3807NRS Advanced Clinical Decision Making

• Subject Code : 380NRS
• Subject Name : Nursing

CLINICAL REASONING CYCLE

Introduction

The provision of safe and quality care are the key principles in nursing practice and to ensure the safe and quality provision of case, the nurses are required to engage in effective decision making. The Levett-Jones clinical reasoning cycle (CRC) is an effective tool which helps the nursing students and other nursing professionals to make effective decisions for addressing the needs of patients with the help of best available options for the provision of care (Levett-Jones et al., 2010). In CRC, there are eight steps for guiding the reasoning and decision-making process among healthcare professionals (Levett-Jones et al., 2010). In the given assessment, the clinical decision-making process has been explored and discussed with the help of first seven steps of CRC by taking the reference of a patient admitted to the hospital with chief complaints of hypoglycemic episode. This has been followed with a conclusion at the end of assessment for the discussion of important concepts explored in this assignment. 

Consider the patient

It is the first stage in CRC which focuses on the important details available about the patient and various needs of the patient (Levett-Jones et al., 2010). A 35-year-old man was admitted to the hospital with the chief complaints of ongoing diarrhea and vomiting due to food poisoning. The medical history of the patient revealed that he was suffering from hypertension and type2 diabetes mellitus. The student nurse was providing care to the patient and during the afternoon shift (around 3 PM) on second day of hospital admission, dizziness and headache were reported by the patient.

Collect cues/information

The focus of second stage of CRC is to collect all the relevant information about patient. In order to collect all the cues, the student nurse read the relevant history of the patient and got engaged in researching about pharmacological principles (Levett-Jones et al., 2010). The patient charts, charts for fluid intake and output were also observed by the student nurse for understanding the causes behind present problem of the patient. The nurse applied her previous clinical knowledge for recall and suspected that present condition of the patient could be resulted because of electrolyte imbalance as a consequence of excessive fluid loss. The nurse asked that if he vomit after his lunch or not and the patient confirmed that he had vomiting but he forgot to notify the same because he thought it could be a normal symptom of food poisoning. The vitals of the patient were monitored y the student nurse and observed the tachycardiac situation of the patient along with low BGL nearly 3.8 mmol/l. The postprandial BGL was also checked and recorded his BGL as 8 mmol/l. In addition, the restlessness and sweating were observed by student nurse even in AC room. 

Process information 

The third stage of CRC focuses on interpretation of data, discrimination of relevant and irrelevant information, development of relation between collected cues with history of patient, matching and inferring of information and prediction of outcomes (Levett-Jones et al., 2010). The low BGL level of the patient was indicating his hypoglycemic condition (Martín-Timón & del Cañizo-Gómez, 2015). The clinical manifestations like sweating, dizziness and headache were also indicating the hypoglycemic condition of the patient (Desimone & Weinstock, 2017). The decline in glucose concentration in the body was also indicated by vomiting of the patient as interpreted by student nurse (Desimone & Weinstock, 2017). The consequences of hypoglycemia could be life-threatening for the patient and severe drop in BGL can lead to cardiovascular complications which were indicated by tachycardia situation of the patient and can lead to mortality incidents (Yun & Ko, 2015).

Identification of issues

The fourth stage in CRC comprises of synthesis of all facts and carrying a definitive diagnosis for the problems presented by the patient (Levett-Jones et al., 2010). In the clinical scenario, the student nurse in collaboration with RN has identified that the main cause behind the deteriorating condition of the patient was his hypoglycemic condition that has been resulted due to diarrhea and nausea as potential impacts of food poisoning. 

Establish goals

The fifth stage of CRC focuses on the establishment of goals after identification of potential problems of the patient. The goal should be SMART (specific, measurable, achievable, reliable and time-bound) for the provision of best possible care to the client (Levett-Jones et al., 2010). The goal which was established by student nurse was elevating the BGL of the patient and prevention of further deteriorations of patient health. According to Morales and Schneider (2014), there are various treatment options available which can treat the complication of hypoglycemia instantly. The student nurse in collaboration with RN was decided to feed the patient with food items which can help in increasing the BGL of the patient and bring hypoglycemic kit for the same purpose (Cryer, 2016).

Take actions

The aim of this stage is to take actions on the basis of best available resources and evidence-based practice to achieve the set goal and provision of effective and timely care to the patient (Levett-Jones et al., 2010). The actions which have been proposed by the student nurse was to bring hypoglycemic kit, food items containing suffice glucose, fruit juice and tablets of glucose. The patient was administered with fruit juice and glucose tablet. In addition, the student nurse asked for complaints of nausea and discomfort experienced by the patient, if any. Also, PRN antiemetic dug was administered to treat the complication of nausea (Chou, Tso & Goadsby, 2016).

Evaluation

The seventh step of CRC is evaluation of outcomes in which the expected outcomes of the proposed interventions have been done to check the efficacy of care provided to the patients (Levett-Jones et al., 2010). For the evaluation of impacts of glucose tablets and fruit juice on patient health outcomes, the assessment of BGL was done by student nurses after 10 minutes and the BGL level improved up to 5.3 mmol/L. In addition, the reduction in headache and improved comfort of the patient was also observed. 

Conclusion

Form the assessment, it has been concluded that CRC helps the nursing professionals in making clear and informed clinical decisions and practicing the profession which can promote patient health. In the given clinical situation, it has been analyzed that CRC helped the student nurse in making decisions effectively after following each step of CRC. The decisions made by student nurse through CRC facilitated in normalizing the BGL level of the patient and achieving improved health outcomes of the patient.

Resources

Chou, D. E., Tso, A. R., & Goadsby, P. J. (2016). Aprepitant for the management of nausea with inpatient IV dihydroergotamine. Neurology, 87(15), 1613-1616.

Cryer, P. E. (2016). Management of hypoglycemia during treatment of diabetes mellitus. Retrieved from http://www. uptodate. com/contents/management-of-hypoglycemia-during-treatment-of-diabetes-mellitus. 

Desimone, M. E., & Weinstock, R. S. (2017). Non-diabetic hypoglycemia. In Endotext [Internet]. MDText. com, Inc..

Levett-Jones, T., Hoffman, K., Dempsey, J., Jeong, S. Y. S., Noble, D., Norton, C. A., ... & Hickey, N. (2010). The ‘five rights’ of clinical reasoning: An educational model to enhance nursing students’ ability to identify and manage clinically ‘at risk’patients. Nurse Education Today, 30(6), 515-520. 

Martín-Timón, I., & del Cañizo-Gómez, F. J. (2015). Mechanisms of hypoglycemia unawareness and implications in diabetic patients. World Journal of Diabetes, 6(7), 912.

Morales, J., & Schneider, D. (2014). Hypoglycemia. The American Journal of Medicine, 127(10), S17-S24.

Yun, J. S., & Ko, S. H. (2015). Avoiding or coping with severe hypoglycemia in patients with type 2 diabetes. The Korean Journal of Internal Medicine, 30(1), 6.