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Decision-Making in Palliative Care: A reflective case study
Melissa Birchall
Macmillan Clinical Nurse Specialist, Palliative Care, Ty Cymorth, West Wales General Hospital, Carmarthenshire NHS Trust, Wales, United Kingdom
Abstract
Critical examination of the processes by which we as nurses judge and reach clinical decisions is important. It facilitates the maintenance and refinement of good standards of nursing care and the pinpointing of areas where improvement is needed. In turn this potentially could support broader validation of nurse expertise and contribute to emancipation of the nursing profession.
As pure theory, clinical decision-making may appear abstract and alien to nurses struggling in 'the swampy lowlands' (Schon 1983) of the realities of practice. This paper explores some of the key concepts in decision-making theory by introducing, then integrating, them in a reflective case study. The case study, which examines a 'snapshot' of the patient and practitioner's journey, interwoven with theory surrounding clinical decision-making, may aid understanding and utility of concepts and theories in practice.
Keywords
clinical decision-making, reflective practice, palliative care, critical reflection, clinical judgement, nursing ethics
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