Clinical Decision-Making And Evaluation Assignment Sample

Introduction to Clinical Decision-Making And Evaluation Assignment Sample

Clinical decision-making in acute healthcare settings is a pivotal tool for healthcare professionals when it comes to managing the complex scenario of a patient. In a healthcare setting, clinical decision-making is a complex, iterative process that healthcare providers and professionals use to gather information, analyse it, and make informed decisions regarding patient care (Kalaitzidis, 2016). It includes integrating knowledge, experience, and patient-specific factors to select the most appropriate course of action, including diagnosis, treatment, and management (Gamborg et al., 2020). In diabetes care, clinical decision-making can help healthcare professionals in designing patient-centric treatment plans for individual patients, by ensuring better management of the disease. This assignment aims to explore the clinical decision-making processes through the scenario of Olga, a 55-year-old woman with Type 1 diabetes mellitus, admitted to the hospital with the complexities related to hypoglycaemia by using the CDM frameworks, and by aligning with ethical principles set up by the NMC. The structure includes an overview of the clinical presentation, a critical reflection using assessment tools such as NEWS2, SBAR, and the ABCDE assessment tool, as well as the Waterlow Score, followed by an evaluation of the ethical, legal, and professional frameworks that informed clinical decisions. Key decision-making models such as the Dreyfus Model of Skill Acquisition will also be applied in this assessment. As a whole, by integrating the assessment models, escalation protocols, and reflective practices, this analysis underscores the necessity of structured decision-making to ensure patient safety and optimal outcomes.

Explore this Clinical Decision-Making and Evaluation Assignment Sample covering clinical assessment, decision-making frameworks, ethical considerations, and patient safety. An Assignment writing helper can support students in understanding structured clinical decisions, assessment tools, and professional healthcare practices.

Overview of the scenario

The scenario includes the case study of Olga, who is a 55-year-old woman. She had been brought into the emergency department by her sons after noticing her health deterioration and confused behavioural approach. Upon analysing the case scenario, it seemed that Olga already had a long-lasting history of Type 1 Diabetes Mellitus, which was diagnosed when she was 18 years old. According to Addissouky et al. (2024), Type 1 diabetes mellitus is an autoimmune disease which can be characterised by immune-mediated destruction of pancreatic beta cells, resulting in absolute insulin deficiency, onset of hyperglycaemia, and increased risk of diabetes ketoacidosis.

Apart from that, Olga has a three-week history of nausea, polyuria, lethargy, and abdominal pain, with a tendency to drastic weight loss. Upon deteriorating health condition, her son admitted Olga to the Diabetic Assessment Unit. Upon analysing the case scenario of Olga, it can be seen that her vital signs, including low GCS, rapid breathing, low oxygen saturation, hypertension, and tachycardia, indicate a critical condition which needs urgent care. Physical signs like dry mucous membranes, low skin turgor suggest significant dehydration. Despite no visible injuries, her NEWS2 Score of 10 reflects a high risk of deterioration. These findings as a whole point out the inability of her body’s compensatory responses due to metabolic imbalance.

Rationale for choosing the case scenario:

Upon analysing the case scenario of Olga, it can be stated that this case scenario has been selected because of due to the complexities and critical urgency, which provides an ideal context for demonstrating advanced clinical decision-making skills. More specifically, Olga’s health conditions, like acute hypoglycaemia (CBG 1.2 mmol/L), altered consciousness (GCS 8/15), respiratory distress, and signs of other health conditions indicate the medical emergency which needs immediate intervention and medical attention. Her long-standing history of poorly managed Type 1 Diabetes Mellitus, combined with missed insulin doses and skipped meals, highlights the risk of non-adherence and its consequences. This elevates the NEWS2 score, which also necessitates a quick emergency response, aligning with the NMC guideline. This scenario also enabled the application of the ABCDE approach, prioritisation of care, early recognition of deterioration of health status, and supporting evidence-based clinical judgement.

Critical reflection

The A-E assessment of Olga’s case scenario:

Based on Olga’s ABCDE assessment (Refer Appendix 1), it can be stated that she has a compromised airway, which is contributing to the increased rate of respirations and reduction of oxygen saturation level. This condition necessitates the implementation of airway support through the provision of supplemental oxygen, which can prevent possible organ damage as a consequence of hypoxia (Resuscitation Council UK, 2024). And it can improve her comfort level. Moreover, her HR level of 122 per minute with blood pressure level of 95/60 mmHg and CRT 3 seconds necessitate the administration of IV 0.9% saline to support perfusion. In order to highlight the rationale for choosing the ABCDE tool for Olga’s clinical decision-making process, it can be stated that this tool enables carrying out a structured and priority-based evaluation of her condition, which ensures immediate treatment and disease management. By assessing Airway, Breathing, Circulation, Disability, and Exposure, clinicians can stabilise her air obstruction, correct the hypoxia, and address circulatory collapse due to hypoglycaemia and dehydration. This approach aligns with emergency care best practice and can also support clinical decision-making and facilitate timely escalation and intervention, which is important to improve Olga’s chances of recovery and prevent further complications. The ABCDE findings should be used to complete the NEWS2 Criteria to ensure a comprehensive assessment and support the clinical decision-making to manage the complexities related to Type 1 diabetes mellitus for the patient (Welch et al., 2022).

The National Early Warning Score 2 or NEWS2 (refer to Appendix 2) is a clinical tool used to detect the risk of deterioration of a patient by assessing six physiological parameters: respiratory rate, oxygen saturation, systolic blood pressure, pulse rate, temperature, and degree of consciousness (Williams, 2022). Every parameter has a score between 0 and 3, where larger numbers denote more serious anomalies. Patients who need extra oxygen are awarded an extra point. Clinical reaction is guided by the overall score; a score of five or higher indicates an urgent or emergency response. NEWS2 facilitates early critical illness detection, standardises assessments, and enhances professional communication. In the case of Olga, this scoring system can provide an evidence-based, standardised framework to identify and monitor clinical deterioration. Focusing on unstable vital signs, the NEWS2 assessment tool can enable healthcare professionals in recognising life-threatening changes and prompts timely intervention and support effective communication among healthcare providers, and Olga for coordinated emergency care and clinical decision-making.

As per the NEWS 2 table (appendix 2), the NEWS 2 score for Olga is 13, which indicates a high clinical risk of further deterioration. Her respiratory rate and oxygen saturation level at room air score the maximum points, which indicate the severe respiratory compromise. Though she is not yet on supplemental oxygen, which should be initiated to suppress the risk related to obstruction in the airways. Since the NEWS2 score is higher than 7, the patient has immediate needs for clinical assessment by a multidisciplinary team and continuous monitoring by the nurses.

Olga's case demonstrates the challenges of treating acute diabetic complications in the hospital due to severe hypoglycaemia and significant physiological instability. Contemplating her case, the importance of following evidence-based guidelines such as those set out by the Joint British Diabetes Societies for Inpatient Care (JBDS-IP). The use of intravenous dextrose for severe hypoglycaemia is advocated, and prompt reassessment of capillary blood glucose to direct further therapy is stressed in the guidance (Joint British Diabetes Societies for Inpatient Care, 2023). It does so to break the neurological damage that is a result of a prolonged state of hypoglycaemia, even if the patients, like Olga, are not conscious.

And Olga’s dehydration – indicated by the dryness of her mucous membranes, the disability of her skin, her low BP, and her rapid heart rate – means she’s going to need intravenous fluids fast, to replete her volume and tissue perfusion. This is particularly important to avoid the evolution of hypovolaemic shock and multi-organ failure. The suggestion to closely monitor vital signs, notably BP, is also consistent with recommendations within" best practice acute care. This necessitates the immediate implementation of fluid replacement therapy in her treatment plan by using 0.9% sodium chloride to boost the tissue perfusion (nice.org.uk, 2020). Repetitive measurement of the patient’s blood pressure at every 5-minute interval will also be essential to include in Olga’s treatment plan to normalise the systolic blood pressure level (above 100 mmHg).

As per the case scenario, she faces additional difficulties since she is unconscious, such as not being able to adjust her posture or self-report pain, which raises her risk of developing pressure ulcers. Olga's comfort and skin integrity are prioritised even in situations where she is unable to express her demands, thanks to the objective evaluation of pain and pressure injury risk made possible by the use of structured assessment tools like the Waterlow scale and the Critical Care Pain Observation Tool. In acute diabetic care, this situation emphasises the value of interdisciplinary teamwork, prompt escalation, and the application of validated assessment instruments. It also emphasises the moral need to stand up for patients who are at risk, making sure that all actions are prompt, supported by evidence, and focused on the needs of the patient (Williams, 2024). In the end, Olga's example serves as a reminder of the attention to detail and flexibility needed in clinical decision-making to maximise outcomes for patients with high-risk diabetes.

As per the Waterlow Assessment table (Refer Appendix 3), Olga is at risk of developing a pressure ulcer as her score remains between 10 to 14. The key risk factors include her bedbound status (mobility 3), diabetes with non-compliance (neurological deficit 5), and weight loss (malnutrition 2). Olga's risk of developing pressure ulcers is assessed by using the Waterlow Assessment Tool. This tool helps healthcare providers in designing preventive strategies like repositioning and skin care, ensuring proactive individualised care for maintaining skin integrity and preventing complications (Safiejko et al., 2022).

Based on the Waterlow Assessment, Regular repositioning, skin checks, and nutritional support are essential to prevent pressure injuries. So, in the case of Olga, in such a scenario, she will be recommended to undergo thorough regular repositioning and skin checks. Apart from that, balanced nutritional intake and maintenance of adequate hydration will also be recommended to her.

Identification and analysis of the decision-making

Upon analysing the case scenario, it was seen that Olga is unconscious and unable to take part in the decision-making process regarding her treatment plan. Additionally, there is no proof that Olga has a legal proxy who can make decisions about her health on her behalf. This can cause her boys to have different opinions about the best way to provide care. To make sure that decisions about her care are in her best interests, it is crucial that the family and the medical staff participate in shared decision-making. This strategy is in line with the Nursing and Midwifery Council's Code of Conduct, which highlights how crucial it is to collaborate and build connections with patients, families, and other professionals in order to deliver person-centred care (Nursing and Midwifery Council Code of Conduct, 2015).

In the case of Olga, both shared and collaborative decision-making are important to ensure patient-centric care, particularly to manage her poorly managed type 1 diabetes mellitus. According to Montori et al. (2022), shared decision-making involves actively engaging Olga in her care plan by respecting her preferences, concerns, and values while offering her evidence-based and informed healthcare services. On the other hand, collaborative decision-making extends this approach by involving the MDT or multi-disciplinary team, including the nurse, diabetes educators, endocrinologists, and Olga’s family, to support in understanding the risk of non-compliance and the importance of regular monitoring (Andersen et al., 2023). Therefore, both shared and collaborative decision-making are important for Olga’s treatment plan to address her non-compliance, promote self-management, and align her treatment process with her values, preferences, and support system. This approach as a whole can ensure that the patient is receiving safe and patient-centric care, which can improve her engagement, health outcomes, and continuity, specifically at the time of acute health deterioration and long-term diabetes management.

Considering the case scenario of Olga, it can be stated that Olga’s case was complex and time-sensitive. The A-E approach was used in the first assessment with attention directly to the airway and breathing. Olga was comatose with a GCS of 8/15 and required urgent airway care and oxygen therapy. She was identified as urgent by the NEWS2 score, which was high enough to prompt escalation to the critical care outreach team.

The SBAR tool provided a structured format of communication and helped to make sure that the important elements of the case were communicated to the attending. This promoted effective shared decision-making.

The Dreyfus Model of Skill Acquisition offers a helpful perspective for comprehending clinical decision-making in Olga's situation. At the proficient level, the nurse was able to detect acute deterioration patterns intuitively, such as Olga's hypoglycemia, respiratory distress, and altered awareness, and take immediate action. Conversely, skilled medical professionals only used analytical thinking when results didn't match their expectations (AlFaris et al., 2023). For example, Olga's condition worsened even after receiving the right insulin, which may indicate an underlying infection or metabolic issue. Further diagnostic research was necessary as a result, illustrating the transition of clinical knowledge from rule-based practice to experience-driven, intuitive judgement. Based on the complexities and urgency of Olga’s case scenario, the shared decision-making process should be aligned with the NMC Code of Conduct, which mandates the implementation of professional codes of conduct and referrals by the care professionals (Nursing and Midwifery Council Code of Conduct, 2015).

This case underlines the integration of critical thinking, ethical conduct, and person-centred care, as stated in the NMC Code (2015). Following the Information Processing Theory, the nurse undergoes the processes of attention, memory, and reasoning in clinical decision-making to collect, interpret, and act on cues from the deteriorating physiological condition of Olga. The action of giving IV glucose upheld the ethical principles of beneficence and non-maleficence, conceived to prevent further neurological damage (NHS England, 2023). Justice was served in delivering care fairly despite her history of missed appointments; her autonomy was respected by the involvement of her sons in care planning upon her regaining consciousness. Specialist services were referred for continued care, ensuring that the NMC standards of "prioritise people" and "practise effectively" are supported. Full documentation in the electronic record underlined the accountability of the nurse and multidisciplinary transparency in decision-making. Guided by the NHS Framework for Person-Centred Care, the shared care plan accounted for Olga's values and preferences (NHS England, 2023). The Francis Report (2013) warned of the consequences of not recognising deterioration in time. Olga's case reinforces that lesson; early recognition and intervention mattered most in this situation. The nurse's interventions, in essence, echo the NMC Code's professional values of compassion, safety, and advocacy for the patient.

Care plan

Supporting, treating, and intervening to address a patient's physical, emotional, and psychological needs is known as care. Olga needs a care plan because it guarantees a methodical, tailored approach to managing her complicated health, which includes Type 1 Diabetes with acute hypoglycemia and inadequate self-care (NHS England, 2023). In order to ensure continuity, safety, and prompt reactions to any changes in her condition, it specifies precise objectives, interventions, and monitoring techniques. In addition, it fosters interdisciplinary cooperation and patient-centered treatment, attending to her short-term medical requirements as well as her long-term diabetes control (AlFaris et al., 2023). Utilising a care plan enhances Olga's involvement in her health journey, maximises results, and lowers risks.

The scenario surrounding Olga has greatly influenced my understanding of clinical decision-making and multidisciplinary communication in acute care. For instance, it reinforced the need for the practical application of structured assessment tools such as ABCDE, NEWS2, Waterlow scoring, and the Critical Care Pain Observation Tool for timely and evidence-based interventions. I gained a new understanding of the ethical and legal considerations put forth by the NMC Code relative to prioritising people, practising effectively, and ensuring safety. It also enhanced my decision-making process by critically analysing clinical cues and moving towards an appropriate response through the application of Information Processing Theory and the Benner model (Safiejko et al. 2022). In addition to this, I also gained confidence in using the SBAR communication tool to share concise, structured information with the multidisciplinary team, allowing continuity and clarity in care planning. Ultimately, such a professional encounter has made it possible for me to lead systematic assessments, make effective escalation in deterioration, and be an advocate for person-centred, culturally appropriate care, which definitely has a great bearing on enhancing complex clinical outcomes.

In the case of Olga, SBAR communication has been used to carry out communication between healthcare professionals and care seekers to ensure concise, clear, and effective information exchange among them. It is particularly preferable for Olga, as she is presented with complex and radiply deteriorating health conditions, which need urgent medical intervention. In such scenario, SBAR communication can help her in quickly summarising medical situation, and enable professionals to carry out medical assessment, and administration of immediate care needs. This format ensures that urgent concerns are communicated clearly to the medical team, enabling prompt decision-making, and appropriate intervention. For high-risk patient like Olga, SBAR communication tool improves patient safety, reduce communication errors, and promotes coordinated patient-centric care. Considering the SBAR communication tool, (Refer Appendix 4), the following recommendation can be prompted to Olga for ensuring her health outcome and safety:

Recommendation:

• Immediate implementation of oxygen therapy
• Administration of 100 ml of 20 per cent dextrose over 15 mins (rate: 400ml/hr)
• Administration of IV fluids (0.9% NaCl)
• Consultation with a senior physician
• Implementation of pressure sore prevention (repositioning)

Patient Assessment and Rationale

Considering the health complexities of Olga, which include acute hypoglycaemia (CBG 1.2 mmol/L), reduced consciousness (GCS 8/15), and compromised airway and breathing (RR 34, SpO₂ 88%), refer to the immediate care intervention to manage the health outcome. Her circulation status is unstable with hypotension, tachycardia, and delayed capillary refill (CRT 3 seconds), indicating poor perfusion. Clinical signs of dehydration, including dry mucous and reduced skin turgor, further support fluid imbalance. The NEWS2 Score of 13 indicate a high risk of deterioration, which ensures urgent intervention. The findings from Olga’s health assessment justify immediate oxygen therapy, intravenous dextrose to manage hypoglycaemia, fluid resuscitation, along with senior medical review to stabilise her condition and prevent further onset of health complications.

Conclusion

To conclude this assessment, it can be stated that adherence to the clinical decision-making guidelines and assessment is essential to deliver safe and ethical care in acute settings. In this assessment, the importance of the clinical decision-making process has been discussed by considering the case scenario of Olga. Through Olga’s case, one can see an excellent approach to improve communication and teamwork between healthcare providers, patients and families with the use of a tool, such as SBAR. This, in turn, ensures that we provide evidence-based, patient-centred care at the level demanded by the NHS for quality and safety. Ultimately, these approaches foster shared decision-making, enhance outcomes, and contribute to the delivery of holistic, culturally competent care based on individual patient need.

References

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