Evaluation Of The Clinical Reasoning Cycle

It is widely known that early recognition of a deteriorating patient can contribute largely to a successful outcome, through recognising and taking action on the deteriorating health status of the patient (National Consensus Statement, 2010). This report will explore the ways in which deteriorating patients and clinical reasoning are used in the public health care system in New South Wales (NSW).

Standing (2011), defines clinical decision-making as a complex process that involves observation, gathering information, critical thinking, evaluating evidence, applying necessary knowledge, reflection and problem-solving skills. Every day nurses make important clinical decisions and these decisions have important implications for patient outcomes and deserve serious consideration. Therefore, it is important for nurses to have a better insight of the decision-making process, be able to deliver holistic care and meet essential and complex physical and mental health needs of the patient.

Working Stage—When patients are ready, the work toward changing their thoughts, feelings, and behaviors can begin. However, drastic changes might not be the goal for some patients, particularly the chronically ill. Stabilization with meds, reduction of symptoms, and development of supportive relationships are valid goals. The parts of this working stage begin with in depth data collection. This is where the nurse facilitates awareness, analysis, and interpretation through in-depth exploration of issues and identification of priority issues. Reality testing is the next part, and is an important strategy in the

The purpose of this paper is to conduct an in depth exploration of the nursing care considerations of patients in a specific clinical area. Through the synthesis of prior knowledge, clinical experiences and skills, evidence based best practices, and care of patients a comprehensive care and teaching plan will be composed. Integration of critical thinking and clinical reasoning skills, combined with evidence-based research will provide confirmation of nursing process comprehension. The inclusion of reviewed literature will further support knowledge and understanding.

Alfaro-LeFevre, R. (2013). Critical thinking, clinical reasoning, and clinical judgment : A practical approach (Fifth ed.).

A problem solving approach is a process of planning care for a patient (McFerran and Martin, 2003) using ASPIRE, based on APIE (Yura and Walsh, 1988); Assessment, Plan, Implementation and Evaluation. ASPIRE is a nursing process which includes six stages: assess, a systematic nursing diagnosis, plan, implement, recheck and evaluate (Barrett et al, 2012). Using a range of assessment tools, some potential risks can be identified although, these tools should be used as guidance for treatment and not used in the decision making process as to who and who does not receive treatment, (National Institute for Health and Care Excellence (NICE), 2011) but through gaining consent during each process, as it should be before any care or treatment (NMC, 2008).

Mrs. Alice Palmer is a 54-year old married woman who has been admitted and is being treated with an ischemic stroke which she had 18 hours ago. This paper explores the nursing care of Mrs. Alice Palmer based on the clinical reasoning cycle by considering her situation first, collecting cues and information about her, processing the information gathered, then identifying problems or issues she is experiencing, and finally carrying out a detailed assessment. Also, the paper focuses on setting goals and establishing a nursing care plan in the community, and target ethnically safe practice. Ischemic stroke occurs when the brain tissue does not receive sufficient oxygenated blood due to an obstruction of the carotid artery (Brunner, Suddarth, & Smeltzer, 2008). When the brain does not receive enough oxygenated blood, some or all of its tissues may get damaged

Clinical reasoning is embedded in nurses’ thinking for patient care (Levett-Jones 2013). It is a spiral, continuous mental process, underpinned by critical thinking theory and a sound body of nursing knowledge (Levett-Jones 2013). The clinical reasoning cycle includes considering patient’s situation, collecting cues, processing information, identifying problems, establishing goals, taking action, evaluating outcomes and reflecting on the process undertaken (Levett-Jones 2013). Nursing practice for registered nurses is guided both by the National Competency Standard (Nursing and Midwifery Board of Australia 2006) and the Nursing Practice Decision Flowchart (Nursing and Midwifery Board of Australia 2010) to ensure patients’ safety and to optimise care by challenging medical assumptions and facilitating evidence-based practice. The clinical reasoning framework, therefore, allows nurses to prioritise the most time sensitive and specific information, to recognise deteriorating patients and to manage complex clinical situations (Levett-Jones & Bourgeois 2011). This paper will focus on processing information and identifying the two major problems in the case study of Mr. Brown, a 74-year-old man, who was admitted to hospital after a ‘fainting’ episode with chief complaint of dizziness.

Throughout nursing, there are many theories that nurses may come across and use. Calista Roy’s and Betty Neuman are two theorists that use two different types of models to encompasses the health, person, and the environment. Callista Roy uses a theory that promotes adaptation to the stimuli a person may encounter. Betty Neuman uses a theory that promotes equilibrium in a time where a person will encounter stress. These theories allow the nurse to bring a knowledge to learn more about the person and the factors that influence their health. Although with any theory there are different approaches in how the nursing plan is done, but with the patient in mind, it makes the difference in care that is given and allows for better outcomes for the patient.

This assignment will critically analyse and justify the decisions based around a fictitious patient using a clinical decision making framework highlighting its importance to nursing practice. The chosen model will demonstrate clinical decision making skills in the care planning process. The patient’s condition will be discussed in-depth explaining the pathophysiology, social, cultural and ethical issues where appropriate in the care planning and decision making process. Any vulnerability that the patient may experience will be discussed and dealt with in the care planning and decision making process. The supporting evidence based literature will be analysed and

Underlying both the clinical decision-making process and the nursing process is the skill of critical thinking. Critical thinking has been described as the ability to gather and process data in such a way as to arrive at the best conclusion using the filters of prior knowledge, experience and external resources to overcome personal emotions, biases, and assumptions. (This description was developed during NUR/300 class, University of Phoenix, S. Colorado, March 16, 2006) Note that critical thinking is described as a

Clinical Reasoning is an essential part of the assessment, treatment and evaluation process in occupational therapy (Neistadt, 1996). This reasoning is the skill set that the occupational therapist draws from when working with clients in related to function and performance. Neistadt (1996) suggested that clinical reasoning is the combination of five interacting components (Ward, 2003). This will be explained in the following essay and applied to a case study about a girl named Maria.

Clinical reasoning is “the process of applying knowledge and expertise to a clinical situation to develop a solution” (Carr, 2004 cited in Banning, 2008, p.177). Poor clinical reasoning skills can lead to a “failure to recue” (Aitken et al., 2003) the deteriorating patient. Additionally, studies by Hoffman et al. have compared the way in which the expert nurse and the novice nurse accurately collect cues from which they base their decisions. Effective clinical reasoning is therefore linked to “the ability to collect the right cues and take the right action for the right patient at the right time and for the right reason” (Levett-Jones et al., 2010). The ability to apply these “five rights of clinical reasoning” (Levett-Jones et al., 2010) will be discussed in more detail in Nursing Actions and Interventions: A Reflection.

Clinical reasoning can be defined as, ‘the process by which nurses (and other clinicians) collect cues, process the information, come to an understanding of a patient’s problem or situation, plan and implement interventions, evaluate outcomes and reflect on and learn from the process’ (Levett-Jones & Hoffman 2013, p.4). It requires health professionals to be able to think critically and ensures better engagement and results for the patient (Tanner 2006, p.209). The Quality in Australian Healthcare Study (Wilson 1995, p.460) discovered that ‘cognitive failure’ resulted in approximately 57% of unfavourable clinical events involving the failure to produce and act correctly on clinical information. It also recognises that often nurse’s preconceptions and assumptions can greatly affect patient care and by going through such a process, one can take into account the holistic nature of the patient and provide the best, most appropriate care.

Nurses often encountered various ethical dilemmas in the practice setting. Both virtue ethics and caring ethics support good ethical decision making for nurses (Park, 2012, p. 149) but these are inadequate to assist in solving an ethical dilemma (Park, 2012, p. 149). For that reason an ethical decision making tool is helpful for the nurses or clinicians to come up with an ethical decision (Kelly, 2012, p. 571) that allows them to gather information, identify any gap of understanding on the issue or the disagreements between the involved parties through a clear communication (Park, 2012, p. 140). Several authors presented an ethical decision making processes (Park, 2012, p. 141), here presented the two processes that can be applied in resolving an ethical dilemma. One example of ethical decision making process is the DECIDE model by Thompson, Melia & Boyd (Allen, Chapman, Francis, & O’Connor, 2008, p. 5) and the Integrated ethical decision-making model which was derived from the combination of the different ethical decision-making models strengths (Park, 2012, p. 140). These two ethical decision-making model steps are identical to each but differ on the detailed instruction on how the steps are to be done or used in actual case. By comparing the two models the integrated ethical decision-making model have a detailed instruction. The