McKenna's Pharmacology, 2e

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C H A P T E R 4  Clinical decision making in drug therapy

people’s understandings of their medications and health conditions, and providing evidence-based, accurate information.

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.

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

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.