Week 1 Decision making replies

Anaida Simonyants

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Important processes for nursing practice: clinical judgment, critical thinking, decision-making, and emotional intelligence

In the context of nursing practice, several processes are revealed that are defined and described theoretically independently for better understanding, but that interact and have an impact on health care outcomes in healthcare practice. This project will address the fundamental concepts of clinical judgment, critical thinking and decision-making, establishing the similarities and differences between them and the comparison in their practical expression between general practitioner nurses and advanced practice nurses, through an illustrative example. We will also describe the concept of emotional intelligence, its importance and application to ascent situations of nursing practice in clinics or hospitals, highlighting its role in the effective management of interactions with patients in situations of high emotional impact.

Similarities and differences between the concepts of clinical judgment, critical thinking and decision-making in nursing practice

In nursing practice, clinical judgment, critical thinking, and decision-making represent essential skills that, although interrelated, possess distinctive characteristics in their application. Critical thinking is a complex and dynamic process made up of strategic attitudes and skills, with the aim of achieving a specific goal or objective (Falcó-Pegueroles et al., 2020). It is defined as a systematic process of evaluating information and evidence with a reflective and objective attitude in which two dimensions of critical thinking are defined: the substantive and the dialogic. The substantive dimension encompasses actions related to providing reasons and evidence that support each particular point of view. The dialogic dimension encompasses actions aimed at the analysis and integration of points of view contrary to ours (Jiménez et al., 2021). The elements that measure these dimensions of critical thinking are listening to others, acting differently, thinking autonomously and anticipating search processes, and proposing the existence of courses of action that are not necessarily logical. All of these are skills that should be considered in nursing studies (Jimenez et al., 2021). In this way, critical thinking allows nurses to question the validity of information, review possible alternatives, and consider different perspectives when addressing a problem. Therefore, it is understood that this process goes beyond the simple interpretation of data by promoting deep reflection that avoids impulsive or biased decisions and encourages decision-making based on the best available evidence (Falcó-Pegueroles et al., 2020).

On the other hand, clinical judgment is the result of critical thinking and clinical reasoning and is a prerequisite and necessity for clinical decision-making (Manetti, 2019). Connor et al., 2022 after a thorough analysis defined clinical judgment as a reflective and reasoning process that is based on all available data, informed by an extensive knowledge base, and that results in the formation of a clinical conclusion (Connor et al., 2022). Therefore, clinical judgment in nursing is a reasoning process in concatenated stages of observation, analysis, and evaluation of the information obtained from the patient, which leads to a clinical conclusion, which in turn will allow decision-making adjusted to the patient's individuality, conditions, and particular needs (Dehghani, 2024). Finally, decision-making in nursing refers to the act of choosing an action or intervention among several available options based on a thorough analysis of the circumstances and the clinical knowledge acquired (Watkins, 2020). Critical thinking and clinical judgment are the nurturing pillars on which decision-making is built, as both allow the nurse to evaluate options before deciding on the best intervention for a particular patient (Diamond-Fox & Bone, 2021).

These three processes are intrinsically linked and share several similarities, although they differ in the approach and functions to achieve their goals during health care. For example, although they are all based on analysis and deep reflection, critical thinking focuses on evaluating and questioning, while clinical judgment is nourished by this and interprets clinical data to give rise to decision-making (Manetti, 2019). In turn, decision-making focuses on the evaluation and choice of actions (Watkins, 2020). On the other hand, these processes are based on evidence and use it according to their objectives, this being another similarity. The differences lie in what evidence each one takes and how he uses it. While critical thinking uses scientific principles and data that can be empirical, clinical judgment evaluates practical clinical problems (Critical Thinking, Clinical Reasoning, and Clinical Judgment, 2019). Decision-making is based on the available evidence to select the most appropriate option for the patient in question (Watkins, 2020). As for the end goal, all of these processes are geared towards problem-solving, although the way they do it is different. Critical thinking identifies and defines, clinical judgment evaluates and diagnoses, and decision-making chooses and plans actions (Manetti, 2019). In addition, all three processes require advanced cognitive skills, the ability to analyze information is complex, and they are dynamic processes that require reevaluation and pertinent systematic adjustments (Critical Thinking, Clinical Reasoning, and Clinical Judgment, 2019).

There are some key differences in addition to those mentioned, such as clinical Judgment is based on specific clinical experience and knowledge to evaluate and decide on patient care, while critical thinking is a broader process that applies to various situations, not only clinical, and focuses on the objective and logical evaluation of information (Diamond-Fox & Bone, 2021). Both lead to decision-making that focuses on selecting the most effective action. Each of these processes requires basic skills. Critical thinking includes analysis, synthesis, evaluation, and reflection (Falcó-Pegueroles et al., 2020). On the other hand, clinical judgment is based on observation, identification of problems, and evaluation of clinical outcomes (Manetti, 2019) and finally decision-making identifies options, evaluates risks and benefits, and selects the most effective action (Watkins, 2020).

In summary, clinical judgment focuses on the interpretation of the patient's situation, critical thinking in the exhaustive evaluation of information, and decision-making in the execution of a specific action. The three processes, with their similarities and differences, must be put into practice by nursing personnel in a comprehensive manner to achieve results of excellence in health care. It should be noted that these processes, although studied independently for better understanding, are integrated into a unique thought process that generates actions in favor of effective health care (Critical Thinking, Clinical Reasoning, and Clinical Judgment, 2019).

Comparison of clinical judgment, critical thinking, and decision-making processes between bedside nurses and advanced practice nurses. Illustrative example.

The critical thinking, clinical judgment, and decision-making processes of bedside nurses and advanced nurse practitioners (APN nurses) have differences that reflect varying levels of knowledge, experience, and responsibility in patient care. Bedside nurses use critical thinking primarily in immediate, everyday situations, where they must respond quickly to changes in the patient's condition. Generally, their approach is more reactive and is based on direct observation and interpretation of vital signs and symptoms (Rn, 2023). Meanwhile, the critical thinking of the APNS has a more analytical and proactive approach, as it integrates its advanced knowledge to evaluate complex situations and be able to develop long-term care plans. Therefore, their critical thinking is based on a deeper analysis and understanding of the disease and its pathophysiology (Falcó-Pegueroles et al., 2020).

Clinical judgment of bedside nurses focuses on the rapid identification of immediate problems and the implementation of urgent interventions. These nurses are trained to notice subtle changes, which is crucial for patient safety, so the clinical judgment process is quick and basic in order to make quick decisions (Rn, 2023). APNs use a more complex clinical judgment that involves immediate evaluation and extends to the interpretation and analysis of clinical data in a more comprehensive way, which will allow them to formulate long-term diagnoses and treatment plans. During its analysis and construction of clinical judgment, it considers not only the objective clinical data of the moment but also the influence of social and psychological factors that contribute to the patient's current state and prognosis (Falcó-Pegueroles et al., 2020).

In terms of decision-making, bedside nurses usually make quick decisions based on established protocols and their direct experience with patients. They generally focus on immediate and practical interventions, directed to the specific needs of the patient at the time of evaluation. This bedside nurse uses her clinical judgment and critical thinking to identify and respond to changes in the patient's condition, noting signs and symptoms that may require quick action. The role of this nurse conforms to established protocols and guidelines, focuses on prioritizing patient safety and condition, and is able to handle emerging situations according to established clinical guidelines and under the supervision of other health professionals (Rn, 2023).

The advanced practice nurse has greater autonomy in decision-making, since her more comprehensive training allows her to carry out diagnostic evaluations and more complex treatment plans. Clinical judgment and critical thinking in APNs that encompass not only the response to patient conditions, but also the integration and application of knowledge in pathophysiology, pharmacology, and differential diagnoses enables them to modify or adjust treatments, interpret diagnostic results, and consider long-term health factors, which allows them to intervene more comprehensively and with a preventive or chronic management approach (Watkins, 2020). It is understood that while bedside nurses focus on direct care and the implementation of protocol-based care with more basic critical thinking and clinical judgment for quick decision-making, APNs are trained to perform more comprehensive evaluations, make diagnoses, and be able to make complex clinical decisions.

A practical example that can best illustrate these differences can be taken from the scenarios during COVID-19. A patient with COVID-19 presents respiratory distress and decreased oxygen saturation, which is observed by the bedside nurse. She immediately analyzes using her knowledge and critical thinking to identify these signs as indicators of deterioration and form a clinical judgment based on the established protocols which leads her to make decisions, in this case she administers supplemental oxygen, continuously monitors the patient's vital signs and informs the medical team about the patient's condition. This nurse is governed by medical orders and care protocols guaranteeing the flow of oxygen, supportive care, and patient safety. Nurses provided proactive care to COVID-19 patients, and recognized and embraced their role in protecting the lives and ensuring the health of their patients on a daily basis. The experiences of nurses in COVID-19 units served as an opportunity to reflect and rediscover the meaning of nursing (Shin & Yoo, 2022).

For its part, the APN puts into practice the process of critical thinking during the evaluation of the patient with COVID-19, analyzes the results of laboratory tests and radiological images. This allows his/her to identify elements that lead his/her to think that the patient could be developing a complication in the form of pneumonia associated with COVID-19. Using his/her advanced training, he/she develops the clinical judgment process based on his knowledge, which allows APN to make differential diagnoses to rule out other possible causes of the patient's symptoms. The integration of both processes allows the APN to make therapeutic decisions, and decides to start treatment with antibiotics and corticosteroids, based on the latest clinical guidelines and scientific evidence. The APN also interacts with other specialists and communicates with the patient and family about the management of the disease. The APNS played a decisive role during the COVID-19 pandemic, with their comprehensive action they saved thousands of lives, which raised awareness of the importance of these nurses at the systemic level (Stucky et al., 2021). After analyzing this example, it is understood that both the bedside nurse and the APN have as their objective the health care of the patient, to ensure their safety, comfort and improvement of their state of health, with differences in critical thinking, clinical judgment and decision-making based on their level of preparation, abilities and competencies. It is important that the teams work together so that each member provides their best contribution for the sake of a better health service. The patient, the family and the other professionals benefit from good teamwork

Brief description of the concept of Emotional Intelligence. Its application to ascent situations of nursing practice in clinics or hospitals.

Emotional intelligence is described as the ability to recognize, understand, and manage both one's own emotions and the emotions of others. This concept is mostly applied in complex and emotionally demanding environments. Healthcare settings are examples of this (Faria et al., 2024). In the field of nursing, emotional intelligence is a quality that allows professionals to identify and respond effectively to the emotional states of patients, their relatives or companions, and other health professionals who interact during the health care process. This quality is essential for nurse leaders to establish good communication and provide higher quality care (Prezerakos, 2018). Emotional intelligence encompasses emotional self-regulation, empathy, and the ability to remain calm in stressful situations. In addition, it provides skills for the interpretation of other people's emotions, to be able to respond favorably to the patient and to achieve their emotional well-being (Thompson et al., 2022).

For example, in the case of a patient with a new diagnosis of Diabetes Mellitus, the APN can apply emotional intelligence. Considering that this is a chronic disease, and that the patient will receive bad news, the APN should anticipate the possible empotional reactions that the patient will experience to the news of this disease and the possible short- and long-term implications of it, its complications, and the complexity of the treatment (Nnate & Nashwan, 2023). Faced with the patient's emotional reaction, which can range from anxiety to frustration, the nurse applies her emotional intelligence by recognizing the signs of distress in the patient's nonverbal and verbal language. In this case, the nurse does not focus only on the basic information of the treatment, but also uses her empathy skills to support the patient's feelings, generating an environment of emotional safety (Nnate & Nashwan, 2023). This connection can be adapted in different areas, such as during treatment education and the emotional and cognitive needs of the diabetic patient. The relationship that is created from understanding, comprehension, empathy and sensitivity will allow a deeper understanding of the new condition, a psychological acceptance of the condition, avoiding denial and promoting adherence to treatment (Pérez-Fernández et al., 2021). The emotional sensitivity and adaptability encompassed in emotional intelligence go beyond clinical knowledge, making it an invaluable resource for advanced nursing practice (Faria et al., 2024).

In short, critical thinking, clinical judgment, and decision-making are processes inherent to health care. Despite their differences that define and characterize them, their integration guarantees that the construct of thought on which decision-making that will lead to practical action plans is built has the necessary quality to achieve an optimal health outcome for the patient's well-being. The nursing levels of bedside nurses and APNs differ in theoretical and practical aspects in critical thinking, clinical judgment, and decision-making based on their level of preparation, approaches, and actions. Knowing these differences ensures that work teams have a structured organization that allows for intercollaboration and better work results. Emotional intelligence is an invaluable quality for nurse leaders, as it provides them with skills beyond clinical technicalities, turning them into sensitive, empathetic professionals with a high decision-making power in the field of health care.

References

Connor, J., Flenady, T., Massey, D., & Dwyer, T. (2022). Clinical judgement in nursing - An evolutionary concept analysis.  Journal of Clinical Nursing,  32(13–14), 3328–3340. https://doi.org/10.1111/jocn.16469

Critical Thinking, Clinical Reasoning, and Clinical Judgment. (2019).

Dehghani, A. (2024). Development and validation of the clinical judgment capability questionnaire in nurses: A sequential exploratory mixed method study.  International Journal of Nursing Studies Advances,  6(100191), 100191. https://doi.org/10.1016/j.ijnsa.2024.100191

Diamond-Fox, S., & Bone, H. (2021). Advanced practice: critical thinking and clinical reasoning.  British Journal of Nursing (Mark Allen Publishing),  30(9), 526–532. https://doi.org/10.12968/bjon.2021.30.9.526

Falcó-Pegueroles, A., Rodríguez-Martín, D., Ramos-Pozón, S., & Zuriguel-Pérez, E. (2020). Critical thinking in nursing clinical practice, education and research: From attitudes to virtue.  Nursing Philosophy: An International Journal for Healthcare Professionals,  22(1), e12332. https://doi.org/10.1111/nup.12332

Faria, N., Ramalhal, T., & Bernardes Lucas, P. (2024). Scoping review: the emotional intelligence of nurses in the clinical care environment.  Annals of Medicine,  51(sup1), 206–206. https://doi.org/10.1080/07853890.2018.1560166

Jimenez, J.-M., Lopez, M., Castro, M.-J., Martin-Gil, B., Cao, M.-J., & Fernandez-Castro, M. (2021). Development of critical thinking skills of undergraduate students throughout the 4 years of nursing degree at a public university in Spain: a descriptive study.  BMJ Open,  11(10), e049950. https://doi.org/10.1136/bmjopen-2021-049950

Kahlke, R., & Eva, K. (2018). Constructing critical thinking in health professional education.  Perspectives on Medical Education,  7(3), 156–165. https://doi.org/10.1007/s40037-018-0415-z

Manetti, W. (2019). Sound clinical judgment in nursing: A concept analysis: MANETTI.  Nursing Forum,  54(1), 102–110. https://doi.org/10.1111/nuf.12303

Nnate, D. A., & Nashwan, A. J. (2023). Emotional intelligence and delivering bad news in professional nursing practice.  Cureus. https://doi.org/10.7759/cureus.40353

Pérez-Fernández, A., Fernández-Berrocal, P., & Gutiérrez-Cobo, M. J. (2021). The relationship between emotional intelligence and diabetes management: A systematic review.  Frontiers in Psychology,  12. https://doi.org/10.3389/fpsyg.2021.754362

Prezerakos, P. E. (2018). Nurse managers’ Emotional Intelligence and effective leadership: A review of the current evidence.  The Open Nursing Journal,  12(1), 86–92. https://doi.org/10.2174/1874434601812010086

Rn, A. C. (2023, May 26).  What is a Bedside Nurse? Understanding the Role and Responsibilities. Nursestudy.net. https://nursestudy.net/what-is-a-bedside-nurse/

Shin, S., & Yoo, H. J. (2022). Frontline nurses’ caring experiences in COVID‐19 units: A qualitative study.  Journal of Nursing Management,  30(5), 1087–1095. https://doi.org/10.1111/jonm.13607

Stucky, C. H., Brown, W. J., & Stucky, M. G. (2021). COVID 19: An unprecedented opportunity for nurse practitioners to reform healthcare and advocate for permanent full practice authority.  Nursing Forum,  56(1), 222–227. https://doi.org/10.1111/nuf.12515

Thompson, N. M., van Reekum, C. M., & Chakrabarti, B. (2022). Cognitive and affective empathy relate differentially to emotion regulation.  Affective Science,  3(1), 118–134. https://doi.org/10.1007/s42761-021-00062-w

Watkins, S. (2020, January 23).  Effective decision-making: applying the theories to nursing practice. British Journal of Nursing. https://www.britishjournalofnursing.com/content/clinical/effective-decision-making-applying-the-theories-to-nursing-practice/

 

 

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