of actions hence the practitioner gets to do what they ought to do first. Early interventions ensure that the patient gets the attention they require immediately. This enhances patient survival (Carper, 2015). Failure to employ intuition in nursing may lead to consequences, which include but not limited to delayed attendance to pertinent issues, increased workloads, and poor patient outcomes and may even result to death of the patient.
Empirical Referents
Empirical referents call for the science of the use of research knowledge to determine action. This calls for the use of scientific method of research including data collection, through observations, interviews and experimentation ( Oliver, 2013) . The process of analysis gives rise to information that is usable in clinical areas to guide decision-making. In this case, empirical referents would denote factors such as well-stipulated health policies, drug regimens, clinical procedures and standards of nursing practice (Potter et al, 2016). Application of verified scientific knowledge in nursing practice yields the desired results.
Conclusion
In summation, intuitive nursing plays a crucial role in establishing an appropriate method of patient care. Use of intuition in decision making not only increases proficiency in the field but also limits time wastage, facilitates faster initiation of interventions and improves patient outcomes. The role that this model of decision-making makes it easier for nurses to employ the experiences they have garnered in practice over the time. Adoption of this concept in hospital care is important as intuition plays a pivotal role to evidence-based practice.
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