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about patient safety and the clinical reasoning cycle....

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PART A:

The process of the clinical reasoning cycle is by which nurses follow is to collect cues, process the information, identify issues, establish goals, take action, evaluate the outcome and reflect on the process and learning (Levett-Jones et al., 2010). To be able to effectively follow this clinical reasoning process all depends on the nurse’s actions to obtain the correct information from a patient. Nurses with a lack of clinical reasoning skills are often failing to recognise that a patient is showing signs of deterioration as they are unaware of the signs a patient is showing. Clinical reasoning skills play an essential role in competence, although learning and teaching skills do not always involve the correct level of skills required (Koivisto et al., 2018). Nurses who are showing competent practice requires not only affective skills and good cognitive functions but a dense process of thinking. Nurses play a major role when it comes to making significant decisions and judgements made in healthcare (Levett-Jones et al., 2010). Even the student nurses and new graduate nurses are responsible for making tortuous decisions about patients with health care needs. The use of effective clinical reasoning skills can prevent patient deterioration, when the correct clinical reasoning skills are not applied a nurse’s clinical judgments might be false and can lead to an increased number of patient mortality (Levett-Jones et al., 2010).

PART B CRC PHASES:

1) The first phase The first stage of the clinical reasoning cycle is ‘consider the patient situation’ this is when the nurse starts to obtain information about the patient and identifies any important characteristics of the current situation (Levett-Jones, 2018). This first step in the clinical reasoning cycle is important as it allows the nurse to gain knowledge, obtain critical information and acquire any background on the patient. If a nurse fails to gain this first step in the clinical reasoning cycle it can have a negative impact onto the following steps (Levett-Jones, 2018).

2) The second phase

A) The second stage of the clinical reasoning cycle is ‘collect cues/information’, this is an important stage as it cannot be misjudged. When the wrong cues are collected this can lead to negative patient outcomes. During this stage the nurse collects and reviews the information about the patient, this includes the patients social and medical history, online medical records, the handover report from another nurse, information from family members and any other relevant documentation (Levett-Jones, 2018). Therapeutic communication is paramount competence within healthcare and is an important relationship between the nurse and patient through empathy. This requires listening skills, verbal and non-verbal communication. If there is not a presence of

a therapeutic relationship, this could then affect patient outcomes (Abdolrahimi et al., 2017). B) Review: Mrs Williamson has a history of hypertension and she is on antihypertensive medication. Her blood pressure was 145/90 mm Hg when admitted into hospital. Mrs Williamson has pain and redness of her left foot, which has increased over the last 3 hours her pain level now is 8/10.

Gather: Mrs Williamson’s vital signs are: T 36.8°C, PR 110/min, RR 18/min, BP 140/90 mm Hg and O2 sat 95%. She has had an initial dose of 1000mg Paracetamol l in ED 3 hours ago; with an ongoing order of 1000mg of Paracetamol PRN 6 hourly. Recall: Paracetamol can reduce pain in her left foot. C) The three additional assessments I would conduct on Mrs Williamson is a Mobility assessment to make sure she is able to walk on her left foot, a Pain assessment to see the severity of her pain and a Nutritional assessment to see if her nutrition has an impact on her overall health since her husband passing 12 months ago (Berman et al., 2018).

3) The third phase A) The third stage of the clinical reasoning cycle is once the collection of the cues has been taken the nurse will then interpret the cues and identifies any abnormal data. During this particular stage nurses use all of their previous clinical experiences and relate

different patients to similar situations. The purpose of processing the information is so that nurses are also able to use this to think ahead and anticipate different potential outcomes depending on the course of action (Levett-Jones, 2018). B) Mrs Williamson has a blood pressure of 145/90 mm Hg which is abnormal, this is known as hypertension. Mrs Williamson also has a pulse rate of 110 beats per minute which is abnormal and is known as Tachycardia (Berman et al., 2018). All of Mrs Williamsons other vital signs appear to be normal.

C) The one cue that would be my priority is Mrs Williamsons blood pressure. Her blood pressure is 145/90 mm Hg and is hypertensive. I would look into her current medications, how much physical exercise she does, her diet and her mental wellbeing. If this is left without action it can lead to a stroke, a heart attack and heart failure (World Health Organization, 2021).

4) The fourth phase A) There are two different nursing diagnoses, actual and potential. The difference between the two is that an actual nursing diagnoses is a clinical problem of a patient pointed out by the nurse that already exists. A potential nursing diagnoses is a clinical problem that may occur on a patient but does not currently exist also known as a risk diagnosis. Using these nursing diagnoses in clinical practice is critical as the diagnoses are used to decide the right goals for the care of the patient and making sure the right nursing actions are made (Levett-Jones, 2018).

B) Hgg C) Bhb D) Bh Establishing goals. Goals must be S.M.A.R.T (Specific, Measurable, Attainable, Realistic and Timely). Identify one (1) appropriate SMART goal for each diagnosis.

5)

REFERENCE LIST

Berman, A., Kozier, B., & Erb, G. (2018). Kozier and Erb’s Fundamentals of Nursing: Concepts, process and practice (4th ed.). Pearson Australia. Abdolrahimi, M., Ghiyasvandian, S., & Zakerimoghadam, M. (2017). Therapeutic communication in nursing students: A Walker & Avant concept analysis. Electron Physician, 9(8), 4968-4977. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5614280/

Koivisto, J., Haavisto, E., & Niemi, H. (2018). Design principles for simulation games for learning clinical reasoning: A design-bases research approach. Nurse Education Today, 60(1), 114-120. https://doi.org/10.1016/j.nedt.2017.10.002

Levett-Jones, T. (2018). Clinical reasoning: Learning to think like a nurse. (2nd ed.). Pearson Australia.

Levett-Jones, T., Hoffman, K., & Dempsey, J. (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. https://doi.org/10.1016/j.nedt.2009.10.020

World Health Organization. (2021, May 17). Hypertension: What are the complications of uncontrolled hypertension?. https://www.who.int/news-room/fact-sheets/detail/hypertension...