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Decision-Making on Procedure-Practice Modification

Decision-Making on Procedure-Practice Modification

According to new research, the ability to change is crucial to the success of any organization and has never been more important than it is in today (Gesme & Wiseman, 2010, p. 257). The Institute of Medicine has identified numerous patients who die each year due to poor decision-making in healthcare. Decision-making is a vital element in nursing practice. It is a complex process that may be characterized by a series of choices, including data acquisition concerning the patient’s circumstance to accomplish the desired outcome. Consistently, nurses make significant decisions, and these decisions do affect the patients’ healthcare. How was a decision made in my nursing practice to change practice?

When we are administering medication in my unit, vital signs must be taken before giving the medicine. Therefore, there was no need to reevaluate the vital sign of the patient after being given narcotics. As indicated in research from O’Connor (2003, p. 18), to meet the patients’ needs, pain should be reassessed after each intervention to evaluate the effect and determine whether a modification is needed. The time frame for reassessment also should be directed by hospital or unit policies and procedures. The patient’s lack of reassessment after being given pain medication may cause the death of a young adult who received multiple-dose of opioids and did not have a proper reassessment. They took action and decided to change the policies and implement safe practices to ensure the patient’s safety. They introduce the “sandwich vital signs’ which means you check the vital sign before and after any pain medication administration. So far, it has been in practice in the hospital, especially in my unit.

According to new research, frequent and vast changes in acute care hospitals can take a toll on nurses and cause change fatigue, which has been largely overlooked and under-researched (Brown et al., 2018, p. 309). At the beginning of the change, nurses complained about the amount of work they would do. They applied the decision-making process by analyzing the problem which is the lack of reassessment leading to death. They implement the alternatives, which means emphasizing the nurse’s return to reassess the patient. They presented new evidence-based research showing the importance of reassessment. They finalize it by introducing a new policy that will eventually improve patient outcomes and prevent sentinel events.

In nursing, the care of the patient depends on us. The decision‐making research in acute care nursing is prevalent; errors in decision‐making continue to lead to poor patient outcomes (Nibbelink & Brewer, 2018, p917). We are the advocate while trying to encourage and reinforce their decision respectfully. Every day in the healthcare system, the nurse must make decision-making to improve the patient’s outcome, and it is all on evidence-based practice. Evidence‐based practice involves integrating the best results in research with clinical experience, which will enable us to provide a higher quality of care and optimize the care given (Bennasar‐ Veny et al., 2016, p.250). The decision to change the policy was not welcomed initially, but nurses started to understand the rationale and began to accept the change. From the time they changed the policy, no sentinel event happened.


Bennasar‐Veny, , Gonzalez‐Torrente, S., De Pedro‐Gomez, J., Morales‐Asencio, J. M., & Pericas‐Beltran, J. (2016). Using Knowledge as the Basis for evidence‐based practice in primary care nurses. International nursing review, 63(2), 250-258.

Brown, R., Wey, & Foland, K. (2018). The relationship among change fatigue, resilience, and job satisfaction of hospital staff nurses. Journal of Nursing Scholarship, 50(3), 306-313.

Gesme, D., & Wiseman, M. (2010). How to implement change in practice. Journal of oncology practice, 6(5), 257–259.

Nibbelink, C., & Brewer, B. B. (2018). Decision‐making in nursing practice: An integrative literature review. Journal of clinical nursing, 27(5-6), 917-928.

OʼConnor, M. (2003). Pain Management: Improving Documentation of Assessment and Intensity. Journal For Healthcare Quality, 25(1), 17–22.


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Decision-Making on Procedure/Practice Modification

Share an example from your nursing practice setting of how a decision was made to change a procedure or practice.

What steps were used in the decision-making process?

Decision-Making on Procedure-Practice Modification

Decision-Making on Procedure-Practice Modification

What evidence was considered for decision-making?

Was the change effective?  Provide rationale.

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