Clinical Decision Making

Lilik S

2012
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 VERIFIKASI

Diagnosis Planning, etc
PERUBAHAN
MORFOLOGI, SELULER & KIMIA

PATOANATOMI
PATOFISIOLOGI

deducto PATOGENESIS
ETIOLOGI

DATA DASAR
MEMPELAJARI PENYAKIT
 Scientific Problem Solving Approach
S.P.S.A. CLINICAL PROCESS

PROBLEM IDENTIFICATION HEALTH PROBLEM

EVALUATION DATA COLLECTION FOLLOW-UP ANAMNESA/ P.D./

LAB. / MED-RECORD

IMPLEMENTATION DATA ANALYSIS IMPLEMENTATION DATA &

INFORMATION
ANALYSIS

PRIORITY SETTING HYPOTHESIS TREATMENT DIAGNOSIS

FORMULATION PRIORITY SETTING SYNTHESIS

PROBLEM SOLVING HYPOTHESIS

ALTERNATIVE TESTING TREATMENT DIAGNOSIS
ALTERNATIVES 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 patient’s
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
 Paramedic’s 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
 Paramedic’s Critical
Thinking Skills (2 of 2)
 Differentiating between relevant
and irrelevant data
 Analyzing and comparing similar
situations
 Explaining decisions and constructing
logical arguments
 terimakasih