NRSG370 | Clinical Reasoning Of Nursing Students On Clinical

NRSG370 | Clinical Reasoning Of Nursing Students On Clinical

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NRSG370 | Clinical Reasoning Of Nursing Students On Clinical

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NRSG370 | Clinical Reasoning Of Nursing Students On Clinical

1 Download8 Pages / 1,964 Words

Course Code: NRS370
University: Australian Catholic University is not sponsored or endorsed by this college or university

Country: Australia

Discuss about the Clinical Reasoning Of Nursing Students On Clinical.

Clinical reasoning cycle is the process, using which the nursing professionals collect cues, process the available information, determines the patient problems and afterwards implement the nursing interventions (LeMone et al., 2015). Further, they evaluate the outcomes and reflect on the process so that in any further similar situation such interventions and strategies can be used (Dalton, Gee & Levett-Jones, 2015). This section deals with a case study of Mr. John Gray who is suffering from severe depression and has attempted self-harm activities. Using this case study, ethical, legal and evidence based holistic care will be used to establish a realistic and relevant goal and for this purpose, the Levett Jones clinical reasoning cycle will be used.
Consider the patient situation (step 1)
This step of clinical reasoning cycle describes the current situation of the patient, without inferring any conclusion from it (Levett-Jones et al., 2015). In the given case study, Mr. John Gray (28) was admitted to hospital following a less severe physical injury due to his self-harm attempt. This morning, he did not have breakfast and was very reluctant to go for lunch. He has confined himself to his bed and is not taking part in any activities. John is on several medications such as Venlafaxine 75 mg bd, vitamin B once in a day and multivitamin capsules once daily. His blood pressure and respiratory rate are normal however; his pulse rate is quite low. Further, he is reluctant to converse about anything to anyone in the healthcare facility.
Collect cues/information
Review current information
In this step, reviewing and thinking about the current observations of Mr., Gray will be done. On handover, it was observed that the body temperature of Mr. Gray is 36.3 Degree Celsius, which is normal as well as his blood pressure is 125/75. Further, his respiratory rate is within 12 to 20 and therefore it is observed as normal. However, his pulse rate is low and he is unwilling to take part in any activities or conversation with care professionals or others within the facility. Mr. Gray has a rope burn mark, due to his self-harm attempt in which, he tried to hang himself but ended up having mild injuries on his body. His injuries are being covered with non-adherent dressing tape. When I, being his assigned carer for the afternoon shift tried to communicate, he turned to wall in aggression.
New gathered information
Mr. Gray is not willing to consume food. The handover determined that he again skipped his breakfast and when forcefully taken to the lunch, he consumed very little food and came back to his ward. As per the occupational therapist, he is unwilling to take part in fun activities such as small group games or one-on-one activities and always. I observed him fully covered on his bed and when I tried to have conversation, he aggressively turned to the wall.
Recall knowledge
John Gray’s symptoms and behavioral aspects indicate towards the fact that he is suffering from severe depression that limited his communication, appetite and thinking ability. It should be noted that he was admitted to the hospital after a suicidal attempt. Fried et al. (2015) mentions that, low appetite, less connectivity with the people around is a common symptom for individual affected with depression, and if such situation persists, they take several attempts of self-harm. Further, Fried and Nesse (2015) also mentioned that people with negative thoughts and behavioral symptoms could be harmful for the people around them; hence, appropriate care should be taken to manage such behavior (Kable et al., 2013).
Process information
While interpreting the current and previous symptoms of Mr. John Gray it can be interpreted that, his physical parameters are normal as per the observations. His body temperature. Blood pressure, respiratory rates are normal however, due to the depression and anxiety related condition, his pulse rate was observed low (Nixdorf et al., 2013). Further, he is suffering from mental disturbance, due to which he is unable to communicate with others, taking part in occupational activities and even is unwilling to consume food (Winser et al., 2013).
This step discriminates the most relevant and important symptoms which is responsible for patients current situation. In case of John Gray, His depression and isolation tendency is the most important symptoms, which is responsible for his current situation, Due to this, he is unable to communicate with professionals, share his mental state to others or take part in occupational activities.
It is important to cluster all the cues collected from John Gray’s current and handover situation and identify relationship between them so that proper interventions can be taken against the prioritized symptoms that has the ability to harm the patient (Levett-Jones et al., 2015). As Mr. John Gray is suffering from severe depression, he ended up harming himself. His failed attempt of self harm filled him with grief and agony due to which is not responding to any medication, communication attempts and activities. Further, he is suffering from low appetite and has confined himself in him ward (Winser et al., 2013).
The above-mentioned cues and information is inferred from the history John Gray. John belongs to a farmer family, in which he was meant to take up the farms to continue their occupation. However, the consistent draught in his district affected his mental state and broke his confidence and self-esteem. Therefore, it is inferred that, due to such situation, he attempted the self-harm activity and failure of it brought him to the healthcare facility with several mild physical injuries (Hawton, Saunders & O’Connor, 2012).
It is important to prioritize the interventions for John Gray’s situation as his tendency to stay away from others and not consuming food can be harmful (Hawton, Saunders & O’Connor, 2012). His depression and appetite related conditions require proper care as with increasing depression, he might attempt self-harming activities again within the healthcare facility, which will affect his health and will affect the environment of the facility.
Identified problems and issues
As John Gray was unable to perform his duties to his family, he lost ahis self-esteem and confidence and ended up harming himself. This self-harm ideation is the primary concern, which needs proper intervention. Further as per Lengacher et al. (2012) severe depression related symptoms such as isolation, low appetite, not willing to indulge in fun activities are another major concern for John Gray. Further, his low pulse rate, unwillingness for communication indicated towards the severe depressive condition that needs to be treated (Hawton, Saunders & O’Connor, 2012).
Establishing Goals
In this step, goals will be established prior to take any action against the prioritized symptoms (Levett-Jones et al., 2015). As Mr. John Gray is unwilling to eat and has a tendency to skip his meals, I will make sure he consumes his food properly in the next 24 hours. This is important to increase his appetite and for the required energy for the activities of daily life. As short-term goal, I will try to empathize him for his condition so that he opens up and share his grief and agony in the next 2 hours. I will ask the psychologist to come and visit the patient so that his mental condition can be properly understood in the next 2 to 4 hours (Hunter & Arthur, 2016).
Take action
The actions and rationale for it has been incorporated in the table below



All the nursing observations and actions will be documented accurately.

It will help to identify the patient condition and proper action taken against it.

A daily food track will be maintained

So that patients food consumption timings and appetite status can be observed

His cognitive state will be checked regularly by occupational therapist

It will help to assess his psychological wellbeing

A psychologist will be appointed for his care

This will help to understand the patient’s mental state and make him open to the healthcare facility and professionals.

He will be encouraged to have food and communication with others in the healthcare facility

It will help to assess the human connect of the patient with others

As per the set up goals and action plan, the evaluation will depend on the estimated hours determined for each goal (Levett-Jones et al., 2015). Therefore, each of the applied intervention will be evaluation for the improvement of the signs and symptoms for John Gray. Hence, in this situation, John’s appetite his communication with others, his cognitive and mental health will be assessed. Further, upon failure to improve the condition, again, the goals will be extended and another action plan will be prepared so that mental and physical health of the patient can be improved (Mather, McKay & Allen, 2015).
After implementing the action, I witnessed a steady change in the patients attitude. As per my understanding, implementing psychologist in the care uplifted the mood of the patient and he was able to communicate his concerns with healthcare professionals. However, the food and activity related interventions failed and several other interventions are needed to be implemented so that the patient’s condition can be improved.
Clinical reasoning is an important process that helps in decision-making and helps to care patients in difficult and multifaceted healthcare environment as per the need of the patient. This assignment dealt with the case of John Gray and his mental and physical ailments. In this step using the Levett-Jones clinical reasoning cycle all the seven steps of this cycle was assessed of the patient and a proper action plan and goals were prepared. These goals are realistic and presented with rationale for the action plan. Therefore, through the sequential problem solving abilities, the healthcare interventions for John Gray was applied and assessed.
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.
Fried, E. I., & Nesse, R. M. (2015). Depression sum-scores don’t add up: why analyzing specific depression symptoms is essential. BMC medicine, 13(1), 72.
Fried, E. I., Bockting, C., Arjadi, R., Borsboom, D., Amshoff, M., Cramer, A. O., … & Stroebe, M. (2015). From loss to loneliness: The relationship between bereavement and depressive symptoms. Journal of abnormal psychology, 124(2), 256.
Hawton, K., Saunders, K. E., & O’Connor, R. C. (2012). Self-harm and suicide in adolescents. The Lancet, 379(9834), 2373-2382.
Hunter, S., & Arthur, C. (2016). Clinical reasoning of nursing students on clinical placement: Clinical educators’ perceptions. Nurse education in practice, 18, 73-79.
Kable, A. K., Arthur, C., Levett?Jones, T., & Reid?Searl, K. (2013). Student evaluation of simulation in undergraduate nursing programs in Australia using quality indicators. Nursing & health sciences, 15(2), 235-243.
LeMone, P., Burke, K., Dwyer, T., Levett-Jones, T., Moxham, L., & Reid-Searl, K. (2015). Medical-surgical nursing. Pearson Higher Education AU.
Lengacher, C. A., Reich, R. R., Post-White, J., Moscoso, M., Shelton, M. M., Barta, M., … & Budhrani, P. (2012). Mindfulness based stress reduction in post-treatment breast cancer patients: an examination of symptoms and symptom clusters. Journal of behavioral medicine, 35(1), 86-94.
Levett-Jones, T., Andersen, P., Reid-Searl, K., Guinea, S., McAllister, M., Lapkin, S., … & Niddrie, M. (2015). Tag team simulation: An innovative approach for promoting active engagement of participants and observers during group simulations. Nurse Education in Practice, 15(5), 345-352.
Mather, C. A., McKay, A., & Allen, P. (2015). Clinical supervisors’ perspectives on delivering work integrated learning: A survey study. Nurse education today, 35(4), 625-631.
Nixdorf, I., Frank, R., Hautzinger, M., & Beckmann, J. (2013). Prevalence of depressive symptoms and correlating variables among German elite athletes. Journal of Clinical Sport Psychology, 7(4), 313-326.
Wisner, K. L., Sit, D. K., McShea, M. C., Rizzo, D. M., Zoretich, R. A., Hughes, C. L., … & Confer, A. L. (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA psychiatry, 70(5), 490-498.

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