Clinical reasoning and decision making in advanced clinical practice - A case study
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Article # 2
Title : Clinical reasoning and decision making in advanced clinical practice - A case study
Author : Paul Curtis
Russells Hall Hospital The Dudley Group NHS Foundation Trust
Keywords : ' Advanced Clinical Practice ', ' Clinical Reasoning ', ' Decision Making '
DOI : https :// doi . org / 10.21252 / jz4q-8996
Clinical reasoning and decision making in advanced clinical practice - A case study
Abstract
Advanced Clinical Practice should be underpinned by complex decision making skills , analysing complex problems to make appropriate , evidence based judgements to improve patient care . This paper presents a case encountered in clinical practice where a 999 call was received for a gentleman who had fallen at home , however clinical assessment revealed he was critically unwell . A decision needed to be made between aggressive treatment and transport or unplanned palliative care . Evidence shows that while clinicians believe they use critical thinking to analyse a problem , most decisions are in fact made by rapid pattern recognition .
Context
Advanced Clinical Practitioners ( ACPs ) must demonstrate advanced problem solving and decision making abilities , making decisions using critical thinking skills and judgement which in turn allow autonomous practice ( Health Education England ( HEE ), 2015 ). Advanced Clinical Practice ( ACP ) should be underpinned by complex decision making skills ( HEE , 2015 ), using analysis and synthesis of complex problems to make appropriate , evidence based judgements or diagnoses to improve patient experiences and outcomes ( HEE , 2017 ). The author presents a case encountered in pre-hospital clinical practice whilst a trainee ACP , exploring the associated decision making theories .
Discussion
An emergency call was received for an 80 year old gentleman , reported to have fallen out of bed . Working as a paramedic mentor , crewed with a newly qualified and a student paramedic we arrived on scene only a few minutes after the call . The patient ’ s wife met us and showed us to the bedroom where we found the patient who , to maintain confidentiality ( Health & Care Professions Council ( HCPC ), 2016 ) will be referred to only by the pseudonym Albert . He was on the bedroom floor , in a prone position . Albert ’ s wife explained that