Assessment on Clinical Reasoning Cycle 2022

Running head:ASSESSMENT ON CLINICAL REASONING CYCLE
ASSESSMENT ON CLINICAL REASONING CYCLE
Name of the Student
Name of the University
Author’s Note

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Introduction
The case study aims at the mental health aspect of a patient, and the patient is suffering
from major depressive disorder as per the diagnosis andthecase study will proceed from the
aspect of clinical reasoning cycle, as it gives a positive outcome of a patient’s point of view
(Levett-Jones, 2018).The nurses who have the responsibility to take care of mental health
affected patients should have their set of rules and implementations with a holistic approach so
that the patient is given the utmost care and facilities to heal quickly. Mr Jim Gray is a 28 year
old man, who is currently diagnosed with major depressive disorder after being admitted to a city
inpatient mental health unit. He attempted suicide five days before being diagnosed, as his
mental health was taking a toss due to his family’s economic issues. Jim is a son of grazier living
in the north of Brisbane, due to the sudden droughts faced in the area his farm is being
deteriorated, which is causing a financial strain in the family. His family is expecting him to take
over the farm after his father retires. However, this is increasing stress and pressure in his life
causing him major depressive disorder. The report below will be presented according to the
clinical reasoning cycle, which shows the data in a systematic format keeping in mind the
patient’s point of view and the information regarding the disorder.
Content
The person’s situation will be reflected upon using the clinical reasoning cycle. During
the handover, it was noted that the patient was irresponsive to most of the interactions and had no
interest in being cured. He showed signs of suicidal tendencies as he mentioned that he does not
want to live anymore, not waking up for breakfast, going to lunch after getting forced, not eating
anything in lunch, immediately returning to bed and not taking part in any activities so that there

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is no scope for any social interaction. His vital signs were routineas the blood pressure was
125/75 mm/Hg, pulse rate was 66 bpm, temperature was 36.3 C, and respiratory rate was 18 per
minute when I checked the parameters.
However, he had burn marks made by the rope he used to hang himself during the
attempted suicide and some minor bruising and skin tearing due to the fall. Venlafaxine an anti-
depressant and few multivitamins were prescribed to him when he was admitted. Moreover,
when I went for my routine check-up he showed no signs of enthusiasm or motivation to be
treated for his issues, he was not ready to talk to me, pulled his blanket on his face, and just said
that he wants to die. These signs show that he is suffering from severe depression. Being a nurse
in a mental health department,my roleis to help this patient in coming out of this black hole that
is decreasing his will to live. The processing of informationsis done though interepretion,
discriminating, matching, relating and predicting (Slavich & Irwin, 2014).
Major Depressive disorder is a disease that causes severe mood swings, hopelessness,
disinterest in the normal activities of life, detesting social interaction, showing vegetative
symptoms such as insomnia and loss of appetite. It has quite a no of root causes such as the
genetics, psychosocial issues, economic factors, health complications and other such problems
that can increase the stress or the mental depreciation of any individual (Otte et al., 2016).
After observing all the issues and health assessment results, the relevant threeissues seen were:
1. Family’s expectations
2. Financial burden
3. Feeling of Hopelessness

3ASSESSMENT ON CLINICAL REASONING CYCLE
As seen in this case study, firstly, Jim‘s family has expectations from him that he will
work on the farm after his father stops working. This is one of the reasonshe has stress,his fear of
not fulfilling the expectations. Depression is caused due to such triggers, and it can be termed
under psychosocial reasons. Work related stress has a strong correlation with depression, it is
perceived that people suffering from depression are usually stressed due to work life. Perceived
anxiety and self-esteem are the triggers of work stress leading to major depressive disorder (Lee,
Joo& Choi, 2013).
Secondly, the continuous stress of making ends meet for his family.One of the essential
means to survive is money. Due to poverty, people are not able to get basic human needs such as
food, clothes, home, medical facilities, education and hygiene. Jim’s family was suffering from
financial constrains due to the drought in his farm. As he is the next earning member after his
father, it is also his responsibility to look after his family’s needs, which is deteriorating his
mental health.Mental health gets affected due to poverty and the power of earning gets slow due
to mental health issues (Anakwenze&Zuberi, 2013).
Lastly, what triggered Jim’s depression is the feeling of hopelessness, as hope is the sole
motivation for anyone to survive, especially for people who already have extreme negativities
going on in life. It is quite evident from the conversation he had with me about not wanting to
live anymore. The socio economic reason is the cause for the cynical attitude. Emerging adults
are suffering from suicidal tendencies due to racial or ethnic reasons, hopelessness and culture
related issues. Depression is the first stage which leads to the feeling of giving up in life and
surrendering to suicide (Polanco-Roman & Miranda, 2013).

4ASSESSMENT ON CLINICAL REASONING CYCLE
Established Goals
A set of goals should be establishedso that patients suffering from mental health illness
and suicidal tendencies getclose monitoring by the health experts and nurses. Further counselling
and therapy is a necessity because the medication is not a thorough treatment. As depression can
be caused due to genetic modelling but also the environmental factors are at action such as stress,
self-esteem issues, economic burden, hopelessness and the feeling of existential crisisit is
necessary to give personal attention as a nurse.(Robson, Haddad, Gray &Gournay, 2015).
Nurses looking after patients should have proper guidance and training when looking
after such patients, as they are vulnerable, and any activity or behavior can trigger their anxiety
and depression. Jim, in this case tends avoid any human interaction but it is the role of nurses to
make an environment for him to express so that he can release his stress that is causing
depression. Another aspect to be seen in this case is that one of the reasons for Jim to go through
grief is the expectations his family has from him regarding work. This gives an idea to
implement a counselling session for his family. They should be informed that all individuals are
different and they should be treated in the same way, if Jim is not comfortable with working in
the farm, he should be given the option to refuse it. Emotionally manipulating him, that he
should help his family economically after his father stops working can create emotional unrest in
his mind.
Major Depressive Disorder is the cause of suicidal tendencies in the majority of the
population and is the most prevalent health disease globally. However, it makes it an
essentialfactor, being mental health nurses it is necessary to look after this issue. Major
Depression Disorder is mostly prevalent in adolescence and adulthood as that is the prime age of
goingany through changes and finding new goals and motive. The nurses should personally

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intervene in the treatment of such patients. From helping them in thinking positive to making a
favourable environment in the mental health unit so that they find hope and goodness in living
their life.
Intervention
The nursing care implemented in this case is the involvement of nurses in giving the
utmost care and help to patients suffering from a mental health disorder, the complications they
are going through should be well heard and taken into consideration when advising them about
anything. Jim attempted suicide, which showed that he felt that he had no reasons to live
anymore that triggers the point of hopelessness. It occurred after the consistent misfortunes in his
life, and it started from drought in his area, which caused the financial strain in his family to the
expectations that he will work in the farm after his father retires. His interactions with me proved
that even after the suicide attempt he was complaining that why is he still alive as he had no wish
to live anymore, the burn marks in his neck and the tearing of his skin will keep reminding him
about the displeasures of his life. The personal outcomes of Jim are not something which will
give him any positive hopes to continue with his life, so it is the role of the nurse to look after his
needs and make him open up by reminding him of all the positives he has in his life which others
do not have (Greenberg et al., 2015). As long as he is in the mental health unit, it is expected that
he will get the prime care and attention like how it is given in any holistic centered
systembecause of the severity of his condition. People having suicidal tendencies are in the most
cynical mind space, and that needs serious counselling to personal attention as the feeling of
attempting suicide can occur again if not monitored (Verrocchio et al., 2016).

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Evaluation
The critical issue in implementation of such plans is the mental condition of the medical
experts who will guide these patients. It is seen that nurses have their burdens and stress they
have to deal with, because of the kind of workload and depressive environment commonly found
in healthcare centers. Nurses suffer from occupational stress due to the severity of their work,
seeing chronic diseases and the dilemma of the patients it makes them feel low and negative
(Saravanan &Wilks, 2014). It is necessary to ensure therapies and counselling for nurses as well
so that they treat these patients better, as feeling sad and exhausted can make them feel irritated
and angry when dealing with such patients who need the utmost care and patience (Segal &
Teasdale, 2018). Having a positive outlook in dealing with issues can help them in making the
patients feel the same, this will cause a two way positivity in these mental health units (Happell
et al., 2013).
Reflection
Jim’s case has been highlighted that he is a person with mental issues and he has a
suicidal tendency. After being treated he complianse about why he has been saved and not dead
yet. Based on this case and condition of Jim I can reflect that he needs attention and positive
communication with patient centred approach will be the intervention for his situation (Iwata,
Ota &Duman, 2013). This case helped me in learning about mental issues and the possible ways
that can be positively implemented for addressing the issues of the patients experiencing this
condition. Hence, implementing the clinical reasoning cycle helped me in evaluation and
analysis of case. Based on the evaluation and analysis I can reflect that the interpersonal skills of
the nurses required for the psychologically affected patient (Hunter & Arthur, 2016). The leaning
from this case study also helped me in gathering experience and it will be helpful in the

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implementation of the approapriate strategies in future practices. I can also state that Jim’s
condition should be prioritized by the nurses for the better outcome that is reducing the risk of
the suicidal activity of the patient. The holistic approach and the proper communication
strategies should be implemented for this kind of case handling (Carter et al., 2015). Hence, I
should focus on the practiced based learning of these skills for proiding better support to the
patients with psychological disparities.
Conclusion
To conclude, Jim’s personal outcome should be reflected. His suffering from major
depressive disorder made him attempt suicide. As he was going through so much in life being a
grazier’s son from a rural community, having financial burdens due to a drought struck farm,
family’s expectation to fulfill and having no hopes in life. Hebeing admitted to a mental health
unit should be helpful to his mental space with medical experts who are up for his assistance
around the clock.

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