Clinical Reasoning Cycle: An Analytical Approach To Nursing Care

Understanding Clinical Reasoning Cycle

Recognition and management of an alining patient is an important part of a nurse’s service to a patient. In order to do so, nurses have to develop a clinical reason skill to analyze the patient’s condition critically. Critical reasoning cycle helps a nurse in making clinical judgments, in solving problems and decision-making. It can be explained as an important tool, which helps the nurse to observe the patient symptoms, collect cues and then process the information (Nighingale, 2015). It is important for the nurse to develop an understanding of the patient problem and situation and based on it, she should make planning and implement interventions. However, her duty is not over with the application of intervention. She also needs to evaluate the outcomes in order to understand whether her interventions are affecting the patient health in a positive way. From the entire management of the patient with clinical reasoning cycle, the nurse also gets the chance to reflect her own practice. Reflecting on the practice helps the nurse to enhance her skill as she gains new experiences while handling each patient.

This essay intends to examine the entire procedure of clinical reasoning cycle and analyze the case study of the patient with the clinical reasoning skill. It will help the nurse to proceed systematically with the entire case and help her provide the correct interventions to the patients.  Understanding Clinical Reasoning Cycle Discussion Paper

The first step of the clinical reasoning cycle mainly considers the patient situation and helps in describing the list of facts and contexts that is visible to the nurse (Zhang  & Sun, 2015). In case of Barbara, it was noted that she had a medical history of dry macular degeneration along with hypothyroidism. She also suffers from rheumatoid arthritis and osteoarthritis. She has restricted movement and suffers from altered mobility. These had made her isolated from friends as she had lost confidence to leave her house and suffers from a sense of depression. She feels herself to be a burden on her daughter Tracy and her family. She also suffers from constipation and occasional dizziness with vision deficit. Recently, her weight has reduced and has become a matter of concern.

The second step of the clinical reasoning cycle mainly consists of reviewing the current information that is available from the medical history reports or the general physician’s reports. The nurse would then gather information by properly analyzing the person herself so that she can verify the reports herself and check whether new clinical symptoms have occurred or not. Then she needs to recall her own knowledge that she had gathered in her course levels and from her experiences in the profession regarding the physiology, pathophysiology, epidemiology, culture and others (Nevitt, 2015). The doctor had handed a report by jotting down the complications that Barbara is facing. Barbara is a strong believer of Catholic Church and wants to remain associated with it. She has suffered macular degeneration due to deterioration of the central portions of the retina. This is present in the inside black layer of the eye that mainly participates in the recording of the images one see before sending them to the brain. Moreover, she is suffering from osteoarthritis due to the degeneration of the cartilage over time. The cartilage undergoes inflammation followed by breakdown and eventual loss of it in the joints (Hunter & Arthur, 2016). She also had a history of hypothyroidism, which usually occurs because of autoimmune disorder where antibodies within the body attack the body’s own organs or tissues, which may be thyroid gland in this case. It might be due to attack of microorganisms or due to genetic flaw but scientists are yet not sure about the cause. A similar autoimmune disorder attacks healthy body tissues, which result in occurrence of rheumatoid arthritis in patients.

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Application Of Clinical Reasoning Cycle To Barbara’s Case

The third step mainly involves the processing of the valuable information to identify the issue and set goals accordingly. This mainly includes interpretation of the data and understanding the causes of signs and symptoms. This is followed by distinguishing between the important and unimportant information, relating between the symptoms and signs and inferring opinions after a logical analysis (Liaou et al.,2016). It is then followed by matching with the current situations and predicting outcomes. In case of Barbara, one can understand that she has history of hypothyroidism. This might be the reason of her symptoms like constipation, swelling of joints, muscle weakness, aches in tenderness and stiffness and depression. Moreover, she is suffering from different rheumatoid arthritis and osteoarthritis. These had been the contributing factors, which had restricted her movement and altered her mobility. This had also resulted in severe pain in the muscular section of the joints and degeneration of cartilage had prevented the smooth movements of the joints. Moreover, the macular mainly takes part on focusing the central vision of the eye and thereby helps to read, drive cars, recognize colors and faces and view objects in details (Emsfors, Christensson & Elgan, 2017). Due to degeneration in this part, she can no more drive car. Her vision has become impaired and she has occasional dizziness. Moreover, she has developed a feeling if social exclusion due to her impairments which had created a sense of depression in her. Her loss of weight may be a contributing factor for depression.

The fourth step mainly involves the synthesis of the facts along with the analysis of the inferences that had been done in the previous steps. This would help the nurse to make a definitive diagnosis of the problem of the patient and thereby provide goals for attaining best quality life by the patient (Koivisto et al., 2016). From the case of Barbara, the nurse can make a definite diagnosis that her main problem is immobility due to severe pain in the joints. She also tries to cope up with weakness in the joints of her knee, hip, fingers that often results in severe pain. Her stiffness of joints needs interventions so that both stiffness and her pain gets reduced. Interventions for her would also include increasing movement of the joints along with care for her vision deficits. Care should be taken so that she does not suffer from falls and takes her medications on time. She should also address her issues of constipation (Rovner & Fontenot, 2016).

The fifth step is concerned with the setting up of goals, which would have desired patient outcomes within particular period. This would help in the maintaining a proper clarity of the interventions that are needed to be taken and the timeframe within which the results would be visible to the patients. The main goals for Barbara would be to take interventions that will help to regain back his mobility and decrease her pain in every joint. Care should be taken so that she does not face any accidents or falls due to her vision deficit and helps her in developing her vision (Kuiper, Pesut & Arms, 2016). Her hypothyroidism should be maintained along with her issues in constipation. She should be able to feel relieved from her symptoms within a month.

Step 1: List Of Facts And Contexts

The sixth step mainly involves taking appropriate actions in order to make the condition of the patient better. This step mainly discusses the set of intervention linking them with the rationale of taking such decision. Medication of the patient would mainly involve the application of ibuprofen, which is actually a non-steroidal anti-inflammatory drug called the NSAID. It mainly functions by controlling the hormones that are responsible for the occurrence of inflammation and pain in the body and is extremely helpful in cases of arthritis (Ndosi et al., 2014). Moreover as his thyroid gland is not functioning properly, it becomes important to provide her with supplementary thyroid hormone and therefore thyroxin medication is included in her medication plan. Hydroxychloroquine is mainly helpful in the treatment of rheumatoid arthritis. It helps in the decrease of the pain as well as the swelling of the arthritis. It also prevents the joint damage and thereby reduces the risk of long-term disability (Nevitt, 2015). Slow release of paracetamol is also found to be extremely helpful in treating osteoarthritis and becomes more convenient for the nurses to treat patients with osteoarthritis. The patients get relieved from chronic pain. The medication has the potential to enhance compliance and thereby helps in relieving pain (Zhang & Son, 2015).

Moreover, her nursing interventions should contain educating the patient about her eyesight deficit, providing sufficient lighting to carry her activities, ensuring night light for patient’s room to meet her needs, giving large print objects and visual aids to carry her activities (Kang et al., 2016). For her symptoms of osteoarthritis, the nurse will provide her with assistive devices like canes, ambulatory devices and others (Kao & Tsai, 2014). She should also ensure that Barbara initiates exercises moderately in the beginning and then increasing gradually. Besides analgesic, she may also arrange for physical therapy for Barbara, which will relieve her from her pain. For rheumatoid arthritis, the nursing intervention would include comfort measures like application of heat or cold, massage, relaxation techniques and others. Reduction of fatigue and increasing mobility could be done by engaging occupational therapist, encouraging Barbara for independence and facilitating self-care (Sparks et al., 2016).  A balanced diet rich in fiber should be provided to overcome her issues of constipation. She should be encouraged to go out and spend time with relatives and friends to overcome her depression.

The seventh step would mainly involve the evaluation of the effectiveness of the different interventions that the nurse has applied (Dalton et al., 2015). This can be ensured by properly analyzing the condition of Barbara. Barbara’s movements, her levels of comfort, her eyesight issues and her mobility development would assure the nurse that whether her interventions are providing positive effects. Based on these, she will need to modify her interventions. Her interactions with the nurse are also crucial for the nurse to understand whether she is still depressed or not.

The last step would be critical reflection of the nurse, which will help her to understand how her interventions have helped the patients. From the episode of the intervention plan, she would be able to gather knowledge and learn about various positive and negative aspects of the interventions that she has applied (Nightingale, 2015). This would enhance her expertise. While handling her next case, she would be much more confident and can handle the case more effectively.

Step 2: Review Of Current Information

The clinical reasoning cycle is a very effective tool, which guides a nurse in a sequential manner while approaching the case of a patient. It helps the nurses in a step-by-step analysis of the cases. After a thorough analysis, it helps the nurse to set up a goal and thereby implement get interventions accordingly. Proper evaluation of the results of the interventions helps the nurse in reflecting on her own practice. This in turn helps in making the nurse confident and makes her learn from experiences. Her positive experiences will help her to enhance her skills and her negative experiences will teach her to avoid such interventions. Therefore, the cycle is often referred to as an important tool for a nurse who wants to provide the best quality care for the patient. It gives the nurses very few scope of performing a mistake or not maintaining the standards, ethics and morals of nursing practice. Therefore, clinical reasoning cycle is also found to be extremely helpful in the case of Barbara. This had helped the nurse to analyze her symptom cluster and provide effective interventions for her, which will help Barbara lead a better quality life.

References:

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.

Emsfors, Å., Christensson, L., & Elgán, C. (2017). Nursing actions that create a sense of good nursing care in patients with Wet Age?related Macular Degeneration. Journal of Clinical Nursing.

Hunter, S., & Arthur, C. (2016). Clinical reasoning of nursing students on clinical placement: Clinical educators’ perceptions. Nurse education in practice, 18, 73-79.

Kang, J. H., Wu, J., Cho, E., Ogata, S., Jacques, P., Taylor, A., … & Schaumberg, D. A. (2016). Contribution of the Nurses’ Health Study to the Epidemiology of Cataract, Age-Related Macular Degeneration, and Glaucoma. American journal of public health, 106(9), 1684-1689.

Kao, M. H., & Tsai, Y. F. (2014). Illness experiences in middle?aged adults with early?stage knee osteoarthritis: findings from a qualitative study. Journal of advanced nursing, 70(7), 1564-1572.

Koivisto, J. M., Multisilta, J., Niemi, H., Katajisto, J., & Eriksson, E. (2016). Learning by playing: A cross-sectional descriptive study of nursing students’ experiences of learning clinical reasoning. Nurse Education Today, 45, 22-28.

Kuiper, R., Pesut, D. J., & Arms, T. E. (2016). Clinical reasoning and care coordination in advanced practice nursing. Springer Publishing Company.

Liou, S. R., Liu, H. C., Tsai, H. M., Tsai, Y. H., Lin, Y. C., Chang, C. H., & Cheng, C. Y. (2016). The development and psychometric testing of a theory?based instrument to evaluate nurses’ perception of clinical reasoning competence. Journal of advanced nursing, 72(3), 707-717.

Ndosi, M., Lewis, M., Hale, C., Quinn, H., Ryan, S., Emery, P., … & Hill, J. (2014). The outcome and cost-effectiveness of nurse-led care in people with rheumatoid arthritis: a multicentre randomised controlled trial. Annals of the rheumatic diseases, 73(11), 1975-1982.

Nevitt, M. (2015). Ask older patients with knee osteoarthritis about buckling to prevent recurrent falls.

Nightingale, K. E. (2015). Embedding Simulation-Based Learning in a Capstone Undergraduate Nursing Subject to Develop Clinical Reasoning Skills.

Rovner, R. C. W., & Fontenot, J. L. (2016). Targeted Vision Function Goals and Use of Vision Resources in Ophthalmology Patients with Age-Related Macular Degeneration and Comorbid Depressive Symptoms. Journal of Visual Impairment & Blindness (Online), 110(6), 413.

Sparks, J. A., Chang, S. C., Liao, K. P., Lu, B., Fine, A. R., Solomon, D. H., … & Karlson, E. W. (2016). Rheumatoid Arthritis and Mortality Among Women During 36 Years of Prospective Follow?Up: Results From the Nurses’ Health Study. Arthritis care & research, 68(6), 753-762.  Understanding Clinical Reasoning Cycle Discussion Paper