Clinical Reasoning Cycle and Challenges in Critical Care Units

Running head: ASSESSMENT 2
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Assessment 2
Student’s Name
University

ASSESSMENT 2
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Assessment 2
Part A: Clinical Reasoning Cycle
The clinical reasoning cycle provides the process for nurses to collect cues, process
information, understand the patient situation, develop a plan of action, implement the plan,
evaluate outcomes and reflect on the process (Levett-Jones, 2013). This process is important in
the decision making made by nurses when dealing with patients.
Ms. Jones is a 17-year-old woman who presented to the local emergency department with
fever, flank pain, and dysuria. She has a history of diabetes mellitus. For management, the
patient was put on pyelonephritis and was placed on IV antibiotics. At 1800hrs her observations
were recorded as charted between the flags, she was altered and orientated. Initially, she had
been polyuric in ED and tolerated sips of oral fluid. She will later appear pale and felt hot/sweaty
and not ‘herself’. The condition of the patient kept deteriorating. The hospital guidelines require
that require high dependency unit to be located to the medical ward for assistance if needed. This
means that the RN in HDU was required to check the medical RN for assistance in the ward.
Registered nurse Cameron did not make the request and did not pick checkup calls by the HDU
RN. Cameron documented the clinical signs of the patients at 0150hrs Temp 38.8, P 128, RR 29
and BP 89/40 SaO2 95% and did not make any other assessments despite the patient remaining
polyuric. The handover was done at the nurse station and not the ward, and when the RN that
took over the shift assessed the patient was pale thus a rapid response was made moving the
patient to ICU but she died of sepsis and DKA secondary to her pyelonephritis.
From the patient’s condition and the nature of the care that she received, three issues can
be seen in the study. The first issue is the patient did not get adequate care during the night which

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could have been associated with the challenge of managing the ward with other patients. The
second issue is that there was no regular assessment of the patient throughout the night. She was
only assessed once despite the nature of her condition that was changing. Lastly, there was a
challenge with the shift handover by RN Cameron. The reason behind the death of the patient
was clinical negligence and the failure by the RN Cameron to follow the established guidelines
on caring for the patient and handover.
The goal of this study will be to determine the required practice of caring for such
patients and the handover method that high dependency nurses need to use when dealing with the
patients.
From the case study, I believe the cause of death for the patient was clinical negligence
which could have been avoided. As a nurse, I think following clinical guidelines is important in
the delivery of care and improving the quality of life of the patient.
Part B:
Issue one: Matlakala, M., Bezuidenhout, M. C., & Botha, A. (2014). Challenges
encountered by critical care unit managers in the large intensive care units. Curationis,
37(1), 1-7. doi:10.4102/curationis.v37i1.1146
The article presents challenges faced by the nurse who cares for critical care patients and
the demands of the jobs. This is due to poor planning by unit managers and the failure to allocate
adequate personnel towards. Through a qualitative, exploratory and descriptive study of five
hospital ICU units in Gauteng South Africa, interviews were collected to address the research
problem. The findings revealed five themes problems, layout, and structure of the units, human
resource issues, provision of materials, presence of stressors and visitors to the ICU. The study