NSG 456 Decision-Making in the Absence of Evidence Essay

NSG 456 Decision-Making in the Absence of Evidence Essay

NSG 456 Decision-Making in the Absence of Evidence Essay

Decision-Making in the Absence of Evidence

Given that safety is a core concern in all patient care activities, the ideal is that evidence acquired through rigorous research informs nursing thought and action. However, this is not always the case. There are barriers to implementing evidence-based practice (ex. lack of available research on certain issues, clinicians not wanting to challenge the status-quo, etc.), which begs the question of what nurses rely on to make decisions in the absence of evidence.

NSG 456 Decision-Making in the Absence of Evidence Essay

Studies identify analysis and intuition as factors that influence how nurses make decisions. Analysis is rooted in the nursing process (assess, diagnose, plan, implement, evaluate) and is relied on by clinicians who have limited patient care experience to draw from. Nurses use patient cues to create a clinical picture that leads to logic-based interventions to meet patient needs. Intuition plays a larger role in decision-making as nurses accumulate experience. Repeated exposure to similar care scenarios allows nurses to recognize patterns and act accordingly (Nibbelink & Brewer, 2018). Another consideration in the absence of research is the role of expert opinion and teamwork. There are clinical situations where scientific evidence cannot be consulted before care decisions are made (ex. responding to an emergency), and deciding to follow the lead of an experienced clinician can mean efficient use of time and delivery of potentially life-saving interventions (Canadian Nurses Association, 2021).

As an example, consider an instance where a nurse encounters a patient during a hypoglycemic event. Instinctually, the nurse would combine knowledge about the signs/symptoms of hypoglycemia (diaphoresis, confusion, trembling, patient verbalizing hunger or feelings of heart palpitations), the patient’s health history (ex. diabetes mellitus II diagnosis), and the results of a fingerstick glucose reading, and determine that the patient needs to be stabilized by elevating blood sugar. Leaving the patient alone to retrieve supplies or trying to contact a doctor for a glucagon order may not be an option. Having the general nursing knowledge to move from least to most invasive intervention, and knowing it is a common nursing order, the nurse may give the patient honey sublingually because the sugar is absorbed instantaneously via the salivary glands. This example demonstrates nursing analysis and intuition in action, as well as the saying that “when research is unavailable, guidelines are grounded in expert opinion and consensus” (Canadian Nurses Association, 2021).

A more recent example would be responding to the COVID-19 pandemic. Initially, we had no scientific evidence of how to prevent the spread, treat, or cure the deadly virus. The lack of information and knowledge about what we were facing meant nurses/clinicians had to make care decisions based on general knowledge (ex. the spread of viruses can be decreased by practicing hand hygiene, wearing masks, and maintaining social distance from others) and available resources. Consider how the World Health Organization initially called COVID-19 a public health emergency before escalating its status to a pandemic. Ongoing research during the pandemic helped determine that like MERS or SARS, people in contact with symptomatic individuals were most susceptible to infection. As a result, healthcare providers were prioritized as those being in particular need of PPE, though shortages in medical supplies and lack of standardized or precise testing measures complicated our ability to respond (Klimek Yingling, 2020). Though the situation was unexpected and difficult, the resourcefulness, creativity, general knowledge, and intuition of healthcare providers bought time for researchers to gather the evidence we needed to respond to patient needs more efficiently and effectively than what was initially possible.

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