The Clinical Reasoning Cycle and Nursing

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The case study shows how one accident may influence and change human life and how to use of the Clinical Reasoning Cycle and realize that people may need more than just expected nursing care (Levett-Jones, 2013; Salminen, Zary, & Leanderson, 2014). The Clinical Reasoning Cycle consists of several closely connected stages that cannot be ignored and have to be implemented to offer a patient an appropriate level of nursing care in a particular situation. These stages are

the identification of the facts about a situation,
the collection and processing of all the necessary information,
the recognition of nursing problems for consideration,
the establishment of the goals to be achieved,
the description of nursing care to be offered with the strategies to rely on
the explanation of the outcomes (Levett-Jones, 2013).

The current paper is an attempt to analyze the situation of a particular patient, William Peterson (Bill), collect information about this person and the situation he suffers from, identify three nursing problems inherent to the situation, establish the goals for this patient’s nursing care, think about the actions that should be taken (a portion of nursing care), and the outcomes to expect from all interventions.

The situation of the patient is rather clear. Bill is a 70-year-old retired print worker, who now works as a School Crossing Supervisor part-time. Six months ago, he witnessed a fatal accident with one of school children. Now, he suffers from sleeping disorders, terrible flashbacks, and the necessity of drinking about half a bottle to take a rest. He can do nothing to block the memories and follow the same style of life. He does not get the necessary portion of support because he is alone; the wife died several years ago, and they had no children. He becomes socially isolated and thinks that he can hardly restart his communication with friends and army fellows. At the same time, it seems weird that a person, who has survived the army and seen the death of people, faces such psychological problems. Maybe, it is connected to the fact that he does not have his own children and lose the one he tried to help. His psychological problems define his physical conditions considerably. Within a short period of time, Bill’s head is bowed in a quiet tone, and the loss of eye contact is observed. Regarding his medical history with his hypertension that is usually observed in many old people, Bill has a good health and should not take many drugs to keep his organism healthy. Still, one accident that happens three years after his wife’s death because of cancer changes all his current life and requires certain nursing and professional care offered to him.

Taking into consideration the situation and facts from the patient’s life, several nursing issues can be identified and analyzed to understand how to implement appropriate patient-centered care. The first issue is a problematic patient satisfaction (Smith, Turkel, & Wolf, 2012). Bill is a patient that is hard to be satisfied because of the existing psychological trauma, personal regrets, and inability to change the past or try to improve the future. Nurses have to provide patients with the necessary portion of support and understanding to make sure he is satisfied with the conditions of treatment. Still, the case under analysis shows that it can become a serious problem for the medical staff. Another issue is the patient’s family relations (Moos & Schaefer, 2013). Nurses cannot get the patient’s family support because he is alone. He does not have children, and his wife is dead. His friends are not that credible source of information and support for nurses. Family support can become a serious nursing problem that has to be solved or even neglected in a proper way to focus on other important aspects of care. Communication between the patient and nurses is the last nursing issue for consideration that has to be properly developed (Morrissey & Callaghan, 2011). Bill suffers from social isolation he created. He does not want to talk a lot. Nurses should know how to treat such patient and promote communication on the necessary level.

All goals should be directed to choose the best treatment and make Bill feeling free from the burden of the accident. There should be several long-term goals (can be observed after Bill leaves a hospital) and several short-term goals (should be achieved before transferring to a new stage of nursing care) (Burton & Ludwig, 2014). One of the first short-term goals to be set and achieved is the choice of treatment with the help of which Bill can sleep without alcohol and be free from his nightmares and flashbacks. Some psychiatric consultations can help Bill forget about the accident and explain that he could do nothing to change the situation. Still, a properly chosen treatment is not the only goal in this case. A new goal for nurses to set is the development of the connection with a patient and explanations to him about the interventions and the reasons for why they are taken. Finally, one long-term goal in Bill’s care is connected with his ability to cope with the outcomes of the accidents similar to the one he has already survived. Bill himself should be able to achieve the goal and understand that everything can happen to him or to the people around, and his reaction to different situation is his own understanding of the problems and the abilities to cope with them.

In addition to the goals and the abilities of nurses, it is necessary to discuss the process of nursing care. It is wrong to offer as many services as possible at once. Nurses should help to pass one stage of rehabilitation and start talking about the accident without fear or anger. Bill has to be ready to understand the problems of his own and find the solutions. Nurses may perform the role of catalyst to promote the communication between Bill and the doctors and Bill and his friends. The process of rehabilitation focuses on the necessity to destroy the distance between Bill and society. It is possible to remind Bill how interesting and captivating his life was before the accident. Nurses should not rely on the medical aspect of treatment only. Their care should be supportive and personal to help Bill forget his nightmares and personal uncertainties. Finally, the options that are available to him should be mentioned: special drugs help to deal with nightmares, and renewed communication with friends can replace the social hollow Bill suffers from. His friends’ and fellows’ support is another positive addition to nursing care offered. Bill should understand that there is a wonderful world waiting for him outside, and he still has a chance to enjoy it.

To make nursing care chosen more effective, several nursing strategies can be applied to this case. For example, the strategy of hourly rounding (Potter, Perry, Stockert, & Hall, 2013) may be used to improve nursing care. Every hour a nurse visits Bill to ask about his health, discuss some issues, and make sure Bill is ok. As a rule, in the beginning, Bill does not understand the frequency of nurse’s visits. With time, as soon as his condition is improved, Bill starts expecting a nurse enters his room. It will tell about his desire, intentions, and needs. Core measurement is a strategy to rely on as it helps to record everything that happens to the patient and understand the reasons for his behavior and reactions (McDowell, 2006). Nurses are able to follow the changes Bill undergoes and develop those that are favorable for Bill and avoid or decrease the level of impact of those change that are harmful to Bill. Finally, the forcing strategy has to be admitted in this case if the conflicts take place and have to be solved (Huber, 2014). If Bill does not want to accept some nursing help or even drugs explaining it as his unwillingness to believe in the power of treatment or even the necessity to continue living. Forcing can be used to make Bill follow the order and schedules defined by the professional doctors.

In general, it is expected that Bill can survive the accident and forget about the details that bother him days and nights. All the strategies, goals, and activities described in this paper should be properly used to provide Bill with a chance to live a normal life enjoying the possibilities he still has. An optimal use of drugs and communication with the best friends and fellows should also help. The only thing to be done by nurses is the explanation that this life is still worth living, and Bill should not forget about the positive aspects of his own life. Though his wife is not with him, he has a number of friends to spend some time with. It is always possible to find some new activities to get involved in and be happy with any possible results achieved.

References

Burton, M.A. & Ludwig, L.J.M. (2014). Fundamentals of nursing care: Concepts, connections & skills. Philadelphia, PA: F.A. Davis.

Huber, D. (2014). Leadership and nursing care management. St. Louis, MI: Elsevier Health Sciences.

Levett-Jones, T. (2013). Clinical Reasoning: Learning to think like a nurse. French Forest, NSW: Pearson Australia.

McDowell, I. (2006). Measuring health: A guide to rating scales, and questionnaires. New York, NY: Oxford University Press.

Moos, R. & Schaefer, J. (2013). Life transitions and crises: A conceptual overview. In R. Moos (Eds.), Coping with life Crises: An integrated approach. New York, NY: Springer.

Morrissey, J. & Callaghan, P. (2011). Communication skills for mental health nurses: An introduction. Berkshire, England: McGraw-Hill Education.

Potter, P. A, Perry, A., G., Stockert, P., & Hall, A. (2013). Fundamentals of nursing. St. Louis, Missouri: Elsevier Health Sciences.

Salminen, H., Zary, N., & Leanderson, C. (2014). Virtual patients in primary care: Developing a reusable model that fosters reflective practice and clinical reasoning.” Journal of Medical Internet Research, 16(1), 29-39.

Smith, M. C., Turkel, M. C., & Wolf, Z. R. (2012). Caring in nursing classics: An essential resource. New York, NY: Springer Publishing Company.

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The Clinical Reasoning Cycle and Nursing

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