Clinical Reasoning Cycle: Provision Of Ethical, Legal, Evidence-Based, Holistic Essay.

John Gray, 28 years old, severe depression following suicide attempt

Mr. John Gray is a 28 year old single male admitted to the unit a week ago after an episode of intentional self-harm.  John is the son of a grazier from a farming community north of Brisbane who is expected to take over the family farm. The farm has been severely affected by the longstanding drought conditions in the district.

You are the nurse assigned to John’s care for the afternoon shift. On handover you were informed John did not get up for breakfast again, went to lunch reluctantly only because he was compelled to but ate almost nothing, and returned to his bed immediately afterwards.

Vital Signs:

Blood pressure 125/75
Temperature 36.3
Pulse 66
Respirations 18

John has a rope burn mark on his neck caused by the breaking of the rope with which he attempted to hang himself and some bruising and broken skin on his arms and legs from the subsequent fall but no serious physical injuries. The areas of broken skin were covered with a non-adherent dressing and tape. The occupational therapist reported John was still choosing not to take part in any activities, including small group games or one-on-one activity.

When you go to introduce yourself to John, you find him lying on his bed with the covers pulled up high. He appears reluctant to engage in conversation with you. When you address him to introduce yourself, he grunts and turns over to face the wall away from you. 

Medications:

Venlafaxine 75 mg bd
Multivitamin once daily
Vitamin B once daily daily

Students will complete a case study which discusses the provision of ethical, legal, evidence-based,holistic person-centred care including the establishment of realistic and relevant goals through the theoretical examination of a particular nursing specialty case study using the Clinical Reasoning Cycle (Levett-Jones, 2013).

•Clinical Reasoning Cycle (Levett-Jones, 2018) as a framework to plan and evaluate person-centred care
•Consider the person’s situation
•Collect, process and present related health information
•Identify and prioritise at least three (3) nursing problems/issues based on the health assessment data that you have identified for the person at the centre of care.
•Establish goals for priority of nursing care related to the nursing problem/issues identified
•Discuss the nursing care of the person; link it to assessment data and history.
•Evaluate your nursing care strategies to justify the nursing care provided
•Reflect on the person’s outcomes

Introduction to Clinical Reasoning

Clinical reasoning is also referred to as clinical judgment or critical reasoning (Kelton, 2014). It is defined as the process of tracing information concerning patient symptom to find out the cause of the epidemiology instead of simply treating it for the sake of recovery. By examining the history of the patient, determining causes to the sickness as well as assessing previous response to medication, health care providers are able to learn the human system of the patient thereby proposing better ways of treating the patient (Rugen et al., 2014). Clinical reasoning refers to techniques used in evidence based exercise or practice. It consist of activities such as taking consideration of patient situation, collecting of patient data, processing these information, identification of the challenge or problem at hand, creation of treating goals, developing action to carry out treatment, undertaking the evaluation of treatment outcome as well as reflecting on those outcome (Tsingos, Bosnic-Anticevich & Smith, 2014). Thus, this information can be represented by the clinical reasoning cycle below

Taking consideration of patient situation entails aspects like; taking time to listen to patient opinion, narration from their relatives concerning their patients as well as assessing the state of ailment.  When it comes to cases like the emergency nursing treatment that involves injury, the information needed is often little for the healthcare providers to initiate treatment (Jefford, 2012). However, there are instances which require the application of the complete process of clinical reasoning cycle is. Nevertheless, clinical reasoning if found to be very effective for patients with chronic cases such as those with arthritis, cancer, Leukemia, asthma as well as the challenging instances like kidney failure, ulcers and diabetes (Staveski, Leong, Graham & Roth, 2012).

Several ways can be used to gather health information of a patient. However, the commonly used method is through checking of the insurance records. When undertaking this process, patients are often informed to become aware that such type of information is crucial and would essential for their treatment hence needs to be acquired with their consent (Forbes & Watt, 2015). All files as well as records that have been stored and contain information of chronic patients with a surplus of vital data which can significantly assist nurses and other healthcare providers in providing adequate care to the client (Cockerham et al., 2011). For example, catheterized patients should make it known to the healthcare providers before they undertake any medical procedure on them to avoid any complication. However, such kind of information and knowledge can miss if the patient is brought into the healthcare setting without their relatives especially when they are in an unconscious state of mind. When nurses know past treatment of the patient, then they can be able to minimize allergic reactions during the treatment process (Andrew & Robb, 2011). Therefore, it is critical for the physicians to inform the patients or their relatives that they will require such information so that they can initiate the process of collecting and organizing them early enough.

Gathering Patient Information

When the information is ready, nurses need to start processing the data the way it is. For example, examining the case of John, the history of the patient inflicting self-harm cannot be diagnosed easily when the physicians have no prior information concerning incidents or factors that always motivates John to carry out such kind of harmful activity. John friends, as well as his relatives, can try to provide an impression that the patients if suffering from various diseases like bipolar disorder, depression, anxiety or hyperactivity disorder. However, it is vital to acquire and know if in case John has been under use of drugs which may have either resulted to complications that he is currently suffering from or may have aggravated the past situations. Now, John is on Venlafaxine an anti-depressant medication, Vit B (Thiamine, pantothenic acid and Riboflavin) as well as multivit (a supplement for his diet). The medications mentioned above are an indication for treatment of an eating disorder and depression.

The next procedure is to find out why Mr. John is undergoing a lot of depression. There are various reasons and causes of depression. Family members, workmates as well as social issues can make a person depressed. However, for John, this information cannot be gotten from any other person apart from his nearest family members. Interviewing with his family members can help to discover why Mr. John is too much stressed to the extent that he decides not to eat. When it comes to clinical reasoning cycle, nurses should not make any assumption. Small information like poor eating habit due to stress must be included when preparing diagnosis for such patient (Bratt, 2013). Therefore, discovering the primary cause why Mr. John is stressed can effectively guide the patients in developing an efficient therapeutically-induced intervention which is capable of helping the patient to recover. For example, Mr. John may require counseling as compared the way in needs medication that he is currently own. Consequently, carrying out tests for Mr. John vitals is exceptionally significant when performing any diagnosis (Dariel, Raby, Ravaut & Rothan-Tondeur, 2013). According to the vital provided; 125/75mmHg, 36.3^o C respiration 18 as well as pulse 66 gives a scenario that put the patient to be out of risk as per the moment. Therefore, therapy looks like an eminent treatment preference. Patient safety is another health challenge that Mr. John is facing since he is not willing to talk to the clinicians. Patient safety refers to the avoidance of unexpected or unintended harm to the patient during healthcare provision. Since Mr. John is unwilling to talk, nurses should ensure that he is in a safe environment as well as protected from unnecessary injuries. Finally, nurses should also take into consideration pain factor that Mr. John is undergoing. Due to the neck pain that Mr. John is experiencing, Nurses attending to her should consider applying heat or ice to the neck and other painful areas. The cause of neck pain that the patient is experiencing can be neck strain, infection such as tuberculosis, throat infection and degenerative disc disease.

Processing Patient Data

One of the vital issues that can be identified from Mr. John case study is that there is a lack of corporation from the patient. From the information provided, it is indicated that Mr. John evades taking part in conversions with the medics. Therefore, this result in inefficient patient care delivery since the physician is not able to effectively tract Mr. John progress to offer him quality care. Additionally, I am also worried about Mr. John neck injury as well as whether it is connected to the depression that he is experiencing. Recent research indicates that severe back or neck pain can result in increased depression as well as stress. As a medic, it is vital to carry out a diagnosis that is aimed at discovering whether depression is associated with pain. Finally, the nursing issue that disturbed me is Mr. John conduct of refusing to eat as well as taking part in any recreational exercise. According to Forbes & Watt, (2015) diet, as well as other activities are the primary contributors to effective recovery from anybody suffering from depression. When the number of exercises is increased, depressed people like Mr. John can easily cope with the grief. Thus, as a clinician, I will encourage Mr. John to take part in events that he likes.

Goal priority for nursing care is established on different principles that are described within the clinical reasoning cycle.  One of the most vital goals is to capture all the information during Mr. John interview and record them for use in the future. Another goal that the clinician should look into is guaranteeing the omission error by continuously pursuing additional information whether they are essential or not (Alfaro-LeFevre, 2012).  Finally, clinicians should ensure that pathophysiological knowledge is incorporated into treatment of the patient and is balanced with the use of current data and previous information acquired from a valuable source.

Based on the medication given to Mr. John, it seems that he is on the recovery path. Nonetheless, mental and eating disorders seem not to be satisfactory.  There is a need for him to be under continuous observation without him noticing that he is being monitored.  The patient also needs to go for counseling. Nevertheless, a majority of patients always face denial thereby failing to take this vital step. Therefore, the critical nursing solution is to have a discussion with Mr. John concerning his action and with time enable him to accept that he needs to get psychological assistance. Through that, Mr. John can entirely get help leading to his recovery. There is a need for Mr. John to continue with his medication until the psychologist clears him from the problem. When it comes to priority nursing care, it is always fundamental to include professional advice from supervisors as well as colleagues (LeMone et al., 2015). Therefore, Mr. John diagnosis needs to be deliberated on by other senior nursing staffs so that they can find out the degree of truth by the diagnosis.

The outcome that is expected as a result of the proposed nursing care of Mr. John includes; agreeing to consult the psychologist, admission of mental problem or depression, restoration of is previous health as well as agreeing to be assisted with a psychologist who is appointed by the hospital. Since Mr. John is expected to continue with his fatherly role, husband as well as colleagues to his friends, there is a need for him to start treatment so that he can open up concerning the challenges he faces. Therefore, this strategy is significant since t the end of all happenings; Mr. John needs to get cured. He should develop a positive attitude so that he can accept the medication to enable the medical intervention work (Staveski, Leong, Graham & Roth, 2012)

The case Mr. John is facing is not an isolated one. It seems that he is struggling with depression-related issues which are social (Alfaro-LeFevre, 2012). Therefore, there is a great need to integrate evidenced-based practiced when treating Mr. John depression since it as resulted in attempted suicide, eating disorder as well as self-inflicted hurts. Therapy appears to be the best decision. Nevertheless, before initiating the therapy, there is a need for him to adhere to his medication as well as lowering levels of stress. After that, Mr. John can begin is treatment and essential counseling to help him deal with depression.

References

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

Andrew, N., & Robb, Y. (2011). The duality of professional practice in nursing: Academics for the 21st century. Nurse Education Today, 31(5), 429-433.

Bratt, M. M. (2013). Nurse residency program: Best practices for optimizing organizational success. Journal for nurses in professional development,29(3), 102-110.

Cockerham, J., Figueroa?Altmann, A., Eyster, B., Ross, C., & Salamy, J. (2011, October). Supporting newly hired nurses: A program to increase knowledge and confidence while fostering relationships among the team. InNursing Forum (Vol. 46, No. 4, pp. 231-239). Blackwell Publishing Inc.

dit Dariel, O. J. P., Raby, T., Ravaut, F., & Rothan-Tondeur, M. (2013). Developing the Serious Games potential in nursing education. Nurse education today, 33(12), 1569-1575.

Forbes, H., & Watt, E. (2015). Jarvis’s Physical Examination and Health Assessment. Elsevier Health Sciences.

Jefford, E. (2012). Optimal midwifery decision-making during 2nd stage labour: the integration of clinical reasoning into midwifery practice.

Kelton, M. F. (2014). Clinical Coaching–An innovative role to improve marginal nursing students’ clinical practice. Nurse education in practice,14(6), 709-713.

LeMone, P., Burke, K., Dwyer, T., Levett-Jones, T., Moxham, L., & Reid-Searl, K. (2015). Medical-surgical nursing. Pearson Higher Education AU.

Rugen, K. W., Watts, S. A., Janson, S. L., Angelo, L. A., Nash, M., Zapatka, S. A., … & Saxe, J. M. (2014). Veteran affairs centers of excellence in primary care education: transforming nurse practitioner education. Nursing outlook, 62(2), 78-88.

Staveski, S., Leong, K., Graham, K., Pu, L., & Roth, S. (2012). Nursing mortality and morbidity and journal club cycles: paving the way for nursing autonomy, patient safety, and evidence-based practice. AACN advanced critical care, 23(2), 133-141.

Tsingos, C., Bosnic-Anticevich, S., & Smith, L. (2014). Reflective practice and its implications for pharmacy education. American journal of pharmaceutical education, 78(1).