Practice Rationale Care Model: The Art and Science of Clinical Reasoning,Decision Making and Judgment in the Nursing Process

Jefferson Garcia Guerrero

Ph.D. NS, DNS, MAN, RN

          Saudi Arabia

Nurses must be enlightened that clinical reasoning, clinical decision making, and clinical judgment are the key elements in providing safe patient care. It must be incorporated and applied all throughout the nursing process. The impact of patients’ positive outcomes relies on how nurses are effective in clinical reasoning and put into action on clinical decision making occurs. Thus, nurses with poor clinical reasoning skills frequently fail to see and notice patient worsening condition, thus misguided decision making arises that leads to ineffective patient care and adding patients suffering. Clinical judgment, on the other hand, denotes on the outcome after the cycle of clinical reasoning. Within this context, nurses apply reflection about their actions from the clinical decision making they made. The process of applying knowledge, skills, and expertise in the clinical field through clinical reasoning is the work of art in the nursing profession in promoting patient safety in the course of delivering routine nursing interventions.  Nurses must be guided with their sound clinical reasoning to have an optimistic outcome and prevent iatrogenic harm to patients. Nurses must be equipped with knowledge, skills, attitude, and values but most importantly prepared to face the bigger picture of responsibility to care for every patient in the clinical field.

Nurse as second victim after adverse event

Essam Ezat Mahmoud

King Saud Medical City, Saudi Arabia

Background: Nurses is being a second victim after made error. They suffered from physical and psychological symptoms followed an event. Healthcare organization has a significant role in support nurses after an event. However, little attention is paid from governmental bodies, to support the second victims.

Aim: To describe nurses' experience followed adverse events and the importance of the organization to support them.

Methods: A descriptive study conducted at King Saud Medical City, a total of 355 staff nurses were selected from clinical areas. Data were collected between July, 2 to Dec 5, 2017, using a self-administered questionnaire.

Results: 33.8% of the participants were involved in an adverse event in their career, and 64.2% involved with no patient harm, while 19% with fetal harm. Also, 82% experienced physical and psychological symptoms. Flashback returned to work anxiety, difficult concentration, grief and depression were the most psychological symptoms reported. Sleep disturbances, unable to relax and Sweaty palms were the most physical symptoms reported by them. 42.3% of them spent one to three weeks till they rid all symptoms. 55.2% received informal support from Head Nurse (216%), Nurse Manager (18.9%), Director of Nursing (8%) and friend/ Family. Nurses were worried a lot about what their clinical peers would think about them after the events. They have not been adequately supported by the organization (77.6%). there was no designated member of the organization guiding them after an event.

Conclusions: Adequate support can work effectively to reduce symptoms, after an event. Lack of supports can lead to an emotional burden.