Clinical Reasoning and the Influence of Gibbs Reflection Model - Essay Example

One of the key factors in the provision of quality care and prevention of adverse patient outcomes is a nurse’s clinical reasoning ability. Clinical reasoning refers to process by which nurse and other clinicians collect cues, process information, come to an understanding of a patient problem or situation, plan and implement interventions, evaluate outcomes, and reflect on while learning from the process. Clinical reasoning has eight critical elements: look, collect, process, decide, plan, act, evaluate, and reflect. This purpose of the paper is to focus on the clinical reasoning cycle while identifying the process by which nurses and clinicians, collect details, process the information, and gain understanding of the situation prior to implementation of quality intervention. In order to achieve this goal, the paper will discuss a male patient (Mr. Mark Cahill) in a case study format. The study has two critical parts. The first part of the research focuses on critical analysis of the decision-making process under the influence of clinical reasoning cycle. In this context, the study concentrates on assessing the strengths and weaknesses of the decision-making process in the clinical scenario. The second of the study will focus on critical reflection on the decision-making process. This is through focusing on the experience of the situation with the intention of identifying as well as discussing reflections on the clinical decision under the influence of Gibbs’ reflection model. From the background information, Mark Cahill is a 60-year-old patient admitted into the hospital for a surgery to help management abdominal aortic aneurysm (AAA) condition. Aorta refers to the main blood vessel, which supplies blood to the abdomen, legs, and pelvis. AAA condition occurs when an area within the aorta becomes very large, thus balloons out (Lewiss, 2011; Greenhalgh, 2010). Some of the factors contributing the increase of the risk of developing the condition include smoking, high blood pressure, male gender, and genetic factors (Tracci, 2012; Braverman et al, 2011). Some of the symptoms of the condition include passing out dizziness, nausea, vomiting, shock, and pain in the abdomen or back. Mark contracted the condition at about 55 years old. Mark is a father of two sons, whom have moved out of their family home to start their lives with their spouses. Mark’s wife passed about 10 years. According to existing medical information, his aunt and father had cases of hypertension. According to the medical history, Mark is hypertensive. In addition, he engages in smoking, which he claims is vital for minimisation of the level of stress and emotional torture he is experiencing because of the lonely living context. In spite of these complications and health conditions, the surgery process was successful. Nevertheless, the condition of the patient started deteriorating after the operation, which was evident in the massive reduction of the blood pressure (BP). There was need to increase Mark’s BP to normal with the intention of preventing any opportunity shock while still undergoing recovering at the ICU. Nurses with effective and efficient clinical reasoning skills tend to have positive implications on patient outcomes. On the other hand, nurses with poor clinical reasoning skills tend to fail in the course of detecting impending deterioration among the patients. This essence proves to be important when perceived against the background of increasing numbers of adverse patient outcomes as well as escalating healthcare complaints (Gigante, 2013; Jerome, 2010). In the first instance, critical reasoning is essential in the nursing accountability and quality care through exhibition of confidence, contextual perspective, flexibility, and reflection (Fleming et al, 2012; Davis, 2009). Nurses incorporate clinical reasoning to facilitate effective analysis, application of standards, discrimination, seeking information, logical evaluation, prediction, and transformation of knowledge towards improving the condition of the patient in question (Simmons, 2010). Clinical reasoning refers to process by which nurse and other clinicians collect cues, process information, come to an understanding of a patient problem or situation, plan and implement interventions, evaluate outcomes, and reflect on while learning from the process. Clinical reasoning is also significant because it occurs within social relationships as well as situations involving patients, community, family, and a team of health care providers or practitioners. Nurses and other clinical practitioners tend to exploit their knowledge and skills to assess these relationships as well as situations involving the condition of the patient. This is an illustration of the essence of clinical reasoning. Clinical reasoning cycle has eight critical elements aiming to enable nurses make valuable and quality decisions. The purpose of the first section of the model is to review the current information with reference to handover reports, history of the patient, charts, and outcomes of investigations as well as nursing assessments in the previous encounter (Alfaro-LeFevre, 2009). According to the evaluation of the existing and current information, Mark had a history in relation to hypertension, which he tends to manage through taking beta-blockers. In addition, the patient had recorded a BP of 140/80 just one hour before the situation. The model also requires the need to gain substantial information through undertaking assessment of the patient (Tracy Levett-Jones et al, 2010). Having checked the BP of the patient, the new reading was 100/60. Moreover, his temperature was 380 C with the epidural (continuous epidural) running at 10ml per hour. The model requires nurses to engage in recalling knowledge with reference to physiology, pharmacology, culture, law, ethics, and pathophysiology. According to nursing knowledge, BP tends to relate to the status of the fluid. In addition, epidurals have the ability to lower BP because of the impact in generating the essence of vasodilation. Furthermore, nurses have the obligation or standing order to manage epidural effectively and efficiently among patients in the ICU (Gigante, 2013) Process information is an essential aspect of the clinical reasoning vital in the dissemination of the information in relation to the past, current, and potential condition of the patients (Darmani, 2010). In the first aspect of information processing, nurses should focus on interpreting data through extensive analysis of the data to facilitate effective understanding of signs, thus comparison between normal and abnormal. From this perspective, the condition of Mark was abnormal. For instance, the BP was low particularly for an individual who is hypertensive in accordance with the past medical history. Another aspect of information processing should concentrate on discrimination (Levett-Jones et al, 2010). In this context, it is ideal to distinguish relevant information from irrelevant information with the intention of recognizing inconsistencies while narrowing down the information to what is significant. The approach is also essential in identifying the gaps from the cues. In this case, Marks’s temperature was slightly high, but did not raise any reason to worry. The main issues of importance in the situation and condition of the patients were his low BP. These attributes led to the perception of the need to assess Mark’s urine output and his oxygen saturations. Information processing also requires relating cues with the objective of discovering new relationships and patterns in relation to relationships between the cues. Mark’s hypotension, tachycardia, and oliguria conditions had indications or signs of impending shock while still recovering in the ICU. In addition, it is critical to note the decrease in the BP following the increase of epidural. These illustrations were essential to make deductions or form opinions while inferring information through interpretation of objective and subjective cues. The essence is also ideal in the consideration of consequences as well as alternatives. Mark’s BP could be low because of two critical reasons. In the first instance, the BP could be low because of the blood loss during the surgery process. Furthermore, Mark’s BP could be low because of the increased epidural while trying to recover at the ICU. The next step in this situation was the need to match the current situation to past situations, which is an expert thought process. In most cases, individuals suffering from (AAA) conditions tend to have hypotension following surgery processes or operation (Jerome, 2010) Matching of the current situation to past situations is vital in the prediction of the outcome, which is also another expert thought process. In the case of Mark, the perception was that he could go into shock in case of any failure to offer more fluids to enhance his situation. The purpose of ‘identify problems/issues’ of clinical reasoning cycle is to synthesise valuable facts as well as inferences with the intention of making a definitive diagnosis concerning the patient’s problem or issue (Ji-Yong, 2011). From this perspective, Mark was hypovolaemic. In addition, the influence of epidural was evident in worsening the BP through generating vasodilation. Nurses and other clinical practitioners should focus on describing what they want to happen through illustration of the desired outcomes as well as appropriate timeframe, thus the concept of goal establishment. This is critical in the achievement of quality decisions concerning the condition or problem of the patient. The objective of the case was to improve Mark’s hemodynamic status. The objective relates to raising Mark’s BP as well as returning the urine output back to normal within one hour of management of the problem. Nurses and clinical practitioners have the obligation of selecting valuable course of action while exploiting diverse alternatives available in the process of managing or treating the condition of the patient. In the first context, there was need to call the doctor with the intention of obtaining an order to increase Mark’s IV rate. Another potential action in this case was to offer aramine to the patient if the situation demanded so, which would be critical in improving his hemodynamic status. The next section of the clinical reasoning focuses on evaluation of the effectiveness as well as efficiency of outcomes and actions. In this situation, there is need to assess whether the situation has improved in accordance with the condition of the patient. After integration of the action, Mark’s BP increased for the moment, but there was still need to assess the situation critically for any potential need of aramine. Moreover, the urine output of the patient was back to normal, thus averaging >30 ml per hour following the actions and interventions to improve his conditions while recovering at the ICU. Nurses and other clinical practitioners should contemplate learnt lessons from the process as well as determining what should have been executed differently (Kuipers and Grice, 2009a; Kuipers and Grice, 2009b). This is an essential facet of the clinical reasoning cycle in aiding effective and efficient decision-making by nurses seeking to improve health conditions of the patient in future similar encounters. In the first instance, it is essential to focus on refuting potential elements of diagnosis rather than focusing on confirming diagnosis in relation to the condition of the patients. In addition, it is critical to avoid overconfidence in handling conditions such as decrease in the BP. In future encounters, the process will focus on evaluation of different possibilities as well as actions with the objective of arriving at the most effective approach in accordance with the condition of the patient. This will be critical in enhancing the conditions of the patients through provision and maximisation of quality health to substantiate valuable skills and knowledge in decision-making. In the course of making these decisions and actions in relation to Mark’s condition, there were diverse clinical reasoning errors. In the first instance, there was the confirmation bias. This relates to the tendency of looking for confirmation evidence with the intention of supporting potential diagnosis rather than assessing for disconfirming evidence to refute the diagnosis. In most cases, the latter is more persuasive and definitive in comparison with the former. In addition, the decision suffers from overconfidence bias (Ryan, 2011). This relates to the tendency of nurses to believe to know more than they actual do with reference to the condition of the patient. From this perspective, this error is essential in reflecting a tendency to act in accordance with incomplete information, intuition, and hunches. In the making of the decision, too much faith was put on opinion rather than uncollected cues. Similarly, the decision-making suffers from unpacking principle threat, which tends to have negative implications on the outcome of the action in relation to the conditions of the patient. The threat relates to failure to collect and evaluate relevant cues in establishing differential diagnosis. This might result in missing significant possibilities. For instance, there is high potentiality of discounting unspecified possibilities in case of inadequate evaluation of the history of the patient. These threats are critical in determination of the outcome of the actions or interventions aiming to improve health condition of the patient. In order to achieve quality and positive outcomes, nurses need to avoid these premature judgments and threats in relation to the condition of the patients. The utilisation of Gibbs reflective model was ideal in the evaluation and assessment of the case in this nursing context. The case focused on handling decrease in Mark’s BP while recovering at the ICU following a surgery process to manage his AAA condition. The decision-making process focused on collection and analysis of critical information concerning the 60-year-old patient with abnormal BP level. The decision sought to enhance his hemodynamic conditions as well as urine output levels through increase Mark’s IV. In the first instance, the situation was perplexing since the patient was hypertensive, thus tendency of higher BP would be ideal. The condition felt like getting out of hand, thus generating substantial thoughts of the possibility of the patient experiencing shock. Increase of the IV of the patient was ideal in enhancing his hemodynamic conditions, hence positive feeling after the improvement of the condition. In spite of the presence of critical errors or threats in relation to decision-making process, it is ideal to note that the situation of the patient improved with BP increasing. In addition, there was no panic in the decision-making process providing the perfect platform for assessing and understanding the existing and potential cues. The best incident about the action was the improvement of the condition of the patient. On the other hand, the presence of certain biases such as overconfidence could have had negative implications on the health of the patient. Integration of the clinical reasoning and critical thinking would have been ideal in enhancing the outcome of the condition of the patient. These tools would have been essential in the achievement of quality decisions while limiting potentiality of threats and biases, which might have negative implications on the conditions of the patient. In addition, there is need to limit overconfidence as well as confirmation of diagnosis in handling such health conditions. Nurses should consider evaluation of possible alternatives while seeking to refute abnormal from normal thus efficiency and effectiveness in decision-making process. It is recommendable for nursing practice to consider integration of the two concepts: critical thinking and clinical reasoning to arrive at quality decisions in accordance with the health conditions of the patients. In retrospect, things could have occurred differently. In the first instance, there would have been need to consider diverse options, which might be responsible for decrease in the BP. In addition, the process should have involved consultation of the doctor immediately on the implications of the patient after the surgery process. Moreover, the process should have focused on examination of potential actions and interventions with the intention of choosing the most effective approach to handling the condition of the patient. In future, there is need to develop an effective relationship as well as communication system with the doctor on the potentiality of such complications. Furthermore, there is need to integrate and incorporate critical thinking as well as clinical reasoning in the course of making valuable decisions in accordance with the past and present information on the condition of the patient. The experience was a valuable encounter because of the emergence of new options on how to handle decision-making appropriately in relation to the conditions of the patients. Conclusively, clinical reasoning refers to process by which nurse and other clinicians collect cues, process information, come to an understanding of a patient problem or situation, plan and implement interventions, evaluate outcomes, and reflect on while learning from the process. 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