Health and Social Care : Clinical Reasoning - Case Study Example

Running Head: Case Study Name of the University: Name of the Student: Name of the Lecturer: Subject Code and Name: Date Submitted: Clinical Reasoning Introduction Clinical reasoning is the judgment in a clinical context so that the nurse is able to decide what is good and what is bad for the patient. It is the hallmark of expert nursing and a very important component in the determination of the competence of the nurse. Clinical reasoning has been divided traditionally into the following groups of nurse’s activity including collection, interpreting the data, selection of the appropriate information and synthesizing the information and make conclusions. Lastly, the nurse does verification of the information. All the above need a range of capabilities including emotional, and cognitive, social and reflective; Patients who are critically will need decisions which are complicated and are supposed to be taken very rapidly. The nurse should also use evidence based practice in which clinical evidence is the determinant of the nursing decisions. Therefore, clinical reasoning is very important for the nurse in her practice (Higgs, 2008, pp. 65). A patient may show early or late cues in the process of his or her management. As argued by Higgs (2008, pp. 65), early signs include such things as the presentation complaints at the time of admission. They also include the findings which the nurse gets from the patient at the time of initial assessment. These include findings like the blood pressure of the patient. This early cues are important in the making of the diagnosis and thus planning of management of the patient. The early cues provide the framework of the management of this patient and therefore ensure that the patient is managed properly. Late cues are those which the nurse will get when the patient has already been admitted to the ward. These are the complications which will arise in the process of management. They can result from the failure by the nurse to notice them in the early stages of the management of the patient and therefore leading to complications, the complication of the disease itself, the complications as a result of the management of the patient or because of the drugs administered. In this patient, the late complications included the respiratory distress. The respiratory distress was a late finding and therefore the nurse had to take an appropriate action and ensure that the patient is taken to an acute room (Denis, et al., 2004, p. 54). The nurse is supposed to monitor the patient on a continuous basis. This is because the monitoring will help the nurse in the identification of the late cues. The nurse is supposed to be checking the vital signs on a regular basis so that they can be able to determine when there is a problem. A change in the vital signs from where they were stable to an unstable position will alert the nurse that the patient is developing other complications. Therefore, proper monitoring of vitals is a good method of identification of the complications in time (Hoffman et al., 2009, p. 1335). The getting of the right cues is an important component of the nursing practice. The nurse should be able to obtain the right cues at the right time. Right cues being obtained early will be a factor of proper assessment of the patient. The nurse should assess the patient early enough when in contact with that patient. This means that the nurse should be very vigilant on the patient whether at the time of admission or in the ward during the management. This will help the nurse obtain the early cues of the disease and thus can take an appropriate action at the right time (Higgs, 2008, pp. 34). Obtaining the right cues at the earliest time possible is an essential for proper nursing management. These cues will help in the prevention of development of complications in the patient as a result of these early complications. When the nurse identifies the complications early, there is a higher possibility that the complications will not get worse and lead to the death of the patient (Higgs, 2008, p. 6). For example, in this case study, the nurse was able to identify the patient’s respiratory distress. With identification of the respiratory distress and the administration of oxygen to the patient ensures that the patients organ do not become hypoxic leading to injury and death (Banning, 2007, p. 177). Failure to obtain the right cues early will lead to complications in the patients. The role of the nurse is to identify the cues in advance and use them to make decisions on the management of that patient (Higgs, 2008, 45). In addition, the nurse will be able to notify the people who are best placed at managing of that particular condition and thus the best action will be taken. It is however impossible to notify other relevant members of the management team if the nurse has not already got the right cues from the patient. This implies that getting the early cues in time is very essential in the proper management of the patient. According to Denis, et al., (2004, p. 54), effective clinical reasoning will enable the nurse to collect the right cues, carryout the right action on the right patient at the right time and for the right reason. These rights will enable the nurse to manage the patients correctly. They include the following rights: Obtaining of the right cues involves the recognition of the important information from the patient which will guide the nurse in the proper nursing management (Levett-Jones, et al., 2010, p. 517). All the strategies of management are based on the right cues and therefore, this is the foundation of nursing management of patients. In addition, the ability of the nurse to know the circumstances under which a patient will enter treatment and this enable the nurse predict the outcome of the disease rather than assuming all the patients who suffer a certain disease will have similar outcomes (Clarke, 2004, p.67). The nurse should make sure that everything is done rightly for the patient. This refers to the identification of a patient who is at a high risk of developing a serious illness or getting an adverse event. The nurse should be able to identify which patient is at a high risk of developing some complications and which one is not (Levett-Jones, et al., 2010, p. 517). Time is also an essential part of the nursing management. Taking the appropriate action at the right time prevents the patient from getting complications from the disease and therefore saves lives. If the nurse takes the appropriate action but late, the patient will have got into complications and thus this action may not help the patient (Levett-Jones, et al., 2010, p. 518). The action of the nurse is the behaviors which they demonstrate after making a certain clinical judgment is called the right action. After the nurse makes a decision, they will definitely take an action as a way of nursing care of the patient. Lastly, the nurse should have a right reason for all the actions they take. Therefore, the nurse should make a proper judgment and develop a clear rationale for all the decisions which they make. Everything that a nurse does in the management of the patient should have an accompanying explanation which should be given to the patient (Levett-Jones, et al., 2010, p. 519). According to Lorna (2008, p. 316), communication is very important between the nurse and the physicians especially for those in the emergency department. Kathleen (2006, p. 167) indicates that poor communication is a common occurrence and usually has devastating outcomes. The nurse should notify the person who is right placed to manage the problem at the right time. The nurse is the patient who is in contact with the patient and knows what the problem is in the patient and therefore should communicate it. After identification of the problem, the nurse is supposed to know who is best placed tom manage this problem and then inform him or her in the right time. The nurse therefore is charged with the responsibility of identifying and communicating the problems the patient has to the right authority. One of ways of an effective communication is the use of the SBAR. It appears to be the best mode of communication in both written and oral communication in a hospital setting. This form of communication improves the patient safety because it provides feedback accurately and clearly (Kathleen, 2006, pp. 174). The problem of communication has been blamed for the mismanagement of patients in health facilities. If the nurse lacks the proper skills of communication, condition of the patient may be misinterpreted by the other health care providers as not a serious problem. This shows that the management of the patients has to include communication skills which will make the nurse acquire the appropriate techniques of communication. Communication in medicine is important since that is the only way the management of the patient will be synchronized and thus ensures that the patient is managed appropriately (Higgs, 2008, 67). In conclusion, it is important for the nurse to have clinical reasoning which will demonstrate the five basics of the nursing clinical reasoning. This will include getting the right information, carrying out the right actions on the right patient and the right time. Lastly, the nurse should have the right reason for the actions taken in the management of the patient. The nurse should also be able to communicate appropriately. Failure to communicate to the other members of the management team will definitely lead to mismanagement of the patient. Therefore, it is an essential part of the nurse’s management of the patient. Bibliographies List Banning, M. 2008, Clinical reasoning and its application to nursing: concepts and research studies Nurse Education in Practice, 8 (3): 177–183., Clarke S. (2004). Failure to rescue: Lessons from missed opportunities in care. American Journal of Nursing 11 (2): 67-71. Denis, F., et al., 2004, Nursing research: Principles and Methods. United States: Lippincott Williams and Wilkins. Higgs, Joy, 2008, Clinical Reasoning in the Health Professions. United States: Elsevier Health Sciences. (http//books.google.com/books?id=yxXXL1Yco4Cpg=PA8&Ipg=PR9&ots=e9DdSevrBc&dq=five+rights+of+clinical=reasoning&Ir=&output=html_text). Hoffman, K., et al. 2009. A comparison of novice and expert nurses cue collection during clinical decision-making: verbal protocol analysis. International Journal of Nursing Studies, 46 (10): 1335- 1344. Kathleen, M. 2006, SBAR: a shared mental model for improving communication between clinicians. Journal on Quality and Patient Safety, 32 (3): 167-175. Levett-Jones T. et al. 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 Lorna, J. 2008, Implementation of the SBAR Communication Technique in a Tertiary Center. Journal of Emergency Nursing, 34, (4): 314-317. Read More