Nursing: The Case Of Mr. T

Since the 1900s the Nursing Profession has continued to grow and change tremendously. Nursing has become of the most sought after jobs today for its glorified assumptions. Al though Nursing has changed one thing remains they same, Nursing is all about the well being of patients.

Ms. Le is a 25 year-old female, with a height of 5’0” and weights 160 lbs. She described herself as not very active who does not regularly exercise and consumes a high amount of fast food and a few alcoholic beverages weekly. She is currently taking prescription medication called Caziant as a contraceptive and moderately takes ibuprofen for headaches and heartburns. She has a medical history of vomiting, heartburn, chest pains, and sever tooth erosion. Due to the many examinations that Ms. Le underwent such as the endoscopy and ph-monitoring test, she was diagnosed with gastroesophageal reflux disease also known as GERD.

The meaning of clinical decision-making is a systematic process of assessment of a range of actions, evaluation and decision-making that will be a factor of a desired outcome (Simpson & Courtney, 2002). Simpson and Courtney (2002) state "incorporating critical thinking skills during the clinical decision-making process will provide clarification, a range of potential solutions appropriate to the circumstances or setting and reasoning to support the clinical decision made."

Nursing theorist, Hildegard Peplau knew that in order to care for patients, the nurse must establish a strong relationship with the patient. This is an essential element in being able to provide adequate planning, diagnosing, and successfully treating patients. Personally, my desire to learn more about Peplau’s theory is because it is a very significant quality to have as a nurse. Nursing is a very interpersonal career, and by forming trusting relationships with patients early in one’s nursing practice, I can provide the best care possible to meet psychosocial needs as well as treat the present illness. The benefits that creating interpersonal relationships can have on the patients’ health condition and their planned outcomes, is also a very interesting area of focus. Many nursing students today did not understand the importance of Peplau’s theory. They choose a career in nursing because of the finical stability and wide range of options that the career offers. Overall, one cannot forget that nursing is patient centered care.

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.

In this essay I am going to look at the importance and purpose of the initial consultation between the client and the therapist and what happens during this preliminary session. I will also cover the ethical definitions that will need to be explored and established, to ensure the safety and wellbeing of both the client and therapist.

Life of a Registered Nurse How do Registered Nurses qualify for their jobs? Registered Nurses have a lot of tasks they do to help people each day. They have management duties, education certifications, and professional skills to be able to help people. The life of a Registered Nurse could be worth the training and the job could be enjoyable. When deciding on a career a Registered Nurse would be something to look into, because Registered Nurses have plenty of duties and amazing job opportunities.

Johnny O’Brien is a 78-year-old man who suffered a fall in a RSL club and was promptly admitted to the emergency department. Clinical reasoning will be applied to Mr O’Brien’s situation, Clinical reasoning is a process which incites clinicians to think critically when attempting to solve a problem that may occur with a patient. It is imperative to health professionals as inadequate clinical reasoning skills can jeopardize a patient’s safety and reduce the effectiveness of how a situation is dealt with this can occur due to bad decision making, ignorance to multiple possibilities and failure to act on the information that is provided clinical reasoning aims to avoid these issues (Levett-Jones, 2013).

According to Jones and Higgs2, the three components of clinical reasoning include knowledge, cognition, and metacognition. In case study one, L.M. narrows her ideas to three commonly billed treatments but is not able to clearly identify the most important treatment for J.K. From the excerpt, it is clear that L.M. uses cognition, which is defined by Jones and Higgs2 as synthesis and evaluation of data. The cognition component is shown by how L.M. met with the client and conducted a standardized examination of the patient including subjective and objective exam components. L.M. is a physical therapist which demonstrates some level of the knowledge component of clinical reasoning. The excerpt however states that she used the same exam on every

As approximately 78% of the nurses in practice in 1965 were graduates of hospital-based diploma programs, concern was expressed regarding the impact of the document on the status of these nurses. (Levinski, 2013). Therefore, in 1966, the ANA Board of Directors approved the publication of a brochure A Date With the Future which interpreted the meaning of the position paper for graduates of hospital schools of nursing. The brochure stated:

The clinical reasoning cycle is a practice based form of reasoning requiring a background of evidence, research and scientific based knowledge. The nurse must distinguish relevant contextual knowledge and skills and apply them to the particular person they are caring for. Jessica needs to be cared for according to her own individual situation, rather than a generic treatment that people will similar conditions may receive. The ability to identify gaps in personal knowledge and skills and address these is also a crucial aspect of clinical reasoning. The clinical reasoning process includes collecting cues, processing the information, coming to an understanding of a patient, problem or situation, planning and implementing interventions, evaluating outcomes and reflecting on and learning from the process. Jessica is an

M.T. presents as an obese Caucasian female with familial history of cardiovascular disease which are all precipitating factors to cause concern for her future health. Along with her hypertension, hyperlipidemia and obesity, other risk factors like diabetes mellitus are a potential concern for her health. While hypertension is one of the most common conditions, individuals often present with comorbidities which must be addressed (Woo & Wynne, 2011).

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.

One of my inspirations that made me have the urge of wanting to become a nurse is, my friend nurse, Carlos Reyes, had provided assistance to numerous amount of people. Knowing that somebody’s life was in jeopardy, it made me realize that I want to have that eager of what that nurse has. Someday I hope to equal his diligence, skill and with such a strong passion as he had done. It is miraculously knowing such little things you do, can make a huge difference in a person’s life. It is an honor providing the needs’ of people that really need it.

While critical thinking and clinical reasoning are similar in many ways, they are not the same thing. Critical thinking includes reasoning inside and outside of the clinical setting. Critical thinking involves cognitive processing, challenging assumptions, and thinking beyond a specific knowledge base. Clinical reasoning consists of reasoning about patient care issues. The nursing process is applied to determine the patient’s problem,