Nursing Process Clinical Decision Making Definition of Clinical Decision Making

Clinical decision-making is defined in the work of Higuchi and Donald (2002) entitled "Thinking Processes Used by Nurses in Clinical Decision Making" to be "a problem-solving activity that focuses on defining patient problems and selecting appropriate treatment interventions." (p.145) Clinical decision marking is stated to be that which "forms the basis of expert clinical practice." (Higuchi and Donald, 2002, p.145) The nurse works in clinical practice settings as a member of a health care team and this requires that the nurse communicate decisions to other team members "to ensure the continuity and coordination of patient care." (Higuchi and Donald, 2002, p.145) The nurse is further required to document clinical decisions in the patient's charts and plans for care. Clinical decision-making, according to Higuchi and Donald has been "studied using the theoretical perspectives of decision theory and information processing. Higuchi and Donald state that the major thinking processes include those as follows:

(1) Description -- the delineation or definition of a situation or the form of a thing;

(2) Representation -- Depiction or portrayal through enactive, iconic, or symbolic means.

(3) Inference -- Act of process of drawing conclusions from premises or evidence;

(4) Synthesis -- composition of parts or elements into a complex whole;

(5) Verification -- Confirmation of accuracy, coherence, consistency or correspondence. (Higuchi and Donald, 2002)

II. Description of Benner's Stages of Clinical Judgment

Benner's stages of Clinical Competence include five different stages as follows:

(1) Novice -- this stage is the beginner stage in which the nurse has no previous experience...

Context-free rules are learned for universal application but these rules are unable to inform the novice which tasks are appropriate for each situation therefore the nurse is limited in applying these rules to the clinical setting. (Saver, 2009, p.1)
(2) Advanced Beginner -- In this stage, the nurse has enough experience to acknowledge "recurring, meaningful components of a situation." (Saver, 2009, p.1) During this stage the nurse begins to "formulate guidelines that dictate actions…they have knowledge skills and know how, but don't have many in-depth encounters with a similar patient population." (Saver, 2009, p.1)

(3) Competent -- The nurses begin to view their actions as they relate to long-term goals or plans. While being competent the nurse lacks both the speed and flexibility of the proficient nurse but is developing a feeling of mastery and is able to rely on advanced planning and organizational skills. "An increasing sense of saliency helps them recognize what is important. They begin to recognize patterns and the nature of a clinical situation more quickly and accurately. They need to examine fewer options to make decisions." (Saver, 2009, p.1)

(4) Proficient -- the nurse who is proficient "views situations as 'wholes' rather than parts, and maxims, reflecting nuances of a situation, guide performance. The proficient nurse learns from experience what events typically occur and how to modify plans in response to different events. The nurse sees goals and salient facts, but still must consciously make decisions." (Saver, 2009, p.1)

(5) Expert -- the expert nurse understands what needs to be accomplished due to a "well-developed ability to recognize demands and resources in situations and attain goals. They no longer rely solely…