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  • Subject Name : Nursing

Clinical Decision-Making

Introduction to Rolfe’s et al’s Reflective Framework

The main purpose of this report is to critically reflect upon an experience in terms of my nursing profession, wherein I had to make a clinical decision. In the due course of this report, the Rolfe’s et al’s Reflective Framework (2001) model would be used to reflect upon my experience, wherein, I am going discuss about the factors that had led me to take that particular clinical decision along with the factors that has obstructed in my path of taking an appropriate clinical decision. In this report, I am also going to reflect upon the strategies that I had applied to overcome the barriers in the course of my clinical decision-making process.

Rolfe’s et al’s Reflective Framework

Through the Rolfe’s et al’s Reflective Framework,I am going to reflect upon my clinical decision-making experience, which I had to make during the time of my internship in the absence of the healthcare practioner to whom I was reporting (Skinner et al., 2016).

Descriptive Level of Reflection ( What)

I still remember the day, when I was working in the night shift at the emergency department of a reputed hospital in Australia and a 19 years accident patient was admitted in the ward where I was working. I could notice, that the patient was bleeding profusely as he had developed a 4 cm wound on the posterial region of his head. Moreover, I also observed that the concerned patient was conscious, in spite of the injuries he had sustained. Since, there was no senior doctor was available at the odd hour and due to weekend, I was prompted by the admin to take the necessary action, which had made me nervous. Since, the patient was found to be conscious, I first tried to initiate a conversation with the patient to enquire more about the incident and found out that the patient did not remember anything about the incident. The first clinical decision, I made in this context was to determine the GCS ( Glasgow Coma Scale) of the patient, which was recorded to be 14, which suggested that further interventions was required to be done on the part of the patient (Jain et al., 2020). Moreover, I had also considered examining the vital stats of the patient was determined to be normal. Furthermore, the pain level of the patient on the occipital area of his head was also very light, without even the administration of any kind of an anesthesia. I think, that at that point of time more interventions were needed to find the out the core cause of his confusion and distress, but I was confused and was unable to choose a proper nursing intervention method.

Additionally, in this short span of time, I did a little bit of research and decided to conduct a CT scan of the patient, that would enable me to determine that if the patient was suffering from any internal injury or not as well as to determine the real cause of his confusion (Jain et al., 2020) . I had a doubt, that the patient was suffering from a trauma due to the accident he had and due to the injury in his occipital area and that is the reason due to which, I wanted to go ahead with the CT scan (Dayan et al., 2017). However, few of my colleagues suggested that there was no need to do a CT scan, because the patient was not suffering from any kind of a pain, nor was he unconscious, so he could just be discharged after proper dresser. Moreover, they also suggested that a sleeping pill should be prescribed to the patient, so that the patient will get a good sleep and will feel relaxed. I think, this was the major reason of confusion on my part, as to my choice of conducting a CT scan or not. The consequences of such type of a non-professional behavior was that the patient got more confused and as per my assumption the patient was falling into more trauma which not good for him.

Theory & Knowledge Development

In order to overcome the confusion created in terms of diagnose made about the patient, I took the initiative of adopting the Team Nursing Care Model, wherein I played the role of a Registered Nurse, there was also a Licensed Nurse and there was a senior nurse who served as the leader of our team and with their assistance only, I came to realize that I should not have delayed the CT scan process, as I was going in the right direction (Englander et al., 2017). Thus, I was now confident enough, that the patient was suffering from a trauma due the injury on his head and blood loss, so I should go ahead and check if the patient had any internal wound or not.

Action-Oriented Reflection

In order to turn things into a better direction and prevent such careless happenings in the future, I think, I should take part in workshops, to enhance my decision-making skills and also build confidence within myself (Englander et al., 2017) .

I think, if I have the adequate level of confidence, no second opinion will create an impact on my decision and I will be able to take a decision that would be beneficial both for me as well as my patient.

Furthermore, after the application of the Team Nursing Care Model, I realized that I had delayed the treatment of my patient due to the confusion over the decision to conduct a CT scan, hence, I decided that I should always go by evidence and not by the words of other people.

Conclusion on Rolfe’s et al’s Reflective Framework

Thus, through this report it can be concluded that a clinical decision should be made based on proper research as well as evidence, no other opinion should be able to influence such type of a decision. Hence, in the case of the 19 years old accident, the CT scan was an urgent requirement because the patient has suffered from a head injury and at the same time the concerned patient was showing great signs of confusion which on itself was not a good sign. In this context, as a Registered Nurse, I should have initially conducted the CT scan and examined if the patient had any internal injury and prove that he was suffering from trauma.

References for Rolfe’s et al’s Reflective Framework

Dayan, P. S., Ballard, D. W., Tham, E., Hoffman, J. M., Swietlik, M., Deakyne, S. J., ... & Mark, D. G. (2017). Use of traumatic brain injury prediction rules with clinical decision support. Pediatrics139(4). Retrieved from https://pediatrics.aappublications.org/content/139/4/e20162709

Englander, H., Weimer, M., Solotaroff, R., Nicolaidis, C., Chan, B., Velez, C., ... & Hartnett, T. (2017). Planning and designing the Improving Addiction Care Team (IMPACT) for hospitalized adults with substance use disorder. Journal of hospital medicine12(5), 339. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5542562/

Jain, S., & Iverson, L. M. (2020). Glasgow Coma Scale. StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513298/

Skinner, M., & Mitchell, D. (2016). “What? So What? Now What?” Applying Borton and Rolfe’s Models of Reflexive Practice in Healthcare Contexts. Health and Social Care Chaplaincy4(1), 10-19. Retrieved from https://journals.equinoxpub.com/HSCC/article/viewArticle/28972

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