Nursing Essay: Case Analysis using Clinical Reasoning Cycle

Question

Task: Overview
The following case study contains the information required to complete nursing essay. The case study is used to facilitate your learning and will allow you to apply the key concepts. You are required to use the information below, along with reviewing current, relevant, peer-reviewed nursing literature. Please choose ONE (1) of the following family members, Peter, Harriet or Lola to examine using the Clinical Reasoning Cycle (Levitt-Jones, 2018). In written essay format you are required to pick ONE (1) member of the Demetriou family and apply the first FOUR (4) phases of the Clinical Reasoning Cycle to demonstrate how a beginning nurse might plan the care of this one individual.

Case Study
The Demetriou family have booked an appointment at their local multidisciplinary Primary health clinic for their yearly influenza injection.

The Demetriou family live in a 2-level home in the suburbs of South-Eastern Sydney. Peter (46 years) and Danielle (44 years) live with their 3 children, Harriet (19), Jack (17) and Lola (12). Peter’s father died 4 years ago from colon cancer and his mother Maria (67) has moved in with the family.

Answer

Introduction
It is evident in this nursing essay that nurses need to make use of evidence-based practice (EBP) by making use of the clinical reasoning cycle (CRC) for patient assessment and then designing the care plan. The Tracy-Levett Jones Clinical Reasoning cycle is an approach that processes information of a patient into eight phases for assessing health issues faced by the patient (Hunter, & Arthur, 2016). Clinical reasoning is essential for enhancing patient outcome and also for maintaining the safety of patients. A beginning nurse might face significant difficulties while planning patient care, the CRC can provide a guided approach to be adopted such that focus on crucial issues/complaints facing the patient can be attended to. In the current case scenario, the case of Peter Demetriou has been undertaken and analyzed such that suitable nursing care can be designed for him. His entire family is seen to have booked an appointment at the local multidisciplinary health clinic for their yearly influenza vaccine. The patient resides in a 2-level home in South Eastern Sydney suburb with 3 children as well as his old mother. The patient faces stress and has a poor diet, drinking occasionally on weekends. Further case assessment of the patient case is undertaken below using the CRC.

Application of CRC
There are 8 stages of the CRC which includes considering the situation of the patient, collecting cues, processing the information, identification of problems, establishing goals, taking action, evaluating outcomes, reflecting on the entire process and undertaking learning. However, only four phases of the CRC are undertaken for devising a care plan for the patient (Yazdani et al., 2017). The patient situation is analyzed further using the CRC by dividing it into eight phases of reasoning as identified below.

Considering the patient situation: As per the current case scenario, the patienthas migrated to Australia from Greece. He has his own successful business. He has been facing considerable stress in his business. He is seen to have an active lifestyle with a poor diet. He is seen to consume fast food for his lunch and drinks socially on weekends. This information is provided as a background in the case scenario. The patient is seen to live a joint family, mother and children but does not seem to carry lunch from home as he eats regularly fast-food during lunchtime (Gummesson et al., 2018). He has considerable responsibilities in his family with his mother living with after his father's death from colon cancer; also he has to care for his 3 children. As he has approached the multidisciplinary Primary health clinic for his yearly influenza injection, it is a nursing priority to assess his health condition before giving him the injection to provide him with safe care and avoid as many complications as possible.

Collection of cues/information: From the analysis of the case study revealing patient information, it is derived that though he runs his business successfully yet being the sole earning member in his large family he faces considerable stress. His stress condition is further complicated by way of eating unhealthily and drinking on the weekends. Though he leads an active lifestyle yet the stress has been building up. The case study information reveals that he has a poor diet which might be compounding levels of stress for him (Calleja et al., 2020). He has a 19-year-old daughter, who has just become sexually active, which might also raise some concern. Also, she is seen to be working casually at the local store and undertaking some volunteering work.

Lola, who is 12 years old daughter, has been a serious asthma patient, managing her symptoms with medications. She is having a tough time adjusting to her high school and feels anxious about attending school. The mental pressure that she faces might be compounding levels of stress for Lola. A beginner nurse needs to communicate with the patient and directly collect some cues regarding his physical and mental state as well as for planning an appropriate plan of care(O’Toole, 2020). Process information: Processing the information collected from the patient, it can be seen that the patient has significant stress build-up with unhealthy eating and a lifestyle of drinking on the weekends (Rutter, & Harrison, 2020). This has a significant ability on impacting the condition of the patient health. Also, his poor diet in his middle age can impact his cardiovascular conditions, insulin sensitiveness and blood pressure levels leading to further complications.

Figure 1: Clinical Reasoning Cycle by Tracy Levett-Jones et al., (2019)
Source: (Levett-Jones et al., 2019)

Identification of problems/ issues: From the analysis of the information collected from the case study information, there have been multiple problems diagnosed for the patient (Dalton et al., 2015). The patient condition reveals that he is at significant risk from cardiac ailments, insulin resistivity, blood pressure related disorders and in severe cases it might lead to heart attack due to his compounding stress levels (Croft et al., 2018). He might be faced with considerable risks for stroke as well due to the high levels of pressure he faces. Due to the stress that he feels there might arises considerable mental health issues for him as well. Hence problems faced by Peter will not only include physiological but mental problems as well.

Nursing Care Plan
In devising a nursing care plan, a beginning nurse will pick up patient cues and process such information to establish goals of nursing priorities. The appropriateness of the nursing priorities needs to be ascertained by evaluating the primary problems faced by the patient and then action needs to be planned accordingly. Once the action is implemented then the process of reflection needs to be adopted to understand the effectiveness of the process (Daly et al., 2017). The nursing care plan for the patient will include evaluating his vital signs such that his physical conditions can be understood with ease, also mental health condition needs to be monitored. Vital sign monitoring for the patient will include BP, T2DM levels, weight, HR, RR and then planning for further physical and mental evaluations. The nursing intervention will include collecting cues from the CRC also communicating directly with the patient such that more relevant information regarding the patient case can be obtained. The patient situation evaluation can provide relevant background to the patient case such that appropriate nursing intervention regarding collecting further cues can be collected further (Theobald, &Ramsbotham, 2019). The health care priorities for the patient are to monitor BP, T2DM, BMR, HR, RR and ECG and then process the information further for planning necessary interventions. Post ascertaining healthcare priorities person-centred nursing care will include devising a multidisciplinary approach for the treatment of the patient which will include GP, psychologists, nutritionists and so on (Haley et al., 2017). This will enable determining patient care by applying a person-centred approach by determining healthcare priorities for the patient. Only after effective interventions, he can be deemed fit for taking the influenza injection.

Conclusion
In conclusion, with clinical reasoning, it is possible to attain better outcome for the health of the patient and also enhance their recovery. Nurses can pose a significant risk on the patient’s life with poor clinical reasoning in place posing a considerable risk of deterioration and even in many cases death. With the application of the CRC, it has been possible to arrive at appropriate health care for the patient also ascertains safe and effective care for Peter. This will allow effective nursing interventions and planning for care and support for the patient.

References
Calleja, P., Estes, M. E. Z., Theobald, K., & Harvey, T. (2020).Health assessment & physical examination (Third Australian and New Zealand edition.).Cengage Learning. 3rd Edition.

Croft, H., Gilligan, C., Rasiah, R., Levett-Jones, T., & Schneider, J. (2018). Thinking in pharmacy practice: a study of community pharmacists’ clinical reasoning in medication supply using the think-aloud method. Pharmacy, 6(1), 1.https://doi.org/10.3390/pharmacy6010001

Dalton, L., Gee, T., &Levett-Jones, T. (2015). Using clinical reasoning and simulation-based education to'flip'the Enrolled Nurse curriculum. Australian Journal of Advanced Nursing, The, 33(2), 29. Retrieved from [https://www.ajan.com.au/archive/Vol33/Issue2/4Dalton.pdf]

Daly, J., Speedy, S. & Jackson, D. (2017).Contexts of Nursing (5th Ed.).Chatswood, NSW: Elsevier Australia.

Gummesson, C., Sundén, A., &Fex, A. (2018). Clinical reasoning as a conceptual framework for interprofessional learning: a literature review and a case study.

Physical Therapy Reviews, 23(1), 29-34. https://doi.org/10.1080/10833196.2018.1450327

Haley, B., Heo, S., Wright, P., Barone, C., Rettiganti, M. R., & Anders, M. (2017).Relationships among active listening, self-awareness, empathy, and patient-centeredcare in associate and baccalaureate degree nursing students. NursingPlus Open, 3, 11-16.https://doi.org/10.1016/j.npls.2017.05.001

Hunter, S., & Arthur, C. (2016). Clinical reasoning of nursing students on clinical placement: Clinical educators' perceptions. Nurse education in practice, 18, 73-79.https://doi.org/10.1016/j.nepr.2016.03.002

Levett-Jones, T., Courtney-Pratt, H., &Govind, N. (2019).Implementation and Evaluation of the Post-Practicum Oral Clinical Reasoning Exam. In Augmenting Health and Social Care Students’ Clinical Learning Experiences (pp. 57-72). Springer, Cham.https://doi.org/10.1007/978-3-030-05560-8_3 O’Toole, G. (2020). Communication: Core Interpersonal Skills for Health Professionals. (4th ed.). Chatswood: Elsevier: Australia.

Rutter, P. M., & Harrison, T. (2020). Differential diagnosis in pharmacy practice: Time to adopt clinical reasoning and decision making. Research in Social and Administrative Pharmacy, 16(10), 1483-1486. https://doi.org/10.1016/j.sapharm.2020.02.020

Theobald, K. A., &Ramsbotham, J. (2019). Inquiry-based learning and clinical reasoning scaffolds: An action research project to support undergraduate students' learning to ‘think like a nurse’. Nursing essay Nurse education in practice, 38, 59-65.

Yazdani, S., Hosseinzadeh, M., &Hosseini, F. (2017). Models of clinical reasoning with a focus on general practice: a critical review. Journal of Advances in Medical Education & Professionalism, 5(4), 177.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5611427/