References

Baake K. Decision-making in a quasi-rational world: teaching technical, narratological, and rhetorical discourse in report writing tutorial. Trans Professional Commun. 2007; 50:(2)163-171 https://doi.org/10.1109/TPC.2007.897619

Banning M. A review of clinical decision-making: models and current research. J Clin Nurs. 2007; 17:(2)187-195 https://doi.org/10.1111/j.1365-2702.2006.01791.x

Beauchamp T, Childress J. Principles of biomedical ethics.Oxford: Oxford University Press; 2001

Bjørk I, Hamilton G. Clinical decision-making of nurses working in hospital settings. Nurs Res Pract. 2011; 1-8 https://doi.org/10.1155/2011/524918

Carta M, Balestrieri M, Murru A, Hardoy M. Adjustment disorder: epidemiology, diagnosis and treatment. Clin Pract Epidemiol Ment Health. 2009; 5:(1) https://doi.org/10.1186/1745-0179-5-15

Casey P, Dowrick C, Wilkinson G. Adjustment disorders fault line in the psychiatric glossary. Br J Psychiatr. 2001; 179:(6)479-481 https://doi.org/10.1192/bjp.179.6.479

Casey P. Adjustment disorder. Central Nerv Syst Drugs. 2009; 23:(11)927-938 https://doi.org/10.2165/11311000-000000000-00000

Casey P, Bailey S. Adjustment disorders: the state of the art. World Psychiatr. 2011; 10:(1)11-18 https://doi.org/10.1002/j.2051-5545.2011.tb00003.x

Casey P, Jabbar F, O'Leary E, Doherty AM. Suicidal behaviours in adjustment disorder and depressive episode. J Affective Disord. 2015; 174:441-446 https://doi.org/10.1016/j.jad.2014.12.003

Cipriani A, Furukawa T, Salanti G Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet. 2018; 391:(10128)1357-1366 https://doi.org/10.1016/S0140-6736(17)32802-7

Constanzo C, Doll J, Jensen G. Shared decision-making in practice, 4th edn. In: Higgs J, Jensen G, Loftus S, Christiansen N (eds). Edinburgh: Elsevier Limited; 2019

Cooper N. Cognitive biases. In: Cooper N, Frain J (eds). Chichester: John Wiley and Sons; 2016

Cox C. Legal responsibility and accountability. Nurs Manag. 2010; 17:(3)18-20 https://doi.org/10.7748/nm2010.06.17.3.18.c7797

Care Quality Commission. Norfolk and Suffolk NHS Foundation Trust inspection report. 2018. https://www.cqc.org.uk/provider/RMY (accessed 30 June 2022)

Croskerry P. Universal model of diagnostic reasoning. Acad Med. 2009; 84:(8)1022-1028 https://doi.org/10.1097/acm.0b013e3181ace703

Croskerry P. From mindless and mindful practice—cognitive bias and clinical decision-making. New Eng J Med. 2013; 368:(28)2445-2448 https://doi.org/10.1056/nejmp1303712

De Leo D. Treatment of adjustment disorders: a comparative evaluation. Psychol Rep.. 1989; 64:(1)51-54 https://doi.org/10.2466/pr0.1989.64.1.51

Psychotherapy of adjustment disorders: current state and future directions. 2018. https://pubmed.ncbi.nlm.nih.gov/30204563/

Domingo Galutira G. Theory of reflective practice in nursing. Int J Nurs Sci.. 2018; 8:(3)51-56 https://doi.org/10.5923/j.nursing.20180803.02

Elstein A, Shulman L, Sprafka S. Medical problem solving: an analysis of clinical reasoning.Cambridge (MA): Harvard University Press; 1978

Ericsson K, Simon H. Protocol analysis: verbal reports as data, 2nd edn. Cambridge (MA): Massachusetts Institute of Technology Press; 1993

Finlay L. Reflecting on ‘reflective practice’.Milton Keynes: Open University; 2008

Forsberg E, Ziegert K, Hult H, Fors U. Clinical reasoning in nursing, a think-aloud study using virtual patients – a base for an innovative assessment. Nurse Education Today. 2014; 34:(4)538-542 https://doi.org/10.1016/j.nedt.2013.07.010

Gibbs G. Learning by doing: a guide to teaching and learning methods.Oxford: Oxford Polytechnic; 1988

Gonge H, Buus N. Is it possible to strengthen psychiatric nursing staff's clinical supervision? RCT of a meta˛ supervision intervention. J Adv Nurs. 2015; 71:(4)909-921 https://doi.org/10.1111/jan.12569

Guerrasio J, Lessing J. Remediating learning and performance of reasoning, 4th edn. In: Higgs J, Jensen G, Loftus S, Christiansen N (eds). Edinburgh: Elsevier; 2019

Guss D. What is going through your mind? Thinking aloud as a method in cross-cultural psychology. Front Psychol.. 2018; 9 https://doi.org/10.3389/fpsyg.2018.01292

Hameed U, Schwartz TL, Malhotra K, West RL, Bertone F. Antidepressant treatment in the primary care office: outcomes for adjustment disorder versus major depression. Annals Clin Psychiatr. 2005; 17:(2)77-81 https://doi.org/10.1080/10401230590932344

Hammond K, Stewart T, Brehmer B, Steinmann D. Social judgement theory. In: Kaplan M, Schwartz S (eds). New York (NY): Academic Press; 1975

Howatson-Jones L. Reflective practice in nursing, 3rd edn. London: Learning Matters; 2016

Hughes M, Nimmo G. Models of clinical reasoning. In: Cooper N, Frain J (eds). Chichester: John Wiley and Sons; 2016

Huxtable R. For and against the four principles of biomedical ethics. Clin Ethics. 2013; 8:(2–3)39-43 https://doi.org/10.1177/1477750913486245

Israelashvili M. Should adjustment disorder be conceptualized as transitional disorder? In pursuit of adjustment disorders definition. J Mental Health. 2012; 21:(6)579-588 https://doi.org/10.3109/09638237.2012.670881

Johansen M, O'Brien J. Decision-making in nursing practice: a concept analysis. Nurs Forum. 2016; 51:(1)40-48 https://doi.org/10.1111/nuf.12119

Joint Formulary Committee. British National Formulary. 2022. http://www.medicinescomplete.com (accessed 1 July 2022)

Kahneman D. Thinking fast and slow.New York (NY): Farrar, Straus and Giroux; 2011

Kazlauskas E, Zelviene P, Lorenz L, Quero S, Maercker A. A scoping review of ICD-11 adjustment disorder research.nglewood Cliffs (NJ): Prentice-Hall; 2017 https://doi.org/10.1080/20008198.2017.1421819Kolb

Koshy K, Limb C, Gundogan B, Whitehurst K, Jafree D. Reflective practice in health care and how to reflect effectively. Int J Surg Oncol.. 2017; 2:(6) https://doi.org/10.1097/IJ9.0000000000000020

Levett-Jones T, Pich J, Blakey N. Teaching clinical reasoning in medical education courses, 4th edn. In: Higgs J, Jensen G, Loftus S, Christiansen N (eds). Edinburgh: Elsevier; 2019

Lustman P, Clouse R. Depression in diabetic patients: the relationship between mood and glycaemic control. J Diabetes Complications. 2005; 19:(2)113-122

Melin˛Johansson C, Palmqvist R, Rönnberg L. Clinical intuition in the nursing process and decision˛making—a mixed˛studies review. J Clin Nurs. 2017; 26:(23–24)3936-3949 https://doi.org/10.1111/jocn.13814

Middleton R. Critical reflection: the struggle of a practice developer. IPDJ. 2017; 7:(1)1-6 https://doi.org/10.19043/ipdj.71.004

Moyo M, Shulruf B, Weller J, Goodyear-Smith F. Effect of medical students' values on their clinical decision-making. J Prim Health Care. 2019; 11:(1)64-74 https://doi.org/10.1071/HC18055

National Institute for Health and Care Excellence. Depression in adults: recognition and management. 2018. https://www.nice.org.uk/guidance/cg90 (accessed 30 June 2022)

Nursing and Midwifery Council. The code: professional standards of practice and behaviour for nurses, midwives and nursing associates. 2018. https://www.nmc.org.uk/standards/code/ (accessed 1 July 2022)

Nursing and Midwifery Council. Benefits of becoming a reflective practitioner. 2019. https://www.nmc.org.uk/news/press-releases/joint-statement-reflective-practice/ (accessed 30 June 2022)

Olfson M, Marcus SC, Pincus HA Antidepressant prescribing practices of outpatient psychiatrists. Arch Gen Psychiatr. 1998; 55:(4)310-316 https://doi.org/10.1001/archpsyc.55.4.310

Overholser J, Braden A, Dieter L. Understanding suicide risk: identification of high-risk groups during high risk times. J Clin Psychol.. 2012; 68:(3)349-361 https://doi.org/10.1002/jclp.20859

Ritter B, Witte M. Clinical reasoning in nursing, 4th edn. In: Higgs J, Jensen G, Loftus S, Christiansen N (eds). Edinburgh: Elsevier; 2019

Royal College of Nursing. Data protection and monitoring at work. 2019. https://www.rcn.org.uk/get-help/rcn-advice/data-protection (accessed 30 June 2022)

Scala E, Price C, Day J. An integrative review of engaging clinical nurses in nursing research. J Nurs Scholarship. 2016; 48:(4)423-430 https://doi.org/10.1111/jnu.12223

Scholl I, LaRussa A, Hahlweg P, Kobrin S, Elwyn G. Organizational- and system-level characteristics that influence implementation of shared decision-making and strategies to address them—a scoping review. Implementation Sci.. 2018; 13:(1) https://doi.org/10.1186/s13012-018-0731-z

Schuwirth L, Durning S, Norman G, Van der Assessing clinical reasoning, 4th edn. In: Higgs J, Jensen G, Loftus S, Christiansen N (eds). Edinburgh: Elsevier; 2019

Seedhouse D. Ethics: the heart of healthcare, 3rd edn. Chichester: Wiley-Blackwell; 2009

Semple D, Smyth R. Oxford handbook of psychiatry, 3rd edn. Oxford: Oxford University Press; 2009

Song H, Woo Y, Wang H Does mirtazapine interfere with naturalistic diabetes treatment. J Clin Psychopharmacol.. 2014; 34:(5)588-594 https://doi.org/10.1097/JCP.0000000000000183

Standing M. Clinical judgement and decision-making in nursing – nine modes of practice in a revised cognitive continuum. J Adv Nurs. 2008; 62:(1)124-134 https://doi.org/10.1111/j.1365-2648.2007.04583.x

Standing M. Clinical judgement and decision-making in nursing, 3rd edn. London: Sage Publications; 2017

Taylor D, Paton C, Kapur S. The Maudsley prescribing guidelines, 12th edn. Chichester: John Wiley and Sons Ltd; 2015

The Health Foundation. Person-centred care resource centre. 2016. http://personcentredcare.health.org.uk/overview-of-person-centred-care/overview-of-person-centred-care/overview-of-person-centred-care-0-0 (accessed 30 June 2022)

Thompson C, Stapley S. Do educational interventions improve nurses' clinical decision-making and judgement? A systematic review. Int J Nurs Studies; 48:(7)881-893 https://doi.org/10.1016/j.ijnurstu.2010.12.005

Thompson C, Yang H. Nurses' decisions, irreducible uncertainty and maximizing nurses' contribution to patient safety. J Healthc Qual.. 2009; 12:e178-e1785 https://doi.org/10.12927/hcq.2009.20946

Treatment of adjustment disorders in mental health crisis care: a reflective case study

02 March 2023

Pharmacology

02 March 2023

Volume 5 · Issue 3

ISSN (print): 2631-8385

ISSN (online): 2631-8393

Abstract

Clinical decision-making is an integral part of the nursing process, as well as a study requirement at Master's level for the advanced professional practice pathway. This article uses Gibbs' reflective cycle as a framework to explore a clinical decision made in practice. Through presentation of a case study of a patient with an adjustment disorder, the authors explore the process of prescribing appropriate treatment in the context of an uncertain evidence base. The authors will examine decision-making and communication theories and consider any biases, as well as ethical, organisational and professional factors that may influence the decision-making process. The individual and organisational steps needed to embed robust decision-making into practice will be discussed.

Clinical decision-making is a fundamental part of nursing care that impacts patient outcomes (Johansen and O'Brien, 2015). It is estimated that nurses make a clinical decision every 30 seconds in acute care (Yang et al, 2014) and five decisions per consultation in the community (Thompson and Yang, 2009).

Decision-making is a complex, non-linear process involving the collection and analysis of data (Tiffen et al, 2014), use of clinical judgement to weigh up treatment options (Thompson and Stapley, 2011) and use of systematic enquiry to problem-solve clinical conundrums (Johansen and O'Brien, 2015). Standing (2008) advocates reflecting on clinical decision-making to further enhance learning within practice (Johansen and O'Brien, 2015). Decisions can sometimes be based on personal judgements (Hammond et al (1975), so reflection can be used to recognise bias (Moyo et al, 2019). Therefore, it is essential to accurately assess the clinical presentation of a patient, identify their concerns and goals and address these by developing an appropriate plan of care.

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Adjustment disorders

Case study

Clinical decision-making

Mental health

Non-medical prescribing

Reflective practice