Best-Worst+Decision+Making+Situations

Best and Worst Decision Making Situations 

An example of the best decision making witnessed by writer was in the case of a long term care resident who had type I Diabetes. The resident was noted to become unresponsive (although still breathing) during the shift and the nurse assistant notified an RN supervisor who was nearby. The RN supervisor jumped to conclusions before assessing the resident and was going to call a code when the charge nurse asked her to wait and let her check the resident's blood sugar. The LPN noted the resident to be diaphoretic, unable to make eye contact, and noted little response to a sternal rub. The resident's blood sugar was 54. The charge nurse then administered Glucagon per standing order. Within minutes the resident began to rouse and was given a snack when she was fully awake. The charge nurse then checked the resident's blood sugar again in one hour and notified the family and oncoming nurse in addition to the physician who applauded the LPN's quick thinking.

An example of the worst decision making noted by writer occurred several years ago when a co-worker entered a resident's room and noted a compound fracture to the resident's right tibia. Instead of stabilizing the appendage, calming the resident and placing the emergency light on, the nurse chose to leave the resident alone literally running down the hall yelling for someone to help. Another nurse took charge of the situation designating two staff to stay with the resident to ensure leg remained stabilized and to keep the resident calm (also to apply pressure if any copious bleeding noted). The second charge nurse then called the rescue squad. In the end the resident became a below the knee amputee but did survive the ordeal thanks to the second charge nurse who remained calm.

The first nurse relied on her knowledge of hypoglycemia in the diabetic patient and assumed the symptoms she noted fell under this category. The signs and symptoms she interpreted were correct the resident indeed had a dangerously low blood sugar at 54. Her decision that giving the resident Glucagon would be the fastest and safest route to return to a normal range was correct and she kept the resident from being coded which she did not require in the first place.

The nurse in the second example assumed the resident would be safe when she left the room which could have been disastrous. Had a major vessel been compromised the resident could easily have hemorraged and no one would have been with her to apply pressure. The nurse's decision to run down the hall simply was not a sound one a patient should never be left alone in a potentially life threatening situation. This nurse did not think the situation through and did not have the resident in mind when she lost her composure.