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NURS3002 Supplementary Assessment System

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Question:

Part 1
 
Discuss two decision making theories you have covered in your tutorials for this topic. What are the identifying features of the theories? How do they develop in nurses? When would you chose to use one theory over another? What are the strengths and limitations of these theories? You must support with relevant, current literature and demonstrate a link to nursing throughout.

Part 2
 
Outline this patient in no more than 250 words to provide the clinical context for the rest of the paper. Ensure you deidentify the patient and do not use their real name. Discuss their reason for admission and their care needs. Provide relevant medical and social history as required to provide context.

Discuss three issues the patient was facing at the time you cared for them. These need to be issues that you were involved in assessing and managing while on PEP. Be explicit in detailing your role. Discuss why these were issues for this patient, how do they relate to this admission? How did you assess them? Link this to the decision-making theory you used and the clinical reasoning you undertook when assessing this patient.

Discuss how you addressed each of these issues in terms of nursing management and providing care. Again, you need to support with evidence-based literature to support your therapeutic interventions. You need to identify which decision-making theory you used here and how you moved through clinical reasoning to manage the care of this patient.
 
 

Answer:

Part A

Information processing theory

The information processing theory reflects that the human mind acts like an information processor in comparison to the notions of behaviourists to the people merely respond to the stimuli. The information processing model focuses on the information that is expanded through various ways (Butler, Guiso and Jappelli 2014). This in turn is involved in affecting the ability of the individuals to access the information later. It also reflects the degree to which the information was extended upon and the way that how the information will be learned. Another study was involved in broadening the depicted idea by adding more information that could be easily retrieved if the way of accessing is similar to the way that the information was stored. Studies showed that the general model of information processing theory involves majorly there components. This includes the sensory memory, the working memory or the short term memory and finally the long term memory (Reyna 2013). While considering the sensory memory, it has been perceived that the information during this is gathered through the senses by a process known as transduction. There is a receptor cell activity present where the information is altered to a form that the brain is able to process. These are the memories that exist for a short amount of time. In terms of short term memory, there are various cognitive functions that affects this memory where the individuals have cognitive load and the information that has been repeated for a number of times does not require intellectual capacity. In long term memory, there are various types of information that is involved like declarative (semantic and episodic), procedural (how to do something), and imagery (mental images). In contrast to the previous memory constructs, long term memory has unlimited space (Trevithick 2014).

De Neys and Osman (2013) suggests that intuitive theory comprises of an ontology of concepts along with a system of laws that are involved in governing the various concepts that interrelate. This theory includes a structure that is coherent in nature and which expresses how a part of the theory is able to influence the other parts of the theory. A major characteristic of this intuitive theory is that they are simply not involved in describing the incident that has happened but also involved in interpreting the evidences through the use of the vocabulary of the theory. The implication of the intuitive theory reflects that it is good in terms of the probabilistic and the generative models that allows the various cognitive skill set to define these programs of the model. The theory of intuition supports prediction in addition to supporting of inference along with explanation.

 

While using the information processing theory, the information is being accessed from long-term memory along with cue assessment. This information is then transformed into parts which can be cognitively manipulated by the short-term memory. Therefore this theoretical approach maintains that there are certain drawbacks to the amount of information which a person can process given at a specific time in addition to the efficient problem solving that helps to the mentioned limits. While in nursing, this theory of information processing has been used with verbal long thinking-aloud, comprising of the protocols to study process of cognition implemented in clinical decision making (Butts and Rich, 2013). In order maintain the tendency of information-processing models to be overly linear and mechanistic, steps have taken to address implement addition of heuristics along with the contextual variables and also varying degrees of task complexity in addition to the varying levels of uncertainty (Hershberger et al. 2013). The theory of Information processing is able to provide a theoretical match in terms of the dynamic environments and the ambiguity of decisions in clinical practice.  It is required to rely on analytical decision to make a more structured process for the identification of options along with the expected outcomes. The process of the assigning of the values to the outcomes along with the determination of the estimated relationships which are thought to exist between the options in addition to the anticipated outcomes. Formal or the informal models are used to bring about the systematize decision making by using decision trees in addition to the grids or decision flow diagrams (Holstein and Gubrium, 2013). It has been reported that the decision analysis can be made useful for evaluation of the options related to medical treatment in association to the cost analysis, quality improvement decisions, sensitivity analysis and the policy decisions (Trevithick 2014).

A brief definition of intuition reflects that it is involved in the immediate apprehension while there is absence of reasoning. Looking from a more technical point of view, it can be argued that intuition might be seen as the contrastive of reasoning which in turn corresponds roughly to the distinction between the two types like Type 1 that is intuitive and Type 2 that is reflective processes that is contemporary to the information and the intuitive process theories of thinking (Rodriguez, Smith and Silvia, 2016). However unlike reasoning, the idea of intuition reflects low effort which does not compete for resources of central working memory. It also provides the default responses which might or often might not be intervened upon with a high effort along with the reflective reasoning. Therefore it can be mentioned that intuition has in turn been blamed for the cognitive biases that exists in the psychological literatures in relation to reasoning along with decision making.

The information processing theory helps the nurses to provide sufficient details about the components of the process for responding to the patients. This theory develops from social psychology and it involves the concepts that are required to be applied by the nurses in order to respond to the social cues received from the patient which involves examples like response generation. This theory have an applicability in relation to how the nurses should act out their professional roles and learn the developmental skills. A study conducted by Shaban (2015), showed that the nurses who are more experienced or has at least five years of experience can act as a preceptor. In contrast a non-expert nurse does not have a role as charge nurse or preceptor.

 

Part 2

Outline of the patient

The patient that I cared for during my nursing placement was a five year old child. The vitals of the patient showed 39 degree Celsius which indicated fever. Additionally the signs and symptoms of the patient detected were sore throat, cough, along which decreased oral intake and drooling. When the tonsils were examined it was seen to be of grade 4 according to the nurses findings. The patient was admitted to the paediatric ward. The assessment showed that the patient has a past medical history of sleep disorder breathing along with neonatal jaundice, low birth weight and seizures disorder. The diagnosis of the patient revealed that the patient had tonsillitis.

Issues the patient was facing

The three issues were fever, sore throat and cough and lastly decreased oral intake and drooling.

The problems that were being faced by the patient when I was attending mainly consisted of the signs and the symptoms of the disease. Most of the children who are suffering from tonsillitis have a tendency to show drooling along with fever and other such health conditions. I being the nurse in charge for this child to care in order to manage the symptoms. In reference to the problems being faced by the patient, in order to conduct a nursing diagnosis I did the following steps with included detection of the risk for aspiration which was related to the impairment of swallowing along with bleeding. There was also assessment of the acute pain that was related to the inflammation of the tonsils. Assessment was also required to determine the deficiency of the fluid that is related to the reduced and inadequate amount of oral volume intake and that is secondary to painful swallowing. The assessment consisted of the preadmission assessment. This was in terms of the preoperative operations that included the laboratory studies also. The assessment of the vital signs of the patient was quite important has it helps to establish a baseline for the monitoring post operation especially. In case of this patient, the most important part was the monitoring of the body temperature. This was required in order to determine that the child has no upper respiratory infection (Bitar and Saade 2013).

Clinical reasoning in nurses includes the information processing theory along with other aspects like decision analysis, skill acquisition or the hermeneutic processes. It has been well established the information processing is done through the cue assessment which is a form of hypothetico-deductive approach (Raj et al. 2016). This theory ensures that diagnostic and treatment decisions are made based on logical thinking and by a rule of thumb or just a simple recognition of pattern. The information processing theory helps the nurses or the medical professionals to analyse and focus on the biophysical facts which can be defined, measured and consensually agreed. Hence by applying this theory I tried to first collect he cues of the patient that is the biophysical factors and then decision for any action for assessing the risk of the health condition of the patient. I used my clinical judgment to carry put the above menytioned nursing diagnosis. This judgement was made by taking into account the clinical features that were relevant in the given situation however it might not always be based on the systematic reasoning process. The steps of clinical reasoning that I have implemented during this involved cue acquisition, cue clustering, cue interpretation, focused cue acquisition, ruling in and ruling out hypotheses, making a diagnosis, evaluate treatment options relevant to the diagnosis, prescribe and/or implement treatment plan, and finally evaluate treatment outcomes (Stelter 2014). By applying these stages of the clinical reasoning I tried to link the clinical features rationally to the disease and the treatment and the interventions of the disease.

 

Addressing the issues of the patient

The nursing interventions or rather the therapeutic interventions that I had implemented and which required to be carried out in order to manage the condition of the patient involved the following interventions like prevention of aspiration. It is required to place the patient in a position that is partially prone having the head placed with the head turned to one side till the time the child is not fully awake. During this process I had to encourage the child to expectorate all the secretions and had to discourage to cough. I also tried to keep the head of the patient slightly lower in comparison in order to the chest to help facilitate drainage of secretions. The interventions also involved reliving of pain of the patient. This I did by applying an ice collar on the patient postoperatively and by administering pain relieving medications as directed. I tried to remain at the bedside of the patient in order to soothe the patient and give the child reassurance since crying might irritate the throat of the patient thereby increasing the discomfort of the patient hence steps should be taken to avoid it at any cost. I also need to encourage the child to intake fluid. This I did by giving small amount of clear fluids to the patient along with giving ice chips. Although I had to take care to fact that the irritating liquids such as juice, ice cream or milk that tend to get attached to the surgical site and make the process of swallowing more difficult. Therefore they are poor choices and it records intake and output until an adequate oral intake is established. According to my experience one of the most important intervention was providing family teaching to the family of the patient. The care giver who will be responsible for caring for the patient after the discharge from the hospital needs to be instructed that the patient is kept quite at least for a few days immediately after discharge. The family members were also instructed to note the signs of haemorrhage if any along with notification of the health care provider. I also provided the family members with instructions and contact numbers of the health providers before discharging the patient.

I also followed the documentation guidelines in order to provide better quality care to the patient which involved of the individual findings including the antibiotic therapy and the infections of the upper respiratory tract. It also involved the current antibiotic therapy along with the cultural and the religious beliefs of the patient. Documentation of the care plan of the patient is quite important in addition to the teaching plan set out for the family members and the patient itself. The documentation also involved the responses to the interventions along with the actions that were performed. The document also involved the plan of care along with attainment or the progress report that is attained by moving towards the desired outcome (Nilsen 2015).

 


During this process I also mad use of the intuitive theory. Often in nursing we require to understand the prevailing situation without any rationale and are required to act on a sudden awareness of knowledge that is related to previous experience. By using intuition I could spontaneously respond to the situation of the patient without wasting any time to articulate the understanding of the condition. As seen in the studies by Venekamp et al. (2015), intuition contains patterns and similarity recognition, common sense, sense of salience and deliberate rationality. A study also showed that clinical experience has improved nursing proficiency. However there are certain limitations in case of both the theories. First in case of information processing theory, the weakness involve recalling and connecting, there is often lack of deep well of knowledge, it also sometimes hard to verbalize. Similarly it requires wide variety of attention spans and the pace is good for most but not all (Thompson et al., 2013). Often it leads to being misinformed or involved one sided opinions. Similarly in case of intuition there are also several limitations that includes flawed information, short term emotional bias, insufficient consideration of alternative, prejudices, inappropriate application and lastly lack of openness since every person has a different experience base.

While in the nursing placement I also applied the dual processing model which is kind of model that consists of both the aspects, the information processing theory as well as the intuitive theory. The first step according to this model is intuition and the second step is analysis. Similarly while caring for patient and managing the health conditions I also made use of dual processing theory. According to this I commenced by clinical reasoning by collection of the cues, followed by the cue interpretation. If after the cue interpretation the situation comprises that the cue interpretation matched the stored patterns of knowledge of diseases clinical features then intuition is put into action. However it the case is that the cue acquisition along with the cue interpretation does not pattern match existing stored memory then the System 2 that is analysis is put into action (DiCenso, Guyatt, and Ciliska 2014). Dual Processing Theory, by focussing on how clinicians actually make decision and does not offer a solution to how to ensure that clinical practitioners can move appropriately between intuitive and analytical modes to reach a good clinical judgement.

 

References

Bitar, M.A. and Saade, R., 2013. The role of OM-85 BV (Broncho-Vaxom) in preventing recurrent acute tonsillitis in children. International journal of pediatric otorhinolaryngology, 77(5), pp.670-673.

Butler, J.V., Guiso, L. and Jappelli, T., 2014. The role of intuition and reasoning in driving aversion to risk and ambiguity. Theory and Decision, 77(4), pp.455-484.

Butts, J.B. and Rich, K.L., 2013. Philosophies and theories for advanced nursing practice. Jones & Bartlett Publishers.

De Neys, W. and Osman, M., 2013. Negative priming in logicomathematical reasoning: The cost of blocking your intuition. In New approaches in reasoning research (pp. 42-58). Psychology Press.

DiCenso, A., Guyatt, G. and Ciliska, D., 2014. Evidence-Based Nursing-E-Book: A Guide to Clinical Practice. Elsevier Health Sciences.

Hershberger, P.E., Finnegan, L., Altfeld, S., Lake, S. and Hirshfeld-Cytron, J., 2013. Toward theoretical understanding of the fertility preservation decision-making process: examining information processing among young women with cancer. Research and theory for nursing practice, 27(4), p.257.

Holstein, J.A. and Gubrium, J.F. eds., 2013. Handbook of constructionist research. Guilford Publications.

Nilsen, P., 2015. Making sense of implementation theories, models and frameworks. Implementation Science, 10(1), p.53.

Raj, G.A., Shailaja, U., Debnath, P., Banerjee, S. and Rao, P.N., 2016. Exploratory studies on the therapeutic effects of Kumarabharana Rasa in the management of chronic tonsillitis among children at a tertiary care hospital of Karnataka. Journal of traditional and complementary medicine, 6(1), pp.29-33.

Reyna, V.E., 2013. Intuition, reasoning and development: A fuzzy-trace theory approach.

Rodriguez, C.M., Smith, T.L. and Silvia, P.J., 2016. Multimethod prediction of physical parent–child aggression risk in expectant mothers and fathers with Social Information Processing theory. Child abuse & neglect, 51, pp.106-119.

Shaban, R., 2015. Theories of clinical judgment and decision-making: A review of the theoretical literature. Australasian Journal of Paramedicine, 3(1).

Stelter, K., 2014. Tonsillitis and sore throat in children. GMS current topics in otorhinolaryngology, head and neck surgery, 13.

Thompson, C., Aitken, L., Doran, D. and Dowding, D., 2013. An agenda for clinical decision making and judgement in nursing research and education. International Journal of Nursing Studies, 50(12), pp.1720-1726.

Trevithick, P., 2014. Humanising managerialism: Reclaiming emotional reasoning, intuition, the relationship, and knowledge and skills in social work. Journal of Social Work Practice, 28(3), pp.287-311.

Venekamp, R.P., Hearne, B.J., Chandrasekharan, D., Blackshaw, H., Lim, J. and Schilder, A.G., 2015. Tonsillectomy or adenotonsillectomy versus non-surgical management for obstructive sleep-disordered breathing in children. Cochrane Database of Systematic Reviews, 2015(10).

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