Nurses who are experienced engage in numerous clinical reasoning episodes for every patient in their care in the course of their clinical practice. A nurse who has experience in the profession may enter the room of a patient and instantly take note of considerable data, make conclusions about the patient and instigate suitable care-this can be attributed to clinical reasoning, which is a learnt skill (Cooper & Frain, 2017). In this paper, I will apply the first 7 stages of the clinical reasoning cycle to a clinical decision that I was involved in during my nursing clinical placement. In this case, the clinical decision entailed responding to a change in the condition of the patient.
Clinical Reasoning Cycle
The clinical reasoning cycle refers to the process by which health professionals and especially nurses gather cues, interpret the information, understand the problem/situation of the patient and execute interventions, assess the outcomes and reflect on the process (Kozier et al., 2014). The first stage of the clinical reasoning cycle entails considering the patient’s situation or his/her facts. In other words, this is the stage where the nurse is presented with the clinical case (Dalton, Gee & Levett-Jones, 2015). On that note, during my clinical placement, the scenario involved a 66-year-old woman (Mrs. K) who was brought to the emergency department complaining of nausea, pain in the shoulder and the back, discomfort in the chest and dizziness. The patient reported that she had been working at her garden earlier that day and had attended a family picnic. The second stage of the cycle involves collecting patient information. That is, assessing their current information, collecting new data, and recalling knowledge (Knox, 2015; Hunter & Arthur, 2016). Mrs. K’s past medical history includes high blood pressure, coronary artery disease, elevated total serum cholesterol and angina. According to the medical records, the patient took 1 aspirin each day and had been put on nitroglycerin tablets to manage angina. The physician at the time ordered for an ECG; the results turned negative. Nonetheless, I knew that there was the need to carry out further cardiac testing because her symptoms were indicative of myocardial infarction.
The third stage of the clinical reasoning cycle involves processing the information that has been collected. In this phase, the nurse/health professional processes the present health status of the patient with regard to pharmacological and pathophysiological patterns, determines the pertinent detail, and establishes the possible outcomes for the decisions that are to be made (Koivisto et al., 2016). When she was admitted, Mrs. K had mentioned that she had engaged in some activities early that morning i.e. had done some gardening; therefore, there was the possibility that her symptoms were related to acid reflux and muscle strain. However, there was the need to worry because she had a history of CAD and angina. For that reason, I decided to monitor her cardiac markers. When the heart is damaged, cardiac markers’ levels go up over time, and this is why blood tests for them are taken over a 1 day period (Zhu et al., 2017; Sweeting et al., 2016). The chest pain and the shoulder pain could be indications that she had suffered a heart attack. It is worth noting that levels of enzymes do not go up instantly following a myocardial infarction (Chew et al., 2016). On that note, I decided to treat Mrs. K with the assumption that a heart attack had occurred and then assessed for a more precise diagnosis.
The fourth stage of the cycle entails identifying the problem with the patient i.e. establishing the reason behind his/her present status (Dalton, Gee & Levett-Jones, 2015). In other words, it is in this phase where the nurse synthesizes conclusions and facts and uses them to make an ultimate diagnosis of the problem that the patient is having. Drawing upon the information I had processed in the 3rd stage, I concluded that the patient had suffered a heart attack. The fifth stage of the clinical reasoning cycle is to set up objectives. This is where one establishes the goals of treatment with regard to the situation of the patient (Daly, 2018). Notably, plans of treatment are neither supposed to be open-ended nor lack a goal that is time-oriented. The health profession should thus know the kind of step to take, and how fast he or she wants to observe the desired outcome (Siegert & Levack, 2015; Perry, Potter & Ostendorf, 2016). With that said the treatment goal for Mrs. K was to improve her symptoms and this would be achieved by administering heart attack medication.
The sixth stage of the cycle entails taking action. This means that the health professional executes the actions steps that are required to meet the treatment objectives of the patient (Delany & Golding, 2014). Other members of the healthcare team are often brought on board; therefore, each person is supposed to be given updates regarding the goals of treatment for the specific patient. With this in mind, I phoned the physician so as to get an order from him instructing me to administer Angiotensin-Converting Enzyme Inhibitors to Mrs. K. Phase seven of the clinical reasoning cycle is evaluation. This stage entails assessing the efficiency of the course of action that one has taken and this will allow the nurse to establish whether to make changes or maintain the line of action (Levett-Jones, Reid-Searl & Bourgeois, 2018). After my intervention, the patient’s symptoms improved in the sense that she stopped complaining of back pains and chest discomfort. Also, Mrs. K reported that she had stopped feeling dizzy.
Obviously, nurses who possess efficient clinical reasoning skills end up impacting patient outcomes positively. On the contrary, those that have clinical reasoning skills that are poor normally fail to identify looming patient deterioration, which results in a “failure to rescue.” From my narration, it is quite evident that I am an effective nurse, as I was able to prevent Mrs. K’s health from worsening by applying the first 7 stages of the clinical reasoning cycle to a clinical decision. I, therefore, purpose to continue to be determined and actively engage in the deliberate practice of the skills for continued learning.
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