Patient Situation Analysis
Question:
Discuss about the Measuring Burden and Mortality of Hospitalisation.
Clinical reasoning cycle was designed by Tracy Levett Jones in an attempt to provide an effective framework that will guide the different health care providers to design and implement a care plan that will suit the needs of the patients receiving the care effectively. The use of this cycle provides the opportunity to the health care providers to facilitate and effectively positive impact on the patents outcomes and their personal preferences. It can be mentioned in this context that the need for a step by step framework is ultimate for the nursing care to be inclusive and holistic, which is provided to them by the clinical reasoning cycle (Levett-Jones, 2013). This assignment will focus on care planning of a patient based on the strategic steps of the clinical reasoning cycle with the aid of the case study.
The very first step first step of the clinical reasoning cycle is the patient situation analysis where the nursing professional will consider the case information of the patient. In this case study, little information is provided about the situation of the patient. Phillip, the patient under consideration of the case study, is a semi-retired man working part time in a local tea shop. He has three adult children living away from him and has been recently separated with his wife. In this first step the nursing professional must develop a therapeutic relation with the patient and attempt to understand the situation of conditions that the patient has been going through very effectively. The preliminary diagnosis of Phillip is the onset of Parkinson’s disease which can be a significant psychosocial burden on the patient. It has to be understood that Phillip also lives alone and has no one to care for him. Hence it is crucial for the nursing care professional to be very compassionate and understanding of the psychological situation of the patient. Along with that it has to be mentioned that this first step of the care planning will also be the stage where the patient will get the first impression of the care providers and the care quality that he will obtain in the future. According to the Kozier et al. (2015), the first therapeutic relationship with the patients needs to be very easy and comfortable for the patient to share his needs freely and the care planning to be as patient centred as possible. Hence the nursing professionals would need to be mindful of the care approach that they are attaining so that the nursing professional can gain the trust of the patient effectively (Connor et al., 2015).
The next priority of the care scenario for the nursing professional in this care scenario is the identification of the care needs of the patients. As per the clinical reasoning cycle, there are two different stages of activities that is needed to be considered in this sector. Collection of the cues is the second stage of the clinical reasoning cycle, and this stage will act like the first step if the process of identifying the care needs of the patient. In this step the nursing professional will investigate all different kinds of inputs from the patient case scenario. On a more elaborative note, this step is associated with the process of the nurse assessing the past medical history, social supports, concerns and preferences, and perceptions effectively, it has to be understood that the patient had been diagnosed for Parkinson’s diseases (Ding et al., 2015). It has to be mentioned here that Parkinson’s disease is a very prevalent chronic neurodegenerative disorder and this diagnosis can be a significant psychological burden on the patient, hence it is very important for the care professionals to emphasize on the psychological state of the patient as well when the care professional is collecting the care need cues. In this stage the nurse would collect information from the previous physician or any other care team that he has been associated with to discover important information regarding the inpatient stay of the patient and any existing patient care planning that is needed to be incorporated in the assignment (Brenner, 2018).
Identification of Care Needs
The third stage of the clinical reasoning cycle is the processing of the information that has been gathered by the assessments that the nursing professional. This step requires the nursing professional to interpret, discriminate, relate, infer, match an predict all the cues collected about the condition of the patient. It has to be mentioned here that the culmination of this and the previous step will complete the process of identification of the different care needs. It has to be mentioned here that Phillip represents a chronic neurodegenerative disorders with a combination of different care needs. First and foremost, it had to be mentioned that the patents had been getting tremors in his hand and unsteady gait (Lawson et al., 2018). This tremor and rigidity can be a significant health risk to the patient and can increase the fall risk of the patient significantly. On the other hand, It had to be understood that the patient under the case study has also been suffering from the speech difficulties and slurring troubles. As per the assessed information that has been gathered by the care professional the patient has also been experiencing intermittent fatigue, bradykinesia, increasing confusion, drooling, increasing nausea. Hence the nursing professional will have to focus on all the mentioned care needs in the long term care plan being devised for the patient management. Along with that, the psycho-social assessment of the patient has discovered tat he had been suffering from mild depression from the last month which can be expected to intensify with the present diagnosis that has been made. The care plan will have to focus on his psycho-social issues with equal amount of attention (Schlesinger et al., 2015).
The fourth stage of the clinical reasoning cycle is associated with identification of the problems and issues that the patient has been facing and how the pressing care needs can impact the other acre factors of the patient. This step is the onset of the process of discovering the care priorities of the patient and how it can be optimized to the fundamental issues that the patient had been facing (Lennaerts et al., 2017). Here the patient will effectively and actively participate in the care planning procedure and will provide insights on the efficacy of the care activities that will suit his needs the best. According to the data that has been gathered and the information shared by the patient, it can be mentioned that the two most basic and pressing care needs of Phillip is altered mobility and unsteady gait with random and frequent tremors. Along with that, the second care priority for Phillip is the slurring speech difficulty to speak (Elbers et al., 2014).
It has to be understood that idiopathic Parkinson’s disease is a progressive mobility disorder that deteriorates over time based on the age of the patient. Along with that, it has to be mentioned in this context that the patient under case study will be living alone as he has been divorced and no one from his family could be able to able to provide care for the patient. In such conditions the care priority like unsteady gait and mobility restrictions will be a significant risk factor for both his safety and his ability to entertain the activities of the daily living (Postuma et al., 2015). As the patient will be living alone the patient, the tremors, unsteady gait and his mobility restrictions can effectively enhancing the fall risk of the patient can lead to severe injuries. Along with that, the speech difficulties and slurring that the patent had been suffering with will be a significant risk for him to communicate his needs during instances of medical emergencies. Hence it has to be mentioned that both of the care priorities that has been selected would collectively become a safety risk for Phillip and can increase the chances of injuries and further deterioration. Hence both of the care needs can be two are priorities for the patient requiring immediate care intervention (Nalls et al., 2014).
Processing of Information
The last few stages of the clinical reasoning cycle is focussed on the designing a few care goals in collaboration with the patient to address and effectively manage the care priorities that has been mentioned. For the first care priority, the most realistic goal for the patient will be to recommend pharmacological intervention. Long-term levodopa with physiotherapeutic interventions on a residential care package system will be beneficial. For the next care priority, the patient can be the speech therapies such as the lee silverman voice treatment will also need to be recommended for the Phillip. Other than the pharmacological interventions, physical and occupation therapies coupled with group and counselling session from the community care services would need to be included in the care plan of Phillip (Low et al., 2015).
Conclusion:
The ultimate step of the clinical reasoning cycle is the reflection stage which will help the nursing professional to reflect upon the care activities performed or planned in order to streamline the care approach systematically to enhance the patient centeredness of the care plan. On a concluding note, it has to be mentioned that the clinical reasoning cycle is a potent tool that helps health care professionals worldwide with a framework to device their care strategies and plan with evidence and reasoning based approach. In this case as well, the implementation of this cycle incorporated science of systematic organization to process of caring for a Parkinson’s disease management.
References:
Brenner, S. R. (2018). Material bias in inheritance in Multiple Sclerosis, Alzheimer Disease and Parkinsons Disease may have a mitochondrial origin.
Connor, K., Cheng, E., Siebens, H. C., Lee, M. L., Mittman, B. S., Ganz, D. A., & Vickrey, B. (2015). Study protocol of “CHAPS”: a randomized controlled trial protocol of Care Coordination for Health Promotion and Activities in Parkinson’s Disease to improve the quality of care for individuals with Parkinson’s disease. BMC neurology, 15(1), 258.
Ding, W., Ding, L. J., Li, F. F., Han, Y., & Mu, L. (2015). Neurodegeneration and cognition in Parkinson’s disease: a review. Eur Rev Med Pharmacol Sci, 19(12), 2275-2281.
Elbers, R. G., Verhoef, J., van Wegen, E. E., Berendse, H. W., & Kwakkel, G. (2014). Interventions for fatigue in Parkinson’s disease. Cochrane Database Syst Rev, 10.
Kozier, B., Erb, G. L., Berman, A., Snyder, S., Levett-Jones, T., Dwyer, T., … & Parker, B. (2015). Kozier and Erb’s Fundamentals of Nursing [3rd Australian edition].
Lawson, R., Collerton, D., Taylor, J. P., Burn, D., & Brittain, K. (2018). Coping with cognitive impairment in people with Parkinson’s disease and their carers: a qualitative study. Parkinson’s Disease.
Lennaerts, H., Groot, M., Rood, B., Gilissen, K., Tulp, H., van Wensen, E., … & Bloem, B. R. (2017). A Guideline for Parkinson’s Disease Nurse Specialists, with Recommendations for Clinical Practice. Journal of Parkinson’s disease, 7(4), 749-754.
Levett-Jones, T. (2013). Clinical reasoning : Learning to think like a nurse. Melbourne, Victoria : Pearson Australia
Low, V., Ben-Shlomo, Y., Coward, E., Fletcher, S., Walker, R., & Clarke, C. E. (2015). Measuring the burden and mortality of hospitalisation in Parkinson’s disease: a cross-sectional analysis of the English Hospital Episodes Statistics database 2009–2013. Parkinsonism & related disorders, 21(5), 449-454.
Nalls, M. A., Pankratz, N., Lill, C. M., Do, C. B., Hernandez, D. G., Saad, M., … & Schulte, C. (2014). Large-scale meta-analysis of genome-wide association data identifies six new risk loci for Parkinson’s disease. Nature genetics, 46(9), 989.
Postuma, R. B., Berg, D., Stern, M., Poewe, W., Olanow, C. W., Oertel, W., … & Halliday, G. (2015). MDS clinical diagnostic criteria for Parkinson’s disease. Movement Disorders, 30(12), 1591-1601.
Schlesinger, I., Eran, A., Sinai, A., Erikh, I., Nassar, M., Goldsher, D., & Zaaroor, M. (2015). MRI guided focused ultrasound thalamotomy for moderate-to-severe tremor in Parkinson’s disease. Parkinson’s Disease, 2015.
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