Clinical Reasoning Model and Quality of Care and Management - Case Study Example

Clinical Practice Name: Course: Tutor: Date: Clinical Practice Introduction In the recent days, the proportion of patients with serious health problems has largely increased in many hospitals around the world. Notably, the contemporary medical practice and health service delivery differs from one hospital settings to another. The inefficiencies and incompetence of some health practitioner has resulted in increased number of deaths of patients with complex health problems. .Despite explicit symptoms indicating the adversity of the patient, health personnel are reluctant to attend them hence putting them at more risks. This scenario is attributed to poor clinical reasoning among health staff service providing centers. Clinical reasoning is a paramount component of effectiveness and competence of nurses, doctors, physicians and other medical practitioners (Levvett-Jones et al, 2010) Efficiency and effectiveness of employees in clinical practice depends entirely on how they handle health problems. The medical care and treatment given to patients should be pursuit after sufficient judgments. Appropriate decisions can only be achieved after undertaking thorough clinical judgments. In any clinical practice, health practitioners ought to be decisive and active when handling health problems. As explained by Levett-Jones et al (2006, p.168), identification of the problems and the needs of the patient is very paramount during health service provisions. Health care researchers and practitioners have argued that Clinical Reasoning is an essential component which helps nurses, doctors, physicians and other medical practitioners make appropriate judgments after considering various alternatives available. In the pursuit of effective health service delivery, nurses are obliged to consider available evidence by either pattern recognition or intuition. As a matter of importance, nurses are expected to collect cues in order to clearly understand the problem of the patient. Thereof, they should plan and execute appropriate interventions that would lead to optimal outcomes. In a hospital setting, different nurses have employed different patterns of Clinical Reasoning. Basing on this disparity, service delivery by novice nurses is quite different from that of expert nurses (Levvett-Jones et al, 2010) Clinical Reasoning model helps clinical practitioners make appropriate judgment and inferences concerning health conditions and needs of the patients basing on valuable information. This entails synthesizing of credible patient’s information that would help diagnose a problem, and this is useful in choosing the apposite course of action to take. Past health researches have revealed that novice experts are reluctant in collecting cues from wider range of information in comparison with their counterparts. Unlike expert nurses, novice nurses ascertain problems facing the admitted patients very late. Consequently, this has had direct negative implications on the safety of the clients. The quality of care and management is influences the rate at which admitted patients die. Nurses ought to employ appropriate clinical reasoning skills in order to promote quality nursing care. Adverse patient outcomes occur due to nurses’ failure to appropriately diagnose, institute recommended treatment and manage complications. According to Levett-Jones et al (2010), this happens when nurses posses poor clinical reasoning skills. Mr. Smith case is a perfect example which calls for decisive actions by the clinicians. Smith has had series of health problems both early and old stages of his life. Therefore, initial nurses assessing his health problems ought to be diligent enough to guarantee the safety of the patient. Well thought processes and organization of ideas in order to reach correct conclusions should form an integral part of clinical dispensation. As such, the initial nurse practitioner should employ relevant problematic reasoning style in order to identify the early warning signs that must be considered to eradicate adverse events that would endanger the life of the patient. The nursing authority should identify these signs and other influential factors that greatly impact the health condition of the patient (Banning, 2008) Identification of the initial warning signs assists the nurses to identify relevant diagnoses hence implementing appropriate nursing interventions that would solve the problem. Significantly, the initial nurse handling Smith should employ correct physiological measurements helpful in classification of the patient. Basing on the medical notation, Smith has a pulmonary congestion. In most cases, patients with death cardiac arrest and severe respiratory conditions are at risk of serious undesirable health events. Pulmonary congestion as depicted by Smith should be used by the initial nurses as the basis for recognizing the deterioration of the individual health. This is an abnormal value which implies that the patient is at risk hence there is need for urgent subsequent management. Recognition of cues have proved worthy in rescuing the life of many patients around the world. In order to provide appropriate nursing care to Smith, the initial nurse ought to consider some of the physiological and psychological modifications experienced by the subject. This can be attained by reviewing past history and respective clinical situation. This information should be related with specific body of nursing knowledge in order to ascertain the fitting nursing care to be subjected to the victim. The nurse should revisit available patient information which is carried in handover reports, patient charts, medical assessments that have been undertaken before, recall of the knowledge and patient history. The information obtained should be utilized by incorporating with knowledge of clinical situations. Three days after admission, Smith developed a red pressure under his heels. He complained of difficult in breathing and limited expansion on the wall of the chest. Smith case should be handled in a timely manner. Using the acquired information, the initial nurse should recommend on the immediate interventions while following the right sequence (Banning, 2008) Smith exhibit warning signs which indicate that he is at risks. As argued by Levett-Jones et al (2010, 170), inability by the initial nurses to identify abnormal values exposes the patient to great deal of health problems. Smith early signs that should be factored by the initial clinicians include chest pain, high respiratory rate, high blood pressure, weight loss, breathing problems and alteration in mentation. These are some of the conditions that ought to be critically analyzed by the initial nursing officer in order to avoid endangering the life of the victim (Levett-Jones et al, 2010). Appropriate nursing actions The quality of health service delivery is affected by the medical practitioners’ effectiveness and competence. Profoundly, admitted patients are exposed to adverse events due to inability of the health staff to deliver their services as expected. Imperatively, course of actions to be taken to safeguard the life of Smith speaks volume. First and foremost, the initial nurses assessing Smith should collect cues and cluster of cues in order to identify relevant course of action in the pursuit of saving the life of the victim. Bu adopting the best clinical reasoning skills, the nurses should inquire about physiological and psychological changes experienced by the patients in the past. As stated earlier, this information can be acquired by visiting handover reports, Smith’s history and charts, previous medical assessments and recall of knowledge. The practitioners should possess deep knowledge of physiology and patho-physiology. The inability to synthesize and apply such knowledge among some nurses has had the effect of negative results. The nature of cues, personal beliefs, assumptions, experience and the nature of task at hand influence nurses’ decision making processes. In order to identify appropriate course of action, the nurse ought to spend more time evaluating the patients until they are sure of the trend occurring. They should utilize effective observational skills and proactive approach when handling the problem. An effective nursing officer should collect relevant background information of the patient that would help in further investigation. After collecting cluster of cues, the nurse should undertake the assessment of the patient. This would help him/her give brief summary regarding the health condition or the situation of the subject. The nurse is expected to give brief and precise explanation of what he/she thinks the problem is. However, this depends on once knowledge and experience. Typically, expert nurses have the ability to pursue detailed assessment basing on the past information and the trend of the individual health in the past three days. Basing on the detailed assessment, the nurse can make recommendation or request to the other health professionals for further management. Communication among the health team The health practitioners handling Smith case have to adopt effective communication between them. Breakdown of communication between the health care team is the major setback in handling complicated problems health centers (Haig et al, 2006). Most untoward events in hospital settings have been associated with suboptimal communication. The health providers should ask and respond to question, and this can be achieved through hand-off communication approach. With effective communication model, the team can avoid tragedies. To foster effective communication, the team must adopt standardized structures and systems for communications. Nurses communicate with medical professionals concerning Smith case after undertaking thorough assessment, reviewing patient’s chart and understanding the admitting diagnosis. The nurse should call the professionals because of specific problems. He/she communicate the actual problem to the professionals. The nurse should give background information of the problem i.e. admission diagnosis, pertinent medical history and the date of admission. This means that the nurse should give brief synopsis of the treatment received by the patient from the day of admission to date. He/she should communicate personal assessment of the patient. This concerns changes noticed prior the assessments. Smith calls for urgent but proper care. Therefore, the nurse should recommend him to be taken to the Intensive Care Unit (ICU) or request for consultant to attend him immediately (Woodhall et al 2008). How Smith condition could have been avoided The condition of Mr. Smith worsen three days after admission as evident by the development of red pressure under his coccyx, breathing problems, chest pains, stabbing pains in the lung and drastic loss of weight. These psychological and physiological changes imply that inappropriate steps and measures were not followed. By adopting the appropriate Clinical Reasoning model as soon as Smith was admitted, this condition would have been avoided. Basing on physiological and psychological changes experienced by the patient, the patient should have been recommended to be seen by a specialist. The initial nursing officer should have collected sufficient information on broad range of factors alongside the presenting signs (Clarke, 2004). In reference to past conditions, Smith should have been exposed to scanning. Smith is a patient who needed immediate care because he is at risk of critical illness. Smith conditioned due to the failure by the health staff to grasp the situation in a timely manner. According to (Hickey, 2010), identification of clinically at risk patient is important in nursing practice because it aids in commissioning suitable interventions at the right time. Smith health deteriorated due to late nursing intervention. Right action was not taken when handling Smith case since relevant information was not considered during the day of admission. The critical alternations depicted by the patient should have been acted upon. Smith’s abnormalities warranted immediate action. If these were taken, the nature of Smith health condition would have changed. His condition would be different if correct reasoning processes had been adopted. The nurses should have pursued their practice while following ethical and professional standards (Hickey, 2010). Conclusion Complex thinking processes and effective skills play very vital roles in a clinical practice. Nurses and doctors responsible for immediate handling of the patients ought to make appropriate judgments and decisions in order to prevent more harm to the patients. Competent nurses display appropriate CR skills helpful; in making complex decisions about victims with different health needs. References Banning, M 2008, ‘Clinical reasoning and its application to nursing: concepts and research studies’, Nurse Education in Practice, vol. 8, no.3, pp.177-183. Clarke, S & Aiken, L 2003, ‘Failure to rescue’, American Journal of Nursing, vol. 103, no. 1, pp. 121-154. Clarke, S 2004, ‘Failure to Rescue: lessons from missed opportunities in care’, Nursing Inquiry, vol. 11, no. 2, pp.67-71. Haig, M, Sutton, S & Whittington, J 2006, ‘A shared mental model for improving communication between clinicians’, Journal of Quality and Patient Safety, vol. 32, no.3, pp.167-176. 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’, Journal of Nursing Education Today, vol. 30, no.2, pp. 515-520. Levvett-Jones, T, Hoffman, K, Dempsey, J, Jeong, S, Noble, D, Norton, C, Roche, J & Woodhall, L, Vertacnik, L & McLaughlin, M 2008, ‘Implementation of the SBAR communication technique between clinicians in a tertiary center’, Journal of Emergency Nursing, pp. 314-317. Read More