C H A P T E R 4
Clinical decision making in drug therapy
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people’s understandings of their medications and health
conditions, and providing evidence-based, accurate
information.
NURSING: ART AND SCIENCE
Nursing
is a unique and complex science, as well as
a nurturing and caring art. In the traditional sense,
nursing has been viewed as ministering to and soothing
the sick through the provision of person-centred care.
In the current state of medical changes, nursing also
has become increasingly technical and scientific. Nurses
are assuming increasing responsibilities that involve not
only nurturing and caring, but also assessing, diagnos-
ing and intervening with people to treat, to prevent and
to educate as they assist people in coping with various
health states.
The nurse deals with the whole person, including
physical, emotional, intellectual, social and spiritual
aspects. Nurses must consider how a person responds
to disease and its treatment, including the changes in
lifestyle that may be required. Therefore, a nurse is a
key healthcare provider who is in a position to assess
the whole person, to administer therapy as well as medi
cations, to teach the person how best to cope with the
therapy so as to ensure the most favourable outcome
and to evaluate the effectiveness of the therapy. Nurses
accomplish these tasks by integrating knowledge of the
basic sciences (anatomy, physiology, nutrition, chem-
istry, pharmacology), the social sciences (sociology,
psychology), education and many other disciplines and
by applying clinical decision making approaches.
MIDWIFERY: ART AND SCIENCE
Midwifery
, too, is a unique discipline that combines
both art and science. The midwife primarily provides
person-centred care for women and their families
throughout childbearing as well as promoting their
health across the lifespan. This includes care before con-
ception; during antenatal, labour and postnatal phases;
and beyond. Midwives are increasingly becoming
involved in public health and health promotion for
women throughout the lifespan, including during ado-
lescence and menopause.
The midwife, like the nurse, provides care that
incorporates physical, emotional, intellectual, social
and spiritual aspects. Such care may incorporate an
array of medications, both supporting normal physio-
logical processes, as well as managing underlying health
problems or health problems arising during child-
bearing, as well as health promotion such as in family
planning. Midwives, too, provide such care through
integrating knowledge of basic sciences (anatomy, phys-
iology nutrition, chemistry, pharmacology), the social
sciences (sociology, psychology), education and many
other disciplines and by applying clinical decision
making approaches.
THE CLINICAL DECISION MAKING
PROCESS
Nurses and midwives used the
clinical decision making
process—a problem-solving process based on person-
centredness—to provide efficient and effective care.
Application of the process with drug therapy ensures
that people receive the best, safest, most efficient, sci-
entifically based, holistic care. Clinical decision making
is a complex activity that requires practitioners to be
knowledgeable in relevant aspects of care and to have
access to reliable and appropriate sources of informa-
tion. The process of making judgements and decisions
involves the person making a judgement or decision
using information; how individuals use information
and where that information comes from are key to
successful decision-making. Many clinical decisions
occur in situations of uncertainty. Each judgement
and decision a clinician makes will require them to
think about an uncertain future, in the present, using
evidence that comes from a (more) certain past. There
are many uncertainties in delivering healthcare, such as
uncertainty about illness and health, as there is no clear
definition of a “disease”.
Assessment
Assessment
(gathering information) involves systematic,
organised collection of data about the person. Because
the nurse or midwife is responsible for holistic care,
data must include information about physical, intellec-
tual, emotional, social and environmental factors. When
viewed together, this information provides the nurse
or midwife with the facts needed to plan educational
and discharge programs, arrange for appropriate con-
sultations and monitor physical response to treatment,
to disease or to pregnancy. The process of assessment
never ends because the person is in a dynamic state,
continuously adjusting to physical, emotional and envi-
ronmental influences.
Drug therapy is a complex and important part of
healthcare, and the principles of drug therapy must be
incorporated into every person’s assessment plan. The
particular information that is needed varies with each
drug, but the concepts involved are similar. Two major
aspects associated with assessment are the person’s
history (past illnesses and the current problem) and
examination of their physical status.
