Mrs Williamson is a 76-year-old woman admitted to your Orthopaedic ward from the Emergency Department (ED) after she had a fall at home. The ED doctor has referred Mrs Williamson for investigations regarding a possible left foot metatarsal bone fracture and ordered further investigations. Mrs Williamson has had an initial dose of 1000mg Panadol in ED 3 hours ago; with an ongoing order of 1000mg of Panadol PRN 6 hourly. The physical exam shows that Mrs Williamson has pain and redness of her left foot, which has increased over the last 3 hours despite analgesia, and her pain level now is 8/10. She is unable to bear weight on the affected foot. Mrs Williamson is oriented and alert, but concerned as she was brought to the hospital alone.
Mrs Williamson has a history of high blood pressure (hypertension) and she is on antihypertensive medication, Avapro 150mg/day. Mrs Williamson was an active member at the local bowling club and local church, but since her husband died 12 months ago, she has not attended church or bowling. When you introduce yourself to Mrs Williamson, she tells you that she “does not want to be in hospital” and asks you “when can I go home?”
Mrs Williamson’s vital signs upon admission to the ward are:
• Blood pressure 145/90 mm Hg
• Temperature 36.8° Celsius
• Pulse rate 110 beats per minute
• Respiration rate 18 breaths per minute
• Oxygen saturation 95%
Note: The purpose of this assessment is to gain knowledge of the theoretical aspect of the Clinical Reasoning Cycle.
Ingham-Broomfield, B. (2018). Chapter 11: Critical Thinking and the Nursing Process. In A. Berman, S. Snyder, T. Levett-Jones, T. Dwyer, M. Hales, N. Harvey, …D. Stanley, Kozier and Erb’s fundamentals of nursing (4th Aust. ed., Vol 1, pp. 192-203). Melbourne, Vic.: Pearson.
Levett-Jones, T. (2018). Chapter 13: Diagnosing. In A. Berman, S. Snyder, T. Levett-Jones, T. Dwyer, M. Hales, N. Harvey, …D. Stanley, Kozier and Erb’s fundamentals of nursing (4th Aust. ed., Vol 1, pp. 221-229). Melbourne, Vic.: Pearson.https://charteredessay.com/learning-resources-required-readings-mcgonigle-d-mastrian-k-g-2017-nursing-informatics-and-the-foundation-of-knowledge-4th-ed-burlington-ma-jones-bartlett-learning/
Levett-Jones, T. (Ed). (2018). Clinical reasoning: Learning to think like a nurse. Frenchs Forrest, NSW: Pearson
Levett-Jones, T., Hoffman, K., Dempsey, J., Jeong, S., Noble, D., Norton, C., . . . 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. Nurse Education Today, 30(6), 515-520.
The following questions will explore each aspect of the clinical reasoning cycle. You MUST use the required readings, the scenario, and the Clinical Reasoning Cycle (CRC) (Levett-Jones, 2018) to assist you to answer these questions. APA referencing is required for these readings and any additional references, such as relevant assessment tools and nursing literature.
You will also be expected to use your critical thinking skills when providing your answers. Critical thinking can be defined as, -the art of analysing and evaluating thinking with a view to improving it- (Paul & Elder, 2009). Short answer questions are those written in sentence and paragraph format, and can be up to 500 words. Use the word count provided for each question as a guide to how much detail you should provide in your answers.
Task Format/ Presentation:
• Short answer questions must use full sentences and paragraphs unless stated otherwise (i.e. when asked to list you may use bullet points), and formal academic English.
• APA style in text referencing and an APA style reference list on a separate page at the end of your assignment
• Direct quotations are NOT to be used for this assignment
• 11 pt Arial font, with 1.5 line spacing.
• Include each question number as a subheading when presenting your answers (i.e. Question 1, Question 2, etc.)
• Include your name, student number, the NURS1201 course code, assignment title, and page numbers in the header and/or footer of your document.
• Word Count 1800 words.
1) Using the Levett-Jones et al. (2010) article, discuss the importance of clinical reasoning in relation to preventing patient deterioration and maintaining safe nursing practice. (200 words maximum) [4 marks]
2) The first phase of the CRC is: Consider the Patient Situation. Identify the aspects that are considered when evaluating the patient situation; and why it is an important initial step in the CRC? (100 words maximum) [2 marks]
3) The second phase of the CRC is: Collecting Cues and Information (250 words maximum) [Total 8 marks]
a) Discuss the importance of collecting cues. In your answer consider the possible consequences for not collecting enough cues, and how therapeutic communication could impact the collection of cues. [2 marks]
b) Current information: Using the scenario, provide a list of all the cues that you identify based on the current information for Mrs Williamson. [ 3marks]
c) Gather new information: Based on the current information listed for 3b, list three (3) additional assessments that you would conduct and provide a brief rationale for each, using the literature to support this discussion. [3 marks]
Note: You can include any assessment that relates to Mrs Williamson. The assessment does not have to relate to the course content.
4) The third phase of the CRC is: Processing Information. As you progress through the degree you will become more confident with processing information, at this point we will focus on the following: (250 words maximum) [Total 8 marks]
a) Briefly describe what is involved in the processing information phase. As a nurse, what is the purpose of processing information? [ 2 marks]
b) Identifying normal versus abnormal: Using your list of cues in question 3b, list what cues you consider are not in the normal range for Mrs Williamson (using supportive literature) [ 4 marks]
c) Discriminate: From the cues identified above, identify the one cue that would be your priority for Mrs Williamson (what are you most concerned about), and why? [ 2 marks]
5) The fourth phase of the CRC is: Identifying problems or issues. (The terms “nursing problem”, “nursing issue” and “nursing diagnosis” are interchangeable during your degree). The purpose of generating a nursing problem and stating what it is related to and evidenced by is to further your understanding of relationships when using clinical reasoning. (250 words maximum) [Total 10 marks]
a) Explain the difference between an actual and a potential (at risk) nursing diagnosis. [ 2 marks]
b) Explain the role of “related to” and “evidenced by” statements when making a nursing diagnosis. (When answering this question explain what information nurses use to make these statements? Be sure to distinguish which information can be used for “related to” and which information that can be used for “evidenced by” statements in your answer). [3 marks]
c) Identify one (1) priority actual nursing diagnosis for Mrs Williamson using “related to” and “evidenced by” statements. [3 marks]
d) Identify one (1) potential nursing diagnosis for Mrs Williamson using a “related to” statement. [2 marks]
An example of nursing diagnosis statement is:
Altered body temperature higher than Normal – related to – Infection process evidenced by – increase in temperature 38.5oC (febrile) and heart rate 98 (tachycardia).
• there may be multiple cues that provide the evidence of a nursing problem
• this is only an example; don’t use this example for this assessment
6) The fifth phase of the CRC is: Establishing goals. Goals must be S.M.A.R.T (Specific, Measurable, Attainable, Realistic and Timely). Identify one (1) appropriate SMART goal for each diagnosis. (50 words/ 2 goals maximum) [4 marks]
Example: to return body temperature to below 37.5oC within one hour
7) The sixth phase of the CRC is: Take action. Taking action identifies nursing actions/interventions that you will undertake to achieve the goal. The action should be related to the priority nursing diagnosis identified in Phase four (question 5, part C of this assessment). Nursing actions/interventions may include Assessments, Education, Medication, and Care activities. (Note: Please do not include the nursing action of
Consultation/communication/referral) (200 words maximum) [Total 10 marks]
a. Assessment: Identify an Assessment that you will undertake with Mrs Williamson and provide a rationale. [2.5 marks]
b. Education: Identify what Education you could provide to Mrs Williamson and provide a rationale. [2.5 marks]
c. Medication: Identify a medication related action for Mrs Williamson and provide a rationale. [2.5 marks]
d. Intervention/care: Identify a nursing care you could provide to Mrs Williamson and provide a rationale. [2.5 marks]
8) The seventh phase of the CRC is: Evaluation. This ensures that you know what you expect to see as a result of your action/nursing intervention. What is the purpose of evaluating nursing interventions as part of the clinical reasoning cycle? Consider how and when nurses evaluate nursing interventions. (150 words maximum) [ 4 marks]
9) The eighth and final phase of the CRC is: Reflection. Reflection is an important part of nursing, the clinical reasoning process, and assists with your future learning. After undertaking this assessment task, use the Gibbs reflective cycle to reflect on what was your most challenging moments in clinical reasoning and why this so? (100 words maximum) [4 marks]