Clinical Decision Making

Lilik S

PRINCIPLES of PATIENT CARE

Decisions making
Evidence based nursing
Practice guidelines
Assessing the outcome of care
Delivering cost-effective & benefit
medical care
Accountability
Continued learning
Research and teaching

Decision-making
is solving a problem using a systematic
approach of sequenced steps, selecting
an alternative approach, and putting the
approach into action.

An organizational decision
relates to organizational purpose:
futurity,impact, philosophy or ethics,
uniqueness.

A personal decision
relates to professional autonomy.

Manager behavior

Applies decision-making theory and the

problem-solving process in achieving the
mission of the nursing agency.

Pitfalls of decision making

Inadequate fact finding

Time constraints
Poor communication
Failure to follow decision-making steps

Steps in problem-solving

Systematically collect, organize, and

analyze data related to a specific problem
or need.
Make a plan of action.
Implement the plan.
Evaluate the results.

Normative model
1. Define and analyze the problem
2. Identify all available alternatives
3. Evaluate the pros and cons of each
alternative
4. Rank the alternatives
5. Select the alternative that maximizes
satisfaction
6. Implement
7. Follow up

PARADIGMA PROSES DIAGNOSIS

MEMPELAJARI PENDERITA
DATA DASAR
MANIFESTASI MASALAH
inducto
KELAINAN
STRUKTUR & FUNGSI

verivicative
hypotetico
SINTESIS
DIGNOSIS
PERUBAHAN
MORFOLOGI, SELULER & KIMIA

PATOANATOMI
PATOFISIOLOGI
PATOGENESIS
deducto
ETIOLOGI
DATA DASAR
MEMPELAJARI PENYAKIT

VERIFIKASI
Diagnosis Planning, etc

Scientific Problem Solving Approach

S.P.S.A.

CLINICAL PROCESS

PROBLEM IDENTIFICATION
EVALUATION

IMPLEMENTATION

DATA COLLECTION

DATA ANALYSIS

HEALTH PROBLEM
FOLLOW-UP

IMPLEMENTATION

ANAMNESA/ P.D./
LAB. / MED-RECORD
DATA &
INFORMATION

ANALYSIS
PRIORITY SETTING

PROBLEM SOLVING
ALTERNATIVE

HYPOTHESIS
FORMULATION
HYPOTHESIS
TESTING

TREATMENT
PRIORITY SETTING

TREATMENT
ALTERNATIVES

DIAGNOSIS
SYNTHESIS

DIAGNOSIS
PLANNING

Making critical decisions

requires critical judgment
the use of knowledge and
experience to diagnose
patients and plan their
treatment.

Critical Decision Making

The ability to anticipate

The ability to prioritize
The ability to problem-solve
Relies heavily on knowledge base
An ability to learn from past
mistakes

Critical thinking is not an

action but a way of life.

Bledsoe et al., Essentials of

Paramedic Care: Division 1I
2006 by Pearson
Education, Inc. Upper
Saddle River, NJ

Acuity

The severity or acuteness of your

patients condition

Protocol

A standard that includes general and

specific principles for managing
certain patient conditions

Standing Orders

Treatments you can perform before

contacting the medical direction
physician for permission

Algorithm

Schematic flow chart that outlines

appropriate care for specific signs
and symptoms

Paramedics Critical
Thinking Skills (1 of 2)

Knowing anatomy, physiology, and

pathophysiology
Focusing on large amounts of
data
Organizing information
Identifying and dealing with
medical
ambiguity

Paramedics Critical
Thinking Skills (2 of 2)

Differentiating between relevant

and irrelevant data
Analyzing and comparing similar
situations
Explaining decisions and
constructing logical arguments

terimakasih