[Sharon]

Think of an example of a decision you made at work; would the decision-making process have helped?

[Alhasan]

In this example, I conducted a client intake, and the family brought in medications from home. During our review, we discovered that the dosage the family was administering differed from the prescribed order. The family was giving a lower dose without any written documentation to support this adjustment. They mentioned that their physician had verbally instructed them to reduce the dose as the child was tapering off the medication, and the prescription would be updated at the next refill.

In this situation, I didn’t have a formal decision-making framework at the time. I had to quickly evaluate the risks and benefits. For instance, I didn’t want to administer a higher dose if the child was in the process of tapering off the medication, yet I also needed to adhere to our medication policy requiring written documentation/prescription. The potential consequences included making a medication error or disrupting the child’s tapering plan, possibly causing adverse effects due to a higher dose. Given that it was after hours and I couldn’t contact the physician, I decided to reach out to the pharmacy for any supporting documentation.

The pharmacist confirmed that they were aware of the tapering plan, which allowed me to proceed with the lower dose safely, ensuring the child’s health and compliance with our policy. Although they didn’t have the latest dosages, they were able to provide documentation indicating the previously lowered doses and the pharmacist was able to provide documentation indicating this would be an appropriate dose for the child.

Reflecting on this experience, I realize that following a structured decision-making process could have provided clearer guidelines and more confidence in making the appropriate decision. Having this framework would have provided a structured approach to decision-making, potentially reducing stress and improving the decision’s accuracy and confidence under pressure.

[Claire]

I really appreciated the decision making tree framework from this weeks learning. I feel we actually all intrinsically complete a thought pattern like this in our every day problem solving /decision making, but in one case in particular I feel we missed a significant element in one particular case.

I can think of a recent example where we had a women in our care who had a family situation of a daughter who arrived from Alberta who had been homeless with mental health issues. We have a policy of family being able to stay bedside with their residents but not “moving in ” as their primary residence. This individual needed their clothing washed, along with the storing of their belongings /food which were more then we traditionally allow people to bring due to the size of the rooms. fridge space, precident and our fire plan. Yet this was a unique scenario and we had been struggling with this residents own sense of wellbeing and past family trauma. We wanted to be low barrier and inclusive.

The decision we needed to make was whether we allowed this person to technically “live” at our hospice with her mother. At the time the arrived the resident was happy she was there. This resident’s prognosis was also inaccurate and had already stayed + longer than our > 3 mt parameters. which added to this clinical picture. We had been needing to be very resident focused with our approach as she required many barriers lowered to meet her where she was at and be allowed to provide care. The decision had also been made to not try to transfer to a facility with a longer prognosis due to the upset/harm it would have caused.

We allowed this family member to stay and with us for an extended period of time and left just prior to this residents death. We completed what I feel was the decision making tree elements of the need for a decision, the goals of care/ outcome for the resident, action and implementation and then evaluation of this decision. Yet, now looking at the framework, we did an inadequate job at the alternatives or actions along with benefits and consequences. We tried gently to connect her with local services but not as meaningfully as we could have. While there might have been benefits in the short term as our residents was happy she was sheltered it caused some negative consequences for our resident which we only really fully understood after a lengthy period of time. It was at the evaluation point that the need for greater effort in exploring the benefits/consequences aspect was acknowledged. I feel that by using this framework we might have come up with a possibly different plan and alternatives , one that if we fully explored it with the resident she might have been more apt to decide upon as a solution for her daughter.

Thank you for this as I will most definitely include this in my practice!

[Carmen]

A decision I made at work would be when I was deciding whether to take an interim clinic position. I think the decision-making process would’ve helped such as pros and cons lists or SWOT analysis, could have provided additional clarity and allowed me to see the positive outcome of my choice.

[Melissa]

One example of a decision I had to make at work would be determining if all residents scheduled for that shift would be able to receive their tub bath due to being short staffed during a storm. I believe this to be part of decision making as I had to identify the problem being not having enough staff to complete all necessary care tasks for 32 residents plus tub bathe 6 of these residents. A plan was then made and implemented on how the team would achieve resident care needs without jeopardizing the quality of care these residents received. I think the decision making process would have helped in this situation as we could have used the “processing model” in our decision to gather other’s “memory” data on what had previously been done in this occurrence and weigh the pro’s/con’s of this situation.

[Janet]

Recently I was out for a on call nursing visit, I was questioning the reasoning for a late night hydration when the client had just been returned from hospital. I spoke with the family and went for the visit, I completed a set a vitals, attempted an iv start and assisted the care givers in personal care. I was speaking with family stating I would send a nurse in the morning as early as possible to reattempt the iv; when I looked at the patient and thought something seems very off and something was very wrong, Client was in distress, I asked family to call 911 as I was concerned I would have to start doing CPR. Client was taken to ER.

If I hadn’t made the decision to re evaluate the patient she may not be with us. She didn’t appear to be in distress however my intuition and critical thinking skills got help and had patient sent to hospital.

[Sherri]

Janet,
Very swift critical thinking and judgement on your part.good work!

[Kristina]

Hi Janet,

I appreciate your post and the time you took to critically think in a situation like this. I feel we are often put into situations as nurses and have to decide very quickly what to do for the sake of our patients. The aftermath of emotions we feel afterwards can be overwhelming; “did we do the right thing?” ‘what else could we have done?” ” should we have done it differently?” . I think you made a proper & educated nursing decision in this situation.

[Ruth]

Critical thinking and problem solving go hand in hand. They both discuss how to effectively address problems. By using skill, evidence, and data. Still, selecting, deciding, and reducing our solution takes up most of our thought when we solve a problem. As a charge nurse, I had a lot of responsibilities during my shift. I usually attempted to complete my work before my shift, but it was not possible. I am always ten to fifteen minutes late leaving work. My family usually complains that I pay extra for my babysitter. Subsequently, I implemented the nursing process to address my issue. Which include assessment, planning, implementing, and evaluating. Although it is difficult to plan for unforeseen events, such as emergencies, the allocated time can be fixed. In order to identify the issue of time management, I conducted an assessment before beginning the nursing process. I then create a to-do list and establish a plan to utilize every minute of my working hours, starting at the beginning of my shift. For example, I do my f/us before I start administering meds. then, as soon as I’ve given the prescribed controlled drugs, sign the paperwork. I was careful to complete the tasks on my to-do lists, and when I looked back at my strategy, I could say that it worked. I can complete my work five to seven minutes ahead of schedule.

[Sherri]

Just recently, I’ve had to implement a decision using autonomy. A problem -solving focus. Retaining all of the factoring points. Taking into consideration the client and her rights. In conglomeration with PT,OT,and her spouse a decision was made. Rather than this resident loose all independence, we (resident) negotiated a plan. The plan also involved the resident, which made the process a bit more operable. Evaluation in due time, but in all, everyone seems satisfied. 100% I believe the decision-making tree has helped with an innovative decision.

[Rebecca]

A recent example of a decision I made at work was, deciding if removing a staff member from a clients care team would benefit the client and staff. I find the decision-making process happens in my head automatically. I review the benefits/risks of allowing the staff member to return and the possible outcomes and then review the benefits/risks of removing the staff member. For this situation clients are allowed to smoke in their homes and have been requested to cease 1hr prior to the staff member arriving, unfortunately in this one situation the client is a heavy smoker and although they follow the smoking cessation policy the house does still smell strongly of smoke. Staff member had requested to please not return as the odor was causing staff to have a headache. In this situation if I choose to request the staff to continue with this client there is a greater risk that staff will complain and or become ill and book off, if I remove the staff and replace them with someone who does not have a concern with the odor then this decision was successful. So, I made the decision to remove the staff and replace with another staff who is comfortable with the odor, this decision was successful, staff was happy, client care not impacted, and a note was added to staffs file to support for future encounters. If I was more limited to staff, I feel I would benefit from using a decision-making process tool but naturally I find I use the process and this works.

[Rebecca]

Hi Melissa,

I agree that you did use the decision-making process to support and determine the outcome of the problem you had being short staffed. When you take a moment to think about it, as nurses we really do use these skills more often without realizing this is what we are doing, it almost like second nature. Taking a moment to think about it all and consider our roles and type it down, we really do a lot of decision-making. I find in our line of work a lot of decision making and how we are trained to think eventually turns into critical thinking in the long run.

[Kristina]

Recently, I had to take on the scheduling role at my work. I was put into this position for 2 days as our scheduler had an unexpected event happen within her personal life. I had to make scheduling decisions and “pull” shifts, to make sure staffing was not in shortage. I also had to trade and make other deals with PSW’s in order to have staff work through the holiday long weekend. I had to outweigh the pros and cons regarding these requests. I feel that at the time I was doing this, that utilizing the decision making process would have helped me more in the long run. As I was completely these scheduling tasks, I felt very disorganized and frustrated. If I was able to stop and reflect and utilize a better tool for decision making, I feel this would have helped me tremendously for the scheduling process.

[Author]

Posts