Professional judgement and clinical decision making in nursing and inter-professional practice.

Professional judgement and clinical decision making are significant competencies for nurses. Understanding on how to make good clinical decision and how to contribute well in shared decision making in inter-professional collaboration is important for nurses. 

Nowadays, a single decision or a series of decisions, made behalf of a patient, is a result of a team work which consists multi health professions (Thompson and Dowding, 2002). Facing this development nursing schools have been developing inter-professional education (IPE). IPE will potentially improve the knowledge and attitudes of students towards interprofessional collaboration and clinical decision making process (Lapkin, Levett-jones, and Giligan, 2013). Rose (2011) also highlights the key components for strengthening interprofessional collaboration, which are shared goals and partnerships including explicit, complementary and interdependent roles; mutual respect; and power sharing.

A problem mostly faced by nursing students in clinical practice during their internship is formulating clinical decisions. It is because the lack of understanding among students about their role and autonomy as a part of a health care team. The decision-making process can be influenced by several aspects, such as unsynchronised perception and unmet expectation among health professions (Muller-Juge et al. 2013). Stacey et al (2010) indicated that the majority of shared decision making (SDM) models mainly focused on patient-doctor relationship without recognizing role of family and other healthcare professionals who may contribute in the decision making process. Thus, it is recommended to formulate a model of care which has interprofessional approach to SDM as the model that can minimize the gap identified in the decision making process. Additionally, the obstacles in clinical decision making process could be managed by strengthening relationship within health professionals (Merrick, Fry, and Duffield, 2014). The IPE should explain clearly about each profession’s roles and also the autonomy of each health provider (Muller-Juge et al. 2013). The socialisation about the role and shared responsibility to medical students can improve their capacity in inter professional collaborative (Whitehead, C, 2007). Additionally, during the simulation of IPE learning process in Udayana University, the ambiguity about the role each profession also happened among facilitators from different backgrounds (nurses, doctors, physiotherapists, and pharmacies). Thus, it is really important to share the same frame of understanding about every role of health profession in decision making process.

Therefore, clinical decision making in inter professional collaboration setting  is important to be explored further  as it potentially will support to develop the current model of IPE. By sharing clinical decision making understanding to students and other facilitators will potentially improve the quality of learning and eventually will improve quality of care.

Reference List

Lapkin S, Levett-jones T, Giligan C (2013) A systematic review of the effectiveness of interprofessional education in health professional programs. Journal Nurse Education Today 33: 90-102

Merrick E, Fry M, Duffield, C (2014) Australian practice nursing: collaboration in context. Journal of clinical nursing. 23, 3525-3532

Muller-Juge V, Cullati S, Blondon K, Hudelson P, Maitre F et al (2013) Interprofessional collaboration on an internal medicine ward: role perceptions and expectations among nurses and residents. PloS ONE 8(2): e57570. doi:10.1371/journal.pone.0057570

Rose, L (2011) Interprofessional collaboration in the ICU: how to define? Nursing in Critical Care. British Association of Critical Care Nurses Vol 16 No1:5-10

Stacey D, Legare F, Pouliot S, Kryworuchko J, Dunn S (2010) Shared decision making models to inform an interprofessional perspective on decision making: A theory analysis. Patient Education and Counselling 80: 164-172

Thompson C, Dowding D (2002 ) Clinical Decision Making and Judgement in Nursing, Churchill Livingstone, Edinburgh

Whitehead C (2007) The doctor dilemma in interprofessional education and care: how and why will physicians collaborate? Medical Education 41: 1010-1016