Clinical Decision-Making in Patient Care

Introduction

In this study, the case study of Amarthya is to be analysed to determine the way clinical decision-making for patients is to be developed and the factors influencing the decision making of care for the patients.

Impact of Organisational factors

In making clinical decision for the patients, the rational decision-making theory is to be followed. The theory mentions that initially the problem in care is to be identified followed by establishment of decision criteria, weighing of the decision, generating alternative decision, evaluating the alternative and choosing the best care for the patient (Djulbegovic et al., 2018). In case of Amarthya, the lack of collaboration is the organisational factor acting as problem and influencing decision making. This is because hindered collaboration between patients and nurses makes the patients avoid trusting the nurse, effectively mention their needs and demands along with show non-compliance in availing care (van der Biezen et al., 2017). In case of Amarthya, initially lack of collaboration from the patient and her daughter was shown for the nurses regarding wash and clean the patient even though the nurses tried to mention maintaining her dignity and importance of the action. It leads the nurses to use rational clinical decision-making theory where their initial decision was to act as per the motive of the patient. However, the alternative decision of cleaning the patients while maintaining her dignity without her permission was found to be better as it would help them in maintaining hygiene for the patients as well as examine for any wounds on the body. Whatsapp

Legal and ethical issues

The ethical aspect of autonomy mentions the patients who have ability to make the decision regarding their care without interference from others are to be supported to decide their own care (NICE, 2018). However, the patient’s autonomy can be restricted if the decision made by them compromises their health condition (hospitalnews, 2021). In case of Amarthya, the autonomous decision to avoid getting cleaned and check for pressure areas was acting not in best interest of the patient. This is because the decision was limiting the nurses to reach holistic analysis of her health and planning of her treatment and support. Thus, restriction of autonomy of the patient to wash and clean her by the nurses was ethical action.

The beneficence indicates acting with kindness and charity with strong intension of doing good to others with moral obligation (West, 2020). In this context, the decision of the nurse to provide a helping hand to Amarthya’s daughter in moving her mother in the home and providing oral paracetamol to Amarthya was an act of beneficence. This is because it limited the fall frequency of Amarthya while being moved in the home on chair or other areas by her daughter and paracetamol helped in temperature of Amarthya to be controlled to normal. Non-maleficence informs avoiding harm to the patients and justice along with duty of care indicates nurses to effective care for the patients while upholding professionalism and avoiding discrimination (West, 2020). In case of Amarthya, the nurse’s decision to clean and check for pressure sores irrespective of consent from the patient or family member was an act of non-maleficence. This is because it helped the nurses to detect the deteriorating health condition faced by Amarthya due to her frailty and take actions to avoid further harm by providing support to her. The justice was also ensured no discriminative form of care was provided to Amarthya.

Factors influencing care decision

The socioeconomic factor such as financial status influences care decision. This is because people with enhanced financial ability are able to access costly care but the people with lack of employment and lower financial status struggle to arrange finances in deciding to use costly care (Davies et al., 2019). In case of Amarthya, the daughter was financially stable and thus, the package of care provided by able to be used by them. The health beliefs also influence care decision as negative belief influences patients and their family members unable to trust the nurses delivering support and avoid accessing care from them (Kennedy et al., 2017). In case of Amarthya, the fear of the nurses thinking Amarthya’s daughter has purposely abused her mother on observing bruises on Amarthya ‘s back without considering they are caused due to her fall out of lack of support and frailty made Amarthya’s daughter decide to avoid cleaning of her mother by the nurse.

Conceptual understanding of healthcare cost and nursing care

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The healthcare cost is to be managed in limited way so that no extra and inappropriate cost is faced by the patients or their family that may lead them to experience financial burden related to care (Mazumdar et al., 2020). Thus, the cost-effective care package was provided to Amarthya to ensure her daughter has to face limited financial burden while using the support for her mother. The safe staffing is important so that competent individuals who are qualified to use resources strategically are recruited to deliver care (Limb, 2018). In case of Amarthya, the nurses are registered individuals under NMC who safely took care of her without creating any hindrance to her dignity or respect.

Conclusion

The discussion concludes that all key ethical aspects in care for Amarthya was effectively maintained by the nurses. The health belief of Amarthya’s daughter regarding nurses may have influenced her decision to initially avoid supporting cleaning of her mother by the them at the hospital.

References

Davies, J.M., Sleeman, K.E., Leniz, J., Wilson, R., Higginson, I.J., Verne, J., Maddocks, M. and Murtagh, F.E., 2019. Socioeconomic position and use of healthcare in the last year of life: a systematic review and meta-analysis. PLoS medicine, 16(4), p.e1002782.

Djulbegovic, B., Elqayam, S. and Dale, W., 2018. Rational decision making in medicine: implications for overuse and underuse. Journal of evaluation in clinical practice, 24(3), pp.655-665.

hospitalnews 2021, Are there limits to a patient’s autonomy in making health care decisions?, Available at: https://hospitalnews.com/are-there-limits-to-a-patients-autonomy-in-making-health-care-decisions/ [Accessed on: 11 October 2021]

Kennedy, B.M., Rehman, M., Johnson, W.D., Magee, M.B., Leonard, R. and Katzmarzyk, P.T., 2017. Healthcare providers versus patients’ understanding of health beliefs and values. Patient experience journal, 4(3), p.29.

Kilbride, M.K. and Joffe, S., 2018. The new age of patient autonomy: implications for the patient-physician relationship. Jama, 320(19), pp.1973-1974.

Mazumdar, M., Lin, J.Y.J., Zhang, W., Li, L., Liu, M., Dharmarajan, K., Sanderson, M., Isola, L. and Hu, L., 2020. Comparison of statistical and machine learning models for healthcare cost data: a simulation study motivated by Oncology Care Model (OCM) data. BMC health services research, 20(1), pp.1-12.

van der Biezen, M., Wensing, M., Poghosyan, L., van der Burgt, R. and Laurant, M., 2017. Collaboration in teams with nurse practitioners and general practitioners during out-of-hours and implications for patient care; a qualitative study. BMC health services research, 17(1), pp.1-9.

West, E., 2020. Ethics and integrity in nursing research. Handbook of research ethics and scientific integrity, pp.1051-1069.


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