What Does it Mean to ‘think like a nurse’?
In the context of health care, the nurses are often accountable for a variety of different judgments and decisions being taken for the patients while assessing the patients or planning and implementing the care interventions. In order to be able to respond adequately to the challenging situations that the nursing professionals face and take logical decisions or clinical judgments, a standard framework with a systematic and easy to follow guidelines is required (Dalton, Gee & Levett-Jones, 2015). The clinical reasoning cycle introduced by Tracy Levett Jones is one such effective framework that serves as a step by step systematic framework that can help in following the care guideline and follow the legal protocols. However, in order to be able to employ the step by step actions of the clinical reasoning, it is very important for the nurses to be able to understand the process with clarity (Hunter & Arthur, 2016). This essay will attempt to explore the different steps of the clinical reasoning cycle and employ them in a real world care scenario taking the assistance of the clinical reasoning cycle taking the assistance of a case scenario.
As per the clinical reasoning cycle, the first step in the care scenario must begin with considering the present situation of the patient under consideration, his appearance, signs and symptoms and recent complaints (Hunter & Arthur, 2016). Vincent, the patient, who had presented to the health care facility with the initial diagnosis of idiopathic Parkinson’s disease. His clinical manifestations include slight right hand tremor that worsens during night or while resting, increasing fatigue, forgetfulness and reacting to small incidents and even decreased sense of smell, which are common manifestation of PD and can lead to self-care deficits. He had no one to care for him and he insisted that he would be fine on his own in the two storied house where he lives alone.
This is the step where the nurse collects all direct and indirect cues associated with the patient such as past medical history, clinical documentation, medical notes and handover reports; and by thorough analysis of the information collected, the aberration from the normal body functioning is identified (Dalton, Gee & Levett-Jones, 2015). The past medical history of the patient is hyperlipidaemia; the drugs targeting high cholesterol deposition in the body often are associated with accelerated progress of Parkinson’s diseases. Hence, it can be one of the possible trajectories leading to the Parkinson’s disease for the patient. Along with that, Vincent lives alone and he has no one to act as the carer for him and hence, it is another very important aspect. As per the case study information, the patient has symptoms that can contribute to self-care deficit and as a result self-care activities and ADLs for the patient can also be affected.
What is clinical Reasoning?
The next step of the clinical reasoning cycle is associated with identification of all the care cues that are associated with the patient and then best on best practice evidence be able to discover the care priorities associated with the patient (Dalton, Gee & Levett-Jones, 2015). For this assignment, the instructions have mandated to focus on two complex care priorities for the assignment. The first and foremost complex care need for Vincent will be the self-care deficit, as there is no one available to care for him after the discharge. It has to be mentioned that Vincent is separated and had been living with alone in the two storied house, due to his forgetfulness, medication management and remembering to take medication can be one of the complex care needs for the patient (Connolly & Lang, 2014).
Along with that, it has to be mentioned that for the Parkinson’s disease patients, the excessive tremors in the body of the Parkinson’s disease patient especially in the upper limbs can lead to enhanced fall risk. Along with that, Vincent is also facing extreme fatigue and right hand tremors, hence self-care deficit is another complex care need facing the patient. For the patients with Parkinson’s disease the impact of the self-care deficit is extremely high focusing especially on activities of daily living and fall risk due to inability to stand too long of shaking hands due to tremors. As Vincent is also facing the similar symptoms and is expected to live alone in his house, the self-care deficit with fall risk is a vital complex care priority. Another considerable care need is the risk of nerve damage due to using Lipitor with the levodopa however with effective dosage management by the care staff before the discharge can easily address this care issue (Valkovic et al., 2015).
As per the care priorities that have been selected for the patient, the first complex care priority for Vincent is the risk of not being able to implement proper medication management. As mentioned by Shin, Habermann and Pretzer-Aboff, (2015), the importance of taking the medication prescribed for the different symptoms of the disease religiously is imperative for the patient to be able to attain effective and visible symptomatic relief and aid in the lifestyle (Ruonala et al., 2018). Hence, Vincent, while suffering with symptoms like right hand tremor and forgetfulness, will have the SMART goal to remember to take the medications on time and regularly without missing a dose along with being able to store the right medication in right place so that the rate of medication misplacement is reduced and Vincent can take all the right medicines at the right tome with the right dosage.
Why is clinical Reasoning Important?
The second complex care need for the patient is the self-care deficit which might lead to risk for imbalanced nutrition and resultant fall and risk of injury. As mentioned by Foki et al. (2016), for people living with Parkinson’s disease, the impact of stiff muscles, fatigue, imbalanced nutrition, balance impairment and tremors can lead to considerable fall risk. Along with that inability to use the right hand might also lead to self-care deficits and inability to complete personal hygiene and activities of daily living (Bryant, Rintala, Hou & Protas, 2015). Hence, the SMART goal for this care need is for him to be able to take full control of his body, avoid the risk of falling, maintain personal nutrition, and carry out activities of daily living especially personal hygiene without compromising the dignity and sense of empowerment.
The very next step for the clinical reasoning cycle is to plan and implement the intervention actions that addresses the care priorities that have been decide for Vincent (Hunter & Arthur, 2016). For the first care priority, the patient is at a great risk of faulty medication management which can lead to a taking wrong medication, missing dosages, taking overdose and misplacing the medication. It has to be mentioned that for the risk for this medication management issues for the Parkinson’s disease patients is far more accelerated during the ‘off’ time of the medication (Lakshminarayana et al., 2017). On a more elaborative note, during the time when the effect of the medications is wearing off which is right near hen the next dosage. Hence, the Parkinson’s disease patients often require the aid of medication management tools and reminders. Hence the care interventions that will need to be taken for the patient includes making a reminder for the medicines with detailed schedule and dosage that can help the patient remember when the take the medication to what dose (Shin, Habermann & Pretzer-Aboff, 2015). The patient will also needed to be encouraged to use a timer for the medications that he is required to take so that he is reminded every time the medications are needed to be taken. He can also be encouraged to use the pill dispensers with different medicines for each day labelled in the dispensers that can help him remember and check whether he has taken the right medication at right time or not (Connolly & Lang, 2014).
For his self-care deficit and fall risk, the care interventions ill need to be more focused on the community care services. The nurse will have to educate the patient it best practice evidence the disability benefits and the aid of community acre activities that he can avail (van der Marck et al., 2014). As, there is no one to possibly care for him and look after him, he will require the assistance of a full time support worker will assist him in his different ADLs and personal hygiene. For his fall risk, the nurse ill also need to recommend walking sticks and other similar gait assistive devices. However with the support of the care support worker, his fall risk and medication management issues will be successfully managed by the virtue of being assisted in everything for every activity (Bryant, Rintala, Hou & Protas, 2015).
Conclusion:
On a concluding note, this had been an excellent opportunity for me to learn how to implement the interlinked steps of the clinical reasoning cycle in the real world care scenario and the possible issues and challenges that can arise while caring for a patient like Vincent. Parkinson’s disease is a progressive diseases that deteriorates with time and is associated with many restrictions and disabilities which can be not just risky but also frustrating for a patient going through the disease (Lawrence, Gasson, Kane, Bucks & Loftus, 2014). For a patient like Vincent how had no one to care for him, the impact of the diseases is even more daunting. This exercise has given me the opportunity to understand how to care for a patient like him and the pressing care needs and priorities along with how to arrange for the care interventions to assist patients like Vincent Effectively with safeguarding the dignity and empowerment. It can be hoped that this experience will be of excellent help for me in the future practice.
References:
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