While walking through the post-operative care unit during night shift rounds, the nurse noticed a patient lying in bed who appeared unwell with shall

Discussion Topic

CASE SCENARIO  

While walking through the post-operative care unit during night shift rounds, the nurse noticed a patient lying in bed who appeared unwell with shallow ‘disorganized’ breathing. On closer examination, the gentleman appeared cold and clammy with a grey pallor and a blue cyanotic tinge to his lips. The nurse attempted to speak to the gentleman; however, he was confused and anxious and talking incoherently. The nurse immediately undertook an Airway, Breathing, and Circulation (ABC) assessment, checked his airway, placed him on 15 L of oxygen via a non-rebreather mask, and checked his vital signs. 

The gentleman’s pulse rate was 120 beats per minute and regular; he had unrecordable oxygen saturations, and his systolic blood pressure was 89 mmHg. The nurse immediately tilted the base of the patient’s bed and set up an IV infusion of plasma expander (colloid) to raise his blood pressure. Working in post-operative rehabilitation it is often common to encounter patients who suffer with orthostatic hypotension and syncope secondary to hypovolemic shock. However, the nurse was concerned that the patient was not responding to the usual treatment provided and contacted the attending physician on call. He was informed that the gentleman had been assessed some 10 min earlier and there was no cause for concern as the patient appeared comfortable and was sleeping. It was explained that the patient was acutely unwell, and the doctor responded that he would re-review the patient shortly. 

As the nurse was convinced that the gentleman’s condition was deteriorating, he undertook an electrocardiogram (ECG), which upon examination indicated a myocardial infarction. Concerned that he was not getting the appropriate response from the attending physician the author called the clinical lead down from the Post-Anesthetic Care Unit to help assess the patient again. On examination of the ECG, a posterior myocardial infarction was identified, and the gentleman was immediately transferred to a Cardiac ICU bed in another unit. The gentleman was promptly started on the Acute Coronary Syndrome protocol of care and further diagnostic tests revealed an extensive myocardial infarction. 

1. How do nurses use clinical decision-making in nursing practice? 
2. How is clinical decision-making defined? (Support this with available literature). 
3. Why is clinical decision-making important to nursing practice at all levels of nursing? 
4. What do you recognize as the best clinical decision-making model to be employed by nursing? (Make sure this is supported by course readings and other credible literature choices). 
5. Determine three decision-making models that could be applied to the above scenario. First, provide a brief overview of the decision-making model (use literature sources but make sure to put it into your own words). Provide a rationale to support your choice of the decision-making models. Describe 2 pros and 2 cons of this type of decision-making in nursing. 
6. Apply two of the three chosen decision-making models to the above scenario, making a clear link between the decision-making model and the scenario; this illustrates your understanding of the model that you have chosen. 
7. What decision-making models do you feel are most applicable to nursing and why? Is there just one? (Support your response) 

Many clinical decision-making models would be applicable in this situation; however, it is important to understand the various models, how they can be applied to practice, and the differences between the various suggested models as well as some of their similarities. Some ideas would be utilizing the hypothetico-deductive model. 

1. As a reminder, all discussion posts must be a minimum of 400 words, references must be cited in APA format 7th Edition and must include a minimum of 2 scholarly resources published within the past 5 years.