Clinical Reasoning Cycle And Priorities For The Peter Mitchell Case Study Essay.

Importance of patient's role in the medical process

Question:

Write about the Application of the Clinical Reasoning Cycle for Nursing Science.

The clinical reasoning cycle has eight steps that are applied by the nurse in determining the care priorities that the patient needs. Alfaro-Lefevre (2009) suggests that in a nursing patient set up, the relationship between the two determines the outcome of the process since the nurse relies on information gathered from the patient. Hughes (2008) suggests that when a patient assumes the sick role and seeks medical attention from a professional, means that the individual is willing to take any medical conditions that are given to him/her. However, it is important to ensure that the medical process is tailored to meet the needs of the patient. Such needs vary based on physiological, [psychological and demographic characteristics of the patient. This essay analyses the Peter Mitchel case study by using the clinical reasoning cycle to present two intervention priorities for the patient.

The patients as partners approach suggest that the information gathered from the patient based on their situation is important in determining the medical response that needs to be given. Pomey, Ghadiri, Karazivan, & Fernandez (2015) add that the situation of the patient is based on social factors, medical history, psychological factors and other demographic patterns that may influence the response to medication. Peter has come to the hospital because he feels his weight is getting out control due to poor diet and little exercise which is consuming his productive part of life. To address Peter’s situation, he needs to be treated as part of the medical process to realize an outcome that can improve his health.

Kelley, Docherty, & Brandon (2014) argue that collection of information is the process of knowing the patient as a way of clearly meeting the requirements of the patient. From the case study, Peter has a past medical history of obesity, type 2 diabetes, hypertension, sleeping apnea and gastro esophageal disease. The nature of his medical history has controlled his social life-limiting him to little movement and friends while his family does not lie around with him. He also has a history of smoking which dates back to thirty years. Further, he engages in nothing meaningful in life the reason why his weight keeps on increasing.

Bundgaard, Nielsen, Delmar, & Sorensen, (2011) suggests that when clear inormation about the patient’s background has been collected. The healthcare practionner can easily process the information by looking at the challenges that the patient faces. From the data collected, Peter has difficulty controlling his weight which is increasing his problems. Since he was discharged from work, he has gained more weight thus making him unable to walk freely. At the same time, he feels heavy thus unable to freely exercise or even look for another form of employment. The fact that he survives on state benefits allows him to manage daily needs. On the other hand, he has a smoking history that goes thirty years back which he says he wishes to quit but has been unable to manage.

Collection of patient information

From the diagnosis of Peter, there are three major issues that require attention in his life. The first one is to manage his increasing body weight and obesity that comes from lack of exercise and limited movement. Further, he has a challenged managing his diet since he is diabetic and insulin affects his body mass thus increasing more weight. This problem has led to other challenges like sleeping apnea, social isolation and continued weight gain.

• To control weight gain and obesity through controlling diet and using exercise therapy.
• To develop new behavior patterns that can be used in managing excessive hunger and the smoking urge.

From the above goals, two clinical priorities are needed to assist Peter with the medical problem that he is facing.

• Controlling weight gain
• Assisting him de

Weight gain that Peter is experiencing is a result of diet and insulin use. Weight gain is a normal side effect of insulin since its intake helps in managing sugar thus allowing cells to absorb more glucose. Peter has to formulate a meal plan as a way reducing weight gain while on insulin. The first step will be to share with a dietician who will assist in advising the necessary changes needed for his diet.  The plan needs to be based on the foods that he eats, the portion size, and the timing between meals. By reducing calorie intake, Peter needs to watch proteins, fats and alcohol intake. To lose weight, management of food intake is the first step in reducing. Through portion control, calorie intake will be minimized through the use of the plate method to trim the portion thus lowering the calorie count. Therefore, Peter will be assisted to formulate a new food intake plan that will seek to balance the amount of food that he takes in relation to his body. Through being guided on the food rations that he needs to take and the amount of food that he has to take, he will be able to adequately balance his food intake and ensure that he meets the required standards.

Secondly, there is the need for him to control excessive hunger to ensure that his food eating habits can be regulated to fall within the required portion. Peter needs to learn how to determine the level of hunger that he has before taking any meal. Real hunger needs to be differentiated from craving for food to control excessive eating. In most cases, excessive eating comes from a result of taking small stuff, like snacks and chocolate which are not counted within the three-course meal that people need to take.

From the case study, Peter has been smoking for the last thirty years, thus smoking has become part of his life. The smoking problem can be addressed through the behavioral therapy which focusses on identifying negative thoughts and developing new ways that can help an individual disassociate from them (Foulds, Schmelzer, & Steinberg, 2010). From the case study, one challenge that Peter faces is loneliness which could be the factor that pushes him to regular smoking (McEwan & West, 2010). Since his social life cannot be traced to old friends, it means that he has been a loner most of his life. Loneliness leads to depression, phobia and eating disorders. Since the patient fears going out, it means that the obesity has gone beyond what he can manage. Through the therapy, he can be assisted to join clubs and other groups within his locality to reduce loneliness thus the risk of smoking.

Identifying challenges faced by the patient

On the other hand, Michie, Hyder, Walie, & West (2011) suggest that behavioral therapy can be used to control life problems like use of drugs and excessive food intake. Therefore, exercise can be started slowly through easy jogs and walking in the morning and the evening. Once the system has adapted, he can join gym clubs or any other group that can keep his body busy to cut down some fats.

The outcomes of the exercise should be assessed after every one month to determine the level of improvement made. A program needs to be designed that Peter will use as a target for achieving the required target.

After attaining the required results, Peter needs to ensure that he keeps the required standards that had been designed. This includes maintaining the required diet and taking the appropriate food ration. Exercise and group clubs can be a source of networking and addressing social isolation that he suffers. These checks need to be done after every three months for a whole year until they have become habits thus allowing him to operate on his own.

Conclusion

The clinical reasoning cycle can be applied in the healthcare setting by nurses to address the patient’s cases of different magnitudes. The cycle is the everyday process that the medical practitioner should go through with every patient. Since every case is different, the nurse begins from the first stage and moves to the last when dealing with the patient.

References

Alfaro-Lefevre, R. (2009). Critical thinking and Clinical Judgement: A Practical Approach to Outcome Focused Thinking. St. Louis : Elsevier.

Bundgaard, K., Nielsen, K., Delmar, C., & Sorensen, E. (2011). What to know and how to get to know? A fieldwork study outlining the understanding of knowing the patient in facilities for short-term stay. Journal of Advanced Nursing, 68(10), 2280-2288.

Foulds, J., Schmelzer, A., & Steinberg, M. (2010). Treating tobacco dependence as a chronic illness and a key modifiable predictor of disease. International Journal of Clinical Practice, 64, 142-146.

Hughes, R. G. (2008). Patient Safety and Quality; An Evidence-Based Handbook for Nurses. Rockville : Agency for Healthcare Research and Quality (US).

Kelley, T., Docherty, S., & Brandon, D. (2014). Information Needed to Support Knowing the Patient. Advanced Nursing Science, 36(4), 351-363.

McEwan, A., & West, R. (2010). The PRIME approach to giving up smoking. Practice in Nursing, 21(3), 146-153.

Michie, S., Hyder, N., Walie, A., & West, R. (2011). Development of a taxonomy of behaviour change techniques used in indivudal behavourial support for smoking cessation. Addiction Behaviour, 26, (4), 315-319.

Pomey, M.-P., Ghadiri, D. P., Karazivan, P., & Fernandez, N. (2015). Patients as Partners: A Qualitative Study of Patients’ Engagement in Their Health Care. PLoS ONE, 10(4).