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Question:

Discuss about the Clinical Reasoning Cycle.
 
 

Answer:

Introduction

The purpose here for this essay is to describe the procedure of clinical reasoning, demonstrate, and substantiate why nursing scholars require studying clinical reasoning. In literature, the terminologies clinical reasoning, choice-making, and clinical judgment are habitually used exchangeable (Loftus, 2012). The phrase clinical reasoning is used to illustrate the procedure through which nurses gather cues, deal with the information, arrive at an understanding of the patient’s situation, prepare and execute interventions, assess the result, as well as imitate and study from the process. This process is reliant upon the critical thinking temperament and is affected by an individual’s attitude and philosophical perceptions. It is not a simple procedure on the contrary can be a conceptual one as a coil of concurrent and the clinical meet in progress.

The Clinical Reasoning Process

This cycle characterizes the ongoing as well as cyclical character of clinical interferences as well as the importance of valuation and expression. There are mainly eight stages in this clinical cycle. Clinical reasoning may be divided in the stages of- gaze, collect process, resolve, plan, perform, assess, as well as displays ("Clinical Reasoning – Begründet handel," 2015.) Presumptions and suppositions such as “many native persons are alcoholics”; Eastern ladies tend to have a little pain onset”; and senior people frequently have dementia”, can affect the clinical reasoning process. There are some traits required for clinical thinking and clinical reasoning, which includes creativity, confidence, flexibility, intellectual veracity, intuition, perseverance, open-mindedness, contextual perspective, etc. I have been practicing as a registered nurse in an institution last year. This clinical reasoning cycle below describes my experience where I have been involved with during a BN clinical placement. There was a 60–year-old patient who was having a record of hypertension and he used to take beta-blockers in his previous lifetime ("Clinical Reasoning – Begründet handel," 2015.) He was a hypertensive person normally. The first stage of the clinical reasoning cycle is to “consider the patient situation” in which we have to explain or illustrate the facts, objects, context or persons – that 60-year-aged patient was in ICU as he had gone through an abdominal aortic aneurysm (AAA) surgical treatment yesterday. Second stage is to collect the information in which we have to review the latest data (such as reports, handover, previous record of the patient as well as patient’s record, results of analysis and therapeutic assessments assumed earlier- he had a record of hypertension, moreover he used to take beta-blockers.  The BP of that patient was 140/180 an hour back. Then, collect fresh data (such as to undertake patient’s evaluation) I have tested his BP after that it was 110/60 and epidural streaming @ 10ml/hr. Next is to evoke knowledge (such as pharmacology, therapeutics, culture, ethics, law, pathophysiology,etc ) – as BP is associated with fluid status. Epidurals may decline the BP as they bring about vasodilation. Within ICU, we got the standing instructions intended for epidural running. The third stage is to process information, which further includes; interpret – examine data to come to recognize symptoms. Relate standard and non-standard. - His BP was down, for an individual who is usual hypertensive especially. Then, includes discriminating:  differentiate between relevant and irrelevant information; identifies inconsistencies, contract the data which is mainly important and identifies spaces in cues gathered- his temperature was little high, but I was not bothered too in relation to it – I was worried about his pulse and BP. I would well check his oxygen sats and urine output. Next is to relate: discover latest patterns; collect cues to recognize relationships among them. The patient’s  tachycardia and hypertension might be the symptoms of imminent shock. His BP moved low after we raised his epidural. Infer: create subtraction or form views that chase by elucidating subjective as well as objective cues; judge alternative and its outcome- His BP could slow down due to the loss of blood throughout surgery. Then match the recent position to the past positions or the present patient to past one- AAAs usually has hypotension post op. After that, foretell an outcome (typically an expert thought procedure) -if I would not have given him more fluids he might go into shock. The fourth stage is to identify the issue or the problem, which describes to synthesize facts as well as suppositions to make an ultimate analysis of the sufferer’s difficulty-   he was hypovolaemic, moreover the epidural had made the BP poorer by rooting vasodilation. The fifth stage is to establish goals, which describe what we want to occur, the desired result, and a period I desired to enrich his hemodynamic status- obtain his BP high and urine result to normal back above the subsequent hour (Grace Meissner, 2011). The sixth stage is to take an action which describes to choose an option among various available alternatives- I ranged the doctor for taking the instruction to raise his IV scale as well as to provide aramine in case required. Seventh stage is to evaluate the efficacy of the result and performances. Enquire: has the position improved now? - His BP was high now however, we required keeping an eye on it because he might need aramine still. His urine result is averaging > 30 ml/hr now. The last or eighth stage is to reflect on the procedure and new studying which describes to contemplate what we have learned from this procedure and what we could have prepared diversely ) next moment I would or if I had…!It went well, but I could have been more active so as to make the patient safe completely.

 

Conclusion

Developing excellence in the transfer of patient-centred nursing care needs a nursing working power with the capability for clinical reasoning, critical thoughts, and reflective exercise (Grace Meissner, 2011). This essay describes the “clinical reasoning cycle,” the progress of this device as well as its work in postgraduate and undergraduate nursing studies. It lets us know how the potential advantages of the clinical reasoning cycle as a device for constructing excellence in nursing procedure is examined. Hence, in the preparation of clinical reasoning, the nursing graduates must be offered with chances to display and also question their suppositions, because unsuccessful to do so much negatively affects the clinical reasoning skills and the patient result accordingly (Loftus, 2012).

 

References

Pinnock, R. & Welch, P. (2013). Learning clinical reasoning. Journal Of Paediatrics And Child Health, 50(4), 253-257.

Rochmawati, E. & Wiechula, R. (2011). Education strategies to foster health professional students' clinical reasoning skills. Nursing & Health Sciences, 12(2), 244-250.

Rosen, D. (2011). Learning Clinical Reasonings. JAMA, 303(3), 277.

Boyd, G. (2011). Education debate: clinical diagnostic reasoning. Internal Medicine Journal, 41(7), 573-576.

 Clinical Reasoning – Begründet handle. (2015). Physiopraxis, 13(05), 66-66

Simmons, B. (2010). Clinical reasoning: a concept analysis. Journal Of Advanced Nursing, 66(5), 1151-1158.

Clinical Rounds. (2015). Nursing, 45(11), 21-23.

Clinical Rounds. (2016). Nursing, 46(1), 21-23.

Nurse anesthesia education. (2015). OR Nurse, 9(5), 6.

Resources at Nurse Educator Web Site. (2015). Nurse Educator, 40(4), 198.

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