NUR 4153-Deliverable 1-How is Clinical Decision Making Influenced?
Memo
To: Staff Nurse
From: Charge Nurse
CC: Human Resources
Per deliverable one assignment, this is a recap of how the charge nurse, staff nurse, and a patient with stage five pancreatic cancer occurred. The staff nurse, just coming off of bereavement leave, was assigned a group in the morning on the med-surgical floor, including a patient recently diagnosed with stage five pancreatic cancer. The patient requested assistance with obtaining advance directives and calling his estranged daughter. The staff nurse offers help with getting the forms for advance orders but is unwilling to assist with calling the patient’s daughter. The staff nurse goes to her charge nurse and reports she cannot care for this patient and urges the charge nurse to change the assignment. After assigning the nurse to another patient, the charge nurse goes to the patient with pancreatic cancer to assist him. Nurses and their attentiveness to their surroundings play a huge role in the nursing process and successful patient outcomes. The relational inquiry approach allows the nurse to understand better what the patient may be going through and build a relationship to help guide the patient along the way. ( Doane/Varcoe pg.30)
Many factors play a role in the nursing process, including internal and external factors. Some internal cues for the staff nurse included self-monitoring, in which she recognized she could not care for the patient with stage 5 pancreatic cancer, which she reported to her charge nurse and requested a change of assignment. Self-monitoring is when an individual recognizes their strengths and weaknesses and applies them to their performance ( Kuiper, 2017). Other internal cues could be whether she has ever had a patient with stage five pancreatic cancer and already knows this could be a terminal illness. Is the nurse still dealing with her emotions as she recently came off bereavement leave? The charge nurse recognized when the staff nurse came to her that rather than argue or refuse the assignment change, she changed the assignment for the best outcome for all parties involved. The charge nurse practiced self-monitoring and self-reflection, recognizing behaviors in the nurse and approaching with the best intentions for all. The charge nurse Knowing the staff nurse was just on bereavement leave is an external factor to include when assessing this situation. Nurses gather these cues when approaching similar problems and remember how to process them and have better outcomes each time they deal with them. (Dickison et al., 2016) .
NUR 4153-Deliverable 1-How is Clinical Decision Making Influenced?
Emotional intelligence includes recognizing, expressing, and managing your emotions when dealing with situations (Schub, 2017). The staff nurse realized she could not care for the patient with pancreatic cancer and felt the only solution would be to remove herself from the patient’s case. She could have many reasons, including the just returned from bereavement leave. The staff nurse could have requested assistance from her charge nurse in processing and managing the patient rather than requesting reassignment. The charge nurse was able to practice her emotional intelligence by recognizing that the staff nurse was struggling with this particular patient and resolving the situation the best she could at the time for all parties involved. Practicing emotional capacity by recognizing the feelings of the staff nurse, patient, and the charge is one way to approach the situation and have a better outcome. The patient required a nurse’s compassion to recognize that the patient needed to speak with his family. Acknowledging and applying empathy to yourself and others shows you have emotional capacity. ( Hutchinson, M 2018). Often, in these situations, one must acknowledge their own emotions and compassion, stop, and reflect before reacting. Applying emotional motivation to this situation could predict a better outcome in the future, talking with the patient, asking them about their fears and values, and allowing the patient to be a part of the decision-making process. Recognizing what you cannot control but not losing the motivation to continue to care for the client is a way to recognize your own emotions. ( Hutchinson, 2018) Emotional reasoning allows you to acknowledge your feelings while continuing to perform your duties and learning from your past experiences.
Implementing these factors into your everyday practice will allow you to recognize your emotions and respond differently when faced with this situation again. Having self-compassion and recognizing when you need help is the beginning of a successful nursing career. In nursing, you must identify your limits and know when to ask for help to maintain your compassion for yourself and others.
References
Doane, G. H., & Varcoe, C. (2020). How to Nurse (2nd ed.). Wolters Kluwer Health. https://ambassadored.vitalsource.com/books/9781975166120
Hutchinson, M., Hurley, J., Kozlowski, D., & Whitehair, L. (2018). The use of emotional intelligence capabilities in clinical reasoning and decision-making: A qualitative, exploratory study. Journal of Clinical Nursing, 27(3/4), e600–e610. DOI: 0.1111/jocn.14106.
Kuiper R, Pesut D, Kautz D. Promoting the self-regulation of clinical reasoning skills in nursing students.
Open Nurs J. 2009 Oct 2;3:76-85. DOI: 10.2174/1874434600903010076. PMID: 19888432; PMCID: PMC2771264.
Schub, T. B., & Smith, N. R. M. C. (2017). Emotional Intelligence in Nursing Practice. CINAHL Nursing Guide. Retrieved from http://ezproxy.rasmussen.edu/login? url=http://search.ebscohost.com/login.aspx?direct=true&db=nup&AN=T903079&site=eds-live
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Question 
NUR 4153-Deliverable 1-How is Clinical Decision Making Influenced?
Evaluate factors integral to clinical reasoning.
Scenario
You are working as a charge nurse on a medical-surgical unit in an acute healthcare facility. One of the staff nurses who recently returned from bereavement leave has been assigned to care for an elderly client, newly diagnosed with stage IV pancreatic cancer. While you are visiting with the client, the nurse is completing her assessment. The client requests assistance to set up hospice care, complete an advanced directive, and reach out to his estranged daughter. The nurse stated, “I can get you the paperwork for the advance directive, but I can’t call your child for you, I am not a social worker.” The nurse leaves the room and asks to speak with you stating, “I can’t care for this client, I need my client assignment changed now or else I will go home.”
As the charge nurse, you step in and change the nurse’s client assignment and offer to assist the client with his requests. Later, you have the opportunity to debrief with the nurse regarding her reaction and decisions regarding the client’s requests and make some recommendations on how the nurse could have responded differently. You write up a summary of the events and include the follow-up conversation with the nurse.
Instructions
Compose a written memo of the situation and debrief for the employee’s personnel file. Include the following in the summary:
Analysis of the internal and external cues impacting the responses of the staff nurse and the charge nurse.
Describe how these factors influenced the clinical decision-making of both nurses.
Emotional intelligence action plan for the nurse based on interactions observed with the client and the charge nurse.
Include self-compassion and compassion toward others.
Include an alternative response from the staff nurse and charge nurse.