[Sharon]

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

[Chad]

I believe decision making is essential skill in Nursing and life.
Lets go back to Mary the lovely senior living alone and prone to falling.
First Step, identify the problem.. Mary keeps falling.
Second Step Gather Information. Check medications, environment assessment, check bp, assess her gait and mobility. or combination of factors.
Third Step Consider Alternatives. Involve ot or pt, improve lighting, mobility aid.
Fourth Step Choose and implement best option. in Mary case was the rug being removed.
Lastly Evaluate Outcome. Did falls stop or decrease? Did Mary feel safer? re interventions maintainable? IF Any answer is no time to Reassess.

Applying decision making is very helpful as it adds a structured approach to things that may initially seem simple. I really enjoyed this lesson.

[Jennifer]

Hey Chad,
Your example of Mary is perfect for both discussion questions and flows seamlessly. I enjoyed how you broke things down; it made reading your post feel like a narrative while still including all the necessary steps as a great review of the lesson. I feel so many people likely have a “Mary” somewhere in their lives, whether as a client or personally. Teaching people to utilize critical thinking and the decision-making process could really help individuals in so many facets of their lives.

Side note- thank you so much again for creating your infographics! They really are helpful and eye-catching!

[Chad]

Decision making infographic

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[Dayna]

Thank you, Chad for sending these attachments. They are a great breakdown of the decision making process! I have saved them for my own files.

[Jennifer]

After reading through the articles, I understand how utilizing a decision-making system clarifies and streamlines activities. I feel moving forward I will apply this strategy often.

The scenario that comes to mind is a 16-year-old female with constipation.

1. Problem – low frequency of BMs, straining, difficulty evacuating

2. Gather info- younger female, navigating social, physical, and dietary environments.
– insufficient consistent fluid intake, dietary fibre, exercise and avoiding public restrooms

3. Generate/Consider alternatives – Dietary changes (increase fibre), increase hydration, increase physical activity, establish restroom routine, discuss short-term medications for constipation

4. Choose and implement- start with changes to daily lifestyle activities, consult Dr for OTC meds

5. Evaluate – Monitor BMs by tracking for 48-72 hours (frequency, consistency, comfort)

Reassess and make adjustments as needed if BMs have not returned to client’s “norm.”

Reflecting on this situation, using a more structured decision-making process would have greatly helped optimize creating and implementing my care plan and provided a more measurable timeline for evaluating the client’s outcomes.

[Emma]

I believe when coming up with a care decision for a patient it is very important to have all the aspects explored. this also allows you to follow your decision and evaluate at the end. If the outcome isn’t optimal you then know what route to trial next. Organization is key.

[Dayna]

Thank you, Jennifer for sharing this. This is a great example for many clients/patients/residents. I find that constipation is an ongoing issue relating to comorbidities, lifestyle and medication use. I can relate to your example when I work with our palliative care clients who are suffering from constipation and need addition support and guidance from nurses and doctors.

Great example!

[Emma]

completing an official decision making process. Even though we don’t often write out our process we do work through it in our heads with a lot of decisions we make. for example, we often go through this process when calling a POA for consent for treatment. you often have to given the options of for treatment, possible outcomes, with highlighting pros and cons. walking the POA through a decision making tree.

I feel this process is very important even if it is not written out on paper or illustrated but will working through each route and possible outcome.

[Karolina]

I think Emma we go through this process multiple times a day not even thinking about it’s structure and steps. I think it’s so natural for the nurse that comes as a tool in multiple daily problem solving events.

[Chad]

Emma, contacting a POA is a perfect example of decision making process. From experience, I know you must go through the steps and you correctly stated lots of times it an internal process.
I have seen companies that design what’s called decision making trees and provide them to staff to help facilitate this process.

Thank You for sharing.

Fictional decision making tree below to illustrate what I meant.

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[Leona]

This time let’s focus with John who is refusing his medications!
1. Identify the problem:John refuses to take his prescribed medications.
2. Gather Information:Ask John why he is refusing,assess wether he is experiencing pain,nausea,difficulty swallowing,confusion or other concerns.
3. Consider Alternatives. Explain the purpose of medications,re-offer it later if appropriate, and report the resident’s response to the nurse in charge.
4.Choose and implement best option. Respect John’s right to refuse while ensuring the nurse is informed and the refusal is properly documented and addressed.
5.Evaluate Outcome. Monitor John’s condition and determine wether further intervention is necessary.

In long term care setting decisions ahould always prioritize the resident’s safety,dignity,rights,comfort,and overall well being.

[Jennifer]

Well said Leona. The decisions we make as nurses should be client-centric. Even if the outcome is not ideal for the nurse. In this example, utilizing the decision making process ensures all parties are informed and on the same page. By understanding your client, and documenting accordingly, you put his needs at the centre of the decision.

[Dayna]

An example of a decision I had to make at work would be when I was seeing a client (lets call him, Joe) for lower leg wound care where we had to wrap the legs with dressings and coban compression. During my assessment, I had noticed that Joe’s legs have increased in drainage and have become quite macerated. But, there was something different with his drainage. It was bright green! This was my first time experiencing pseudomonas. I was alone with the client in their home and was debating on what to do moving forward with his care. The decision process helped with this situation.

Problem: Joe had and increase of green serous drainage

Gather Information: This was my first time seeing this kind of drainage. I assessed the wound, gathered all the information (size of wound, color of drainage, amount of drainage, skin color and temperature, pain)

Explore options: Before making any decisions, I called my nursing supervisor to get any additional information and guidance to treating Joe’s legs.

Weigh the options: I went over all the details with my supervisor and she voiced to me that Joe has a pseudomonas bacteria in his wound. She proceeded with asking me if Joe has any proviodine in the home or vinegar. I received the knowledge from my supervisor stating that diluted vinegar and water helps aid the healing process for pseudomonas.

Choose and act: Joe only had vinegar in his home. I was informed by my supervisor to leg the vinegar and water solution soak on the client’s wound for about 10 minutes before proceeding with his dressing. After this was completed, I charted and asked for a Wound Champ to come assess his wound further for any additional treatment.

Evaluate and Reflect: After this day when seeing Joe, I was grateful to have the support of my nursing supervisor to help guide me to treating Joe’s wound.

After this situation, I now that the knowledge of pseudomonas for when this comes up with my colleagues.

[Elena]

I just read your post, and I chose a similar example about a client receiving Coban therapy in the community for the other discussion! Thank you for sharing your experience. I think it shows how important critical thinking and teamwork are in community nursing. Working alone in a client’s home can be difficult, especially when we face something new. I think you did the right thing by carefully checking the wound and contacting your supervisor for advice. This shows good judgment and responsibility. Your experience also helped you learn something new that you can use in the future.

[Sarina]

Dayna, what a great example of using ,your judgement and available resources to come up with a solution!

[Karolina]

Time ago we had a resident that was refusing to eat and loosing weight. Team gathered information about resident’s preferences, diagnosis, swallowing assessment, medications review and analyzed documentation. We also brainstormed with team members regarding staff observation which was very productive. We spoke with family regarding his eating habits and food he likes. We contacted dietician to discuss resident’s food options and supplements. Dietician with the team came with the plan which was presented during huddle and discussed with resident and his family. We evaluated after 2 weeks what is working what failed. I think as a team and resident we all benefited from this experience learning more about the whole process and it’s implementation.

[Jessica]

I agree that this is a great example of how using a decision-making framework can improve resident care. I like how the team took a collaborative approach by gathering information, reviewing the resident’s medical needs, considering personal food preferences, and involving the family and dietitian. This shows the importance of looking at the resident as a whole person rather than focusing only on the weight loss.

I also agree that evaluating the plan after two weeks was an important step because it allowed the team to identify what was working and what needed to be changed. Working together helped ensure that everyone had a voice and that the resident’s needs and preferences remained the priority. This experience demonstrates how a structured decision-making process can lead to better outcomes, improve communication among team members, and support person-centred care

[Elena]

The example that comes to my mind happened a long time ago, when I was working as a nurse in a pediatric unit. During the night shift, we usually admitted children directly from the ER so that the only doctor on duty could remain on the unit and assess emergencies at the same time. The hospital was very small, and we did not usually receive many patients from the ER.
One night, I was working with a very young pediatrician when a teenage girl was admitted from the ER with vomiting and dizziness. I performed the initial assessment and checked her vital signs. The doctor ordered blood work. While drawing the blood, I decided to check her blood glucose using a drop of blood from the puncture site, even though the doctor had not requested it. The result showed elevated blood glucose, and we discovered that the girl was experiencing the first signs of type 1 diabetes. I believe this was an example of critical thinking because I went beyond the immediate medical orders. I used my nursing knowledge and clinical judgment to consider another possible explanation for the girl’s symptoms. I recognized that vomiting, weakness, and dizziness could be related to something other than a simple gastrointestinal problem.
· Identify the problem: The teenager was weak, had been vomiting at home, and was experiencing dizziness.
· Gather information: I performed an initial assessment, checked her vital signs, and considered her symptoms and general condition.
· Consider alternatives: I thought about possible causes of her symptoms and considered whether checking her blood glucose could provide additional information.
· Evaluate options: Since blood was already being collected, checking glucose was a quick and simple additional assessment that could help identify a possible problem.
· Make a decision: I decided to check her blood glucose without waiting for a specific order.
· Evaluate the outcome: The result revealed elevated blood glucose, which helped the physician recognize the possibility of newly diagnosed type 1 diabetes and proceed with further assessment and treatment.

[Sarina]

I can’t say that I apply this process formally, but I do believe we as nurses subconsciously follow these steps every day. I think for big decisions utilizing the process and putting it down on paper would be incredibly beneficial.

After years of our PSW’s applying topical medications, due to a recent policy change regarding the delegation of topical medication to PSW’s, I was faced with the decision between following the premade policy and placing the task of topical administrations to the RPN’s or developing an amendment to the policy and creating an education and delegation plan to accompany it.
My goal was to determine which would provide the least detriment to resident care, while maintaining safety.
Having the RPN’s apply all topicals would provide the highest level of accountability and training. However, my concern was the result would be that either residents were not getting their creams at the optimal time (eg during AM care), or the RPN’s medication pass would be constantly interrupted with PSW’s requesting the RPN to come and apply a cream while the resident was getting ready, potentially resulting the RPN rushing and increasing risk of medication errors.
Writing a policy amendment would mean re-educating all PSW’s following proper delegation guidelines annually and writing and maintaining the amendment. This plan would allow for more resident centered care, in that the PSW could apply the cream when the resident was ready to receive care or requested the cream.
I consulted our director of care with these options; we discussed the pro’s and cons and reviewed the FLTCA and ultimately decided to write the amendment.
I then developed the education plan using resources provided by our pharmacy and implemented the training, utilizing the charge nurses on various shifts to reach the PSW’s that I don’t typically get to see (nights and weekends).
While evaluation of this is still ongoing, I continue to follow up with PSW’s, registered staff and residents for satisfaction and provide follow up education if needed.

Now unfortunately I did not use the formal guidelines we learned in this chapter to make this decision, however I feel that if I had, the decision would have been much quicker and clearer.

[Chad]

I think you followed many of the decision-making steps even without formally writing them down. You identified the problem, weighed the options, consulted others and continue to evaluate the outcome. I liked how you considered both resident preferences and interruptions during medication passes. Using the formal process could have helped organize your thoughts and made the decision clearer.

[Jessica]

One example of a decision I have made while working in nursing was deciding how to prioritize patient care when multiple patients needed assistance at the same time. For example, I may have had one patient requesting help with personal care, another patient reporting increased pain, and another patient showing signs of discomfort or a change in their condition. I had to decide which patient needed my attention first.

I believe having a decision-making framework would have helped guide my decision by allowing me to assess each situation, identify priorities, consider possible risks, and choose the safest course of action. In nursing, it is important to use critical thinking, clinical judgment, and evidence-based practice rather than making decisions based only on what seems most urgent at the moment. A decision-making framework can help nurses stay organized, think through different options, and make informed decisions that prioritize patient safety and well-being.

I believe having a framework is especially helpful in stressful situations because it provides a clear process to follow and helps reduce the chance of overlooking important information. It also builds confidence in decision-making and encourages nurses to reflect on their choices and learn from their experiences. Overall, I believe a decision-making framework is an important tool in nursing because it supports safe, effective, and patient-centred care

[Author]

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