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Nursing: Clinical Reasoning Cycle

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Question:

Discuss about the Nursing for Clinical Reasoning Cycle.

 

Answer:

Introduction

The clinical reasoning cycle is the process with the help of which nurses and other clinical staffs process patient information and undertake appropriate nursing activities based on the patient’s information (Salminen et al. 2014). The clinical reasoning cycle was developed by Levett Jones to help nurses in developing and exploring their clinical reasoning skills, which can have a significant positive impact upon the patient outcomes. In this assignment, a 20 years old patient has been focused to explore the cycle.

Clinical Reasoning Cycle

Consider the patient situation- The current patient is a 20 years old young woman Miss Lucy Wu. Miss Lucy is currently suffering from pneumonia. She is feeling tired, fatigued and having chest pain, while coughing. She has also reported the she is not willing to eat or drink. Currently her vital signs are- BP 140/70 mmHg, pulse 70 beats/minute, temperature 37.5ºC and respiratory rate 16 breaths/minute. In addition, she also declared that she is extremely sweating. She also reported that overnight she undergone a few episodes of vomiting and shaking chills; she vomited a large volume of greenish-yellow fluid, upon which she was brought to the emergency department.

Collect cues- The patient Miss Lucy is a university student. She is a second year student of Bachelor of Business in the University of Tasmania. She is a single overseas student. She is the member of a Chinese family, living in Shanghai, China. Currently she lives in the Inverest apartments in Launceston, Tasmania. She has past history of tuberculosis and hay fever 10 years ago. She is also a hypertension patient for last 2 years and she is currently on medication. She is also allergic to aspirin and comes out in hives. According to her social history, she is a non-smoker, but drinks 1 to 2 standard white wines every night. She started to feel unwell after returning from Launceston.

Process information- reviewing the information present for Miss Lucy; it has been revealed that she has allergic symptoms. Miss Lucy is currently suffering from pneumonia, the source of which is assumed to be her visit to her home, i.e. Shanghai, China. However, she does not smoke; thus, it has no influence upon worsening her respiratory system. Lucy has previous inflections with tuberculosis and hay fever, along with the allergic symptoms, her respiratory system has become sensitive towards infection by microbes (Marcum 2012). She has vomited a large amount of greenish yellow fluid, upon feeling sick in her stomach. Her symptoms became prominent upon reviewing her clinical signs of fatigue and tiredness, after returning from her hometown.

Identify problems/issues- The key problem in the current case of 20 years of Miss Lucy is pneumonia. She is having several episodes of vomiting and shaking chills overnight, which are the key signs of pneumonia. The other key signs include tiredness, chest pain while coughing, unwillingness to eat and drink and excessive sweating. The reason behind the health problem is a bacterial infection, known as Streoptococcal pneumoniae. Her temperature was high at 0600 hours; pulse rate was 110, which was slightly high and temperature was 39 ºC, which is also high. However, these vital signs were under control, when monitored again at 0730 hours, as her pulse was 70 and temperature was 37.5 ºC. Therefore, all over her signs are normal, instead of the coughing, fatigue, sweating and chest pain, all of which are the symptoms of pneumonia.

Establish goals- For ensuring the best nursing care to the patient, Miss Lucy; goals should be set according to her heath issues. Reviewing her current condition and previous health history, the following goals would be developed for her:

  • To monitor her vital signs over every 30 minutes
  • To assist in effective airway clearance
  • To encourage patient to drink and eat adequately
  • To educate patient regarding her health issue and care procedures (Marcum 2012)
  • To manage acute pain
 

Take action- Based on the above mentioned goals, the nursing actions would be undertaken for each goal. For instance, her vital signs including temperature, RR, BP and pulse rate would be measured frequently. The rate and depth of respiration would be assessed by auscultation of lung field (Blais 2015). To help her breathing, her head would be elevated on the bed and position would be changed frequently. Lucy would also taught regarding deep breathing exercise. To assist her with her chest pain, relaxation techniques or breathing exercise would be taught and comfort measures like back rubs, position changes, quite music and massage would be provided (Ishida et al. 2012). Chest pain would be measured frequently, but aspirin would be avoided to eliminate the chance of allergy (Audétat et al. 2013). To eliminate the risk of fluid deficiency, Lucy would be encouraged to consume at least 3000 mL/day. As she is unwilling to eat or drink, she would be advised to drink small amount of fluid over frequent intervals. If necessary, IV fluid supplement would be administered, upon getting consent from the appointed physician (Herdman 2011). In addition, a health promotion program would be arranged for her, to enhance her knowledge regarding pneumonia, importance of adherence with the therapy and prevention measures.

Evaluate outcomes- Reviewing Lucy’s health issue and the interventions undertaken by the nurse, it has been evaluated that Lucy would have significant positive health outcomes with effective recover (Alfaro-LeFevre 2012). The outcomes would be in favour to the patient, ensuring her faster recovery.

Reflection- Undertaking the clinical reasoning cycle, while dealing with the case of Miss Lucy Wu, the importance of the process has been understood. In addition, it has also been demonstrated that effective nursing skills and competencies as well as reviewing the in-depth information of the patient are required for gaining effective health outcomes for the patients (White and Ewan 2013).

Conclusion

It has been revealed from the assignment that clinical reasoning cycle is a systematic cyclic process, through which nurses collection information about the patient, collect and analyze background information, identify the issue, plan and implement interventions, evaluate an reflect on the process through the problem solving and critical thinking approach, which has been done for Miss Lucy effectively in the assignment.

 

Reference List

Alfaro-LeFevre, R. 2012. Applying nursing process: the foundation for clinical reasoning. Lippincott Williams & Wilkins.

Audétat, M. C., Laurin, S., Sanche, G., Béïque, C., Fon, N. C., Blais, J. G., and Charlin, B. 2013. Clinical reasoning difficulties: a taxonomy for clinical teachers. Medical teacher, 35(3), e984-e989.

Blais, K. 2015. Professional nursing practice: Concepts and perspectives. Pearson.

Herdman, T. H. (Ed.). 2011. Nursing diagnoses 2012-14: Definitions and classification. John Wiley & Sons.

Ishida, T., Tachibana, H., Ito, A., Yoshioka, H., Arita, M., and Hashimoto, T. 2012. Clinical characteristics of nursing and healthcare-associated pneumonia: a Japanese variant of healthcare-associated pneumonia. Internal Medicine, 51(18), 2537-2544.

Marcum, J. A. 2012. An integrated model of clinical reasoning: dual?process theory of cognition and metacognition. Journal of evaluation in clinical practice, 18(5), 954-961.

Salminen, H., Zary, N., Björklund, K., Toth-Pal, E., and Leanderson, C. 2014. Virtual patients in primary care: developing a reusable model that fosters reflective practice and clinical reasoning. Journal of medical Internet research, 16(1), e3.

White, R., and Ewan, C. E. 2013. Clinical teaching in nursing. Springer.

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