Clinical decision making (not to take blood cultures from a febrile patient)

0 Comment

To diagnose the cause, blood culture is mostly required for identification of causative bacteria or fungus. A nurse caring for a patient with acute leukaemia is many a time confronted with the clinical scenarios where he or she is required to make clinical decision to take blood culture from a febrile patient. The nurse may herself make the decision to obtain a blood sample for culture on suspicion of an infection or may act on the orders of a physician. In an autonomous decision, the complexity and the nature of the decision task affect the approach taken towards problem solving (Thompson, Kirkness &amp. Mitchell 2007). The decision taken by the nurse can be analysed for the application of evidence based medicine in routine clinical situations.
Decision analysis allows to share a decision with seniors and colleagues and to evaluate its advantages and disadvantages (Bucknall 2003). Nurse uses the domains of prior knowledge about the patient and his circumstances, ethical knowledge and specific knowledge. This knowledge is accessed and applied by the means of pattern recognition and heuristics (Bohinc &amp. Gradisar 2003).
First of all, the component of problem recognition requires the nurse to identify the ‘cues’ or clinical symptoms such as fever in this case. The recall of these cues leads to formulation of a hypothesis of a problem (Jenks 1993). Once the problem has been recognised, the decision maker proceeds on to the next step of assessment in which the data is gathered, assimilated and analysed (Klein 2005). The nurse records the temperature, maintains a temperature chart and records associated symptoms such as chills, sweating, cough and pattern of fever etc. as a part of data collection.
To be able to form a judgement, it is imperative to evaluate and make a choice (Higgs et al 2008. Connolly, Arkes &amp. Hammond 2000). The nurse evaluates the data and infers about what should be done (Thompson &amp.