Analysis of Clinical Reasoning and Integration Models

This assignment involves analyzing several research papers and articles on clinical reasoning and integration models. The selected publications discuss topics such as care integration from the ground up, using clinical reasoning and simulation-based education, clinical data integration models, assessing progression through virtual patients, clinical nursing reasoning in practice, the role of technical advances in patient-reported outcomes, integration of symptom ratings, consequences of contextual factors on clinical reasoning, safety and clinical activity of MK-3475 as initial therapy in NSCLC, and instinctive clinical teaching. The assignment requires a detailed analysis of these models, their applications, and implications for clinical practice.

CASE STUDY IN ESSAY FORMAT

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
MAIN BODY...................................................................................................................................1
CONCLUSION................................................................................................................................4
REFERENCES................................................................................................................................5

INTRODUCTION
Older adults are surrounded by various health related problems. They suffer from the
diseases which deteriorate their quality of life. Disorders affect their mental and physical well-
being. To improve and reduce these problems', health care professionals use clinical reasoning
cycle which helps them in collecting facts related to patient’s situation, establish goals and take
actions in order to enhance condition of service user (Hunter and Arthur, 2016). This report will
include nursing care plan and strategies that may support in improving conditions of aged adults.
It would also consist of Miller's functional consequences' theory in order to implement wellness
in adults.
MAIN BODY
Collection of information
Clinical reasoning cycle allows nurses to collect data regarding the facts or issues faced
by Mr. Dinh. His medical history has revealed that he was diagnosed from multiple sclerosis six
years ago. He had also suffered from osteoarthritis which is now in control. He has also been
analysed with problems such as vision impairment, numbness on face and a pain while moving
his head and neck. Issues like urine incontinence is also seen in Dinh (Verka and Dreyfus, 2014).
Presently patient is prescribed several medicines such as Panadol Osteo, terfluinomide,
prednisolone which are mainly given to cure multiple sclerosis and osteoarthritis.
Identifying problems
Mr. Dinh is suffering from various problems which include blurred vision, numbness in
face and an electronic type of feeling while moving his head and neck which have vital signs of
suffering from multiple sclerosis. Living alone can also be one of the reason for developing of
this disorder. Due to this, patient is also facing ongoing grief which forces him to have suicidal
tendency all the time (Jensen and et.al., 2015). Service user has been diagnosed with urine
incontinence which might appear due to consumption of high doses of medicines.
Establishing goals
Nurses need to establish objectives which support in improving quality and wellness of
patient’s life. They are required to set priorities in order to achieve the targets. Health-care
professionals should implement strategies that focuses on ageing problems, biological, safety,
psychological and self-actualization needs of Mr. Dinh. Main goal of nurses should include
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providing education to patient about the disease from which they are suffering. Imparting
medications supports in reducing pain which is occurring while suffering from diseases. Another
objective which nurses can implement is to understand patients’ needs and providing treatment
by respecting their culture.
Taking action
Actions taken by nurses will be purely based on the priorities defined by them. For better
understanding of the patients' situation, they can also make use of Miller's functional
consequences theory to identify the influence on Mr. Dinh and their level of functioning. They
have strategies which focus on elements like physical, biological, safety and self-actualization
that can be effectively used by health-care professionals by implementing use of human need
theory. As it has been noted that service user has been facing an ongoing brief which means that
an individual often thinks about suicide and also have anxiety issues (Cohen and et.al., 2015).
Nurses can make use of self-actualization theme and support patient in understanding and
supporting for acceptance of person, developing problem solving attitude in them, and making
them self-directed.
Advancing age is also one of the serious issues and nurses can work in accordance to
expand life expectancy of old aged people. As study reveals that Mr. Dinh is an older adult and
living alone from past one year. So nurse can make use of psychological theory on ageing which
addresses variables like learning, intelligence, memory and motivation (Liou and et.al., 2016).
This model focuses more on cultural aspects of patient.
Similarly, as Mr. Dinh is a Vietnamese so specialists may provide care which will lay
emphasis on respecting the beliefs of his culture and tradition. Carers will also offer help to
service user to give them power to accept and adapt experience which has been happened in past
and changes occurring in present life. These models allow health-care providers in knowing the
needs and demands of service user and provide treatment according to that. This also helps in
improving the quality of life for old aged people.
For supporting and enhancing health conditions of older people, nurses can also develop
a care plan to recuperate their well-being (Ethier and et.al., 2015). In this process, service users'
environment will be diagnosed for the purpose of knowing about risk factors that might arise out
of that (Nursing care plan for olderly adults, 2017). For example, Mr. Dinh is living alone and
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has no children, so there is nobody to support him, and thus, these elements can also give rise to
depression and anxiety.
Nursing plan includes interventions in context of medicines provided to old people in
order to evaluate and monitor it for consumption. Mr. Dinh is prescribed with drugs that include
Panadol Osteo, terfluinomide, prednisolone for curing multiple sclerosis and osteoarthritis which
should be analysed by health-care professionals. Benefits and side-effects related to them must
also be made aware to patients.
All the physical activities done by elderly people must be monitored by nurses and any
vital changes in their behaviour must be noticed and immediately addressed by health-care
providers. Care plan will also help nurses in documenting everything including symptoms of
service users (Dalton, Gee and Levett-Jones, 2015). There are few signs like image blurriness,
numbness on face that has been suffered by Mr. Dinh should be noted by nurses in order to
provide them better and effective treatment. Old aged patients require emotional support and as
Mr. Dinh is surrounded by feeling of isolation so care should be provided in a way that he can
share his beliefs, views, sentiments, thoughts with health-care providers.
Nursing strategies
Various strategies can be applied by nurses for treating an unexpected health situation
which might occur in service users. This might include enhancing the communication skills so
that they can better understand the situation of patient. When an unexpected condition occur
health-care providers should provide extra care to service user. They should encourage Mr. Dinh
to have a healthy diet and increase his involvement in physical activities. Diagnosis should be
done by specialists by using easy and understandable language. They should not make use of
tough medical terms (Yang and et.al., 2014). Nurses should motivate patients to share their
thoughts with them that will build personal relationship and help an individual to come out of the
feeling of depression and seclusion.
Health-care providers should make notes regarding patients past history, so that even if
an unexpected situation occur, it can be effectively addressed by them. While documenting
information, nurses should take care that no personal data related to service user must be
disclosed by them. It should remain confidential and secure with them. All these practices should
be followed by providers on ethical background. They should not be involved in doing
discrimination related to age, gender or sex (Rizvi, & et.al., 2014). Patient should be motivated
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to make their own decisions. Also ethical strategies like beneficence should be used by nurses
which includes that they should work in order to provide advantage of better life to patients.
Evidence based practice can also be used by health-care providers to improve the outcome of Mr.
Dinh.
Ways to manage consequences while treating older age people
Consequences may be faced by nurses while treating old aged patients. For overcoming
these, health-care providers can use effective communication in order to reduce problems
between them. Efficient interaction can help in reducing gap between professionals and users.
Specialists are expected to use easy language and slow volume while treating an old age person
(Forsberg and et.al., 2016).
Positive gestures and eye contact can also be used by nurses to make conversation
productive. They should treat elders with respect and dignity and try to solve issues by
discussing with them. Treatment should be provided with honesty which would assist in building
relationship of trust. Nurses should act as friends to eliminate consequences between them. This
will help in improving their quality of treatment. It also influences their relationship (Martel and
et.al., 2015).
Older people can also suffer consequences of health deterioration while living at home as
they might face injuries while falling from bed and can hurt themselves by performing daily
routine tasks like cooking, washing utensils or clothes. These problems may impact their body
severely. Accidents may also occur like Mr. dinh might get fracture by falling from bed, or by
hitting table or any other material.
Evaluation and interpretation
Mr. Dinh has been suffering from multiple sclerosis which has affected his body
severely. Currently, various signs like blurred vision, numbness on face are evident in his life
(McBee and et.al., 2015). It has been assessed that these problems can be solved by following
various nursing strategies. Also, health-care professionals can make use of holistic approach
which support in knowing exact needs and demands of patients. They can make use of evidence
based practice which includes multi-disciplinary team like dietician, physicians that can help in
improving condition of patient. By keen listening and supervising, it can support nurses in
knowing their service users better. It has also been interpreted that ongoing grief of patient got
occurred because of living alone and having no emotional support.
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CONCLUSION
This is to summarised that this essay consisted of health issues faced by Mr. Dinh. It has
been analysed that the patient is suffering from multiple sclerosis, ongoing grief and
osteoarthritis. Service user has also recognised signs like numbness on face, weakness etc.
Further, it involved few nursing strategies like providing proper diet to patient to improve their
health conditions. Essay also showed ways to reduce consequences that has been arisen between
patient and service user. There are methods that may include interacting effectively with patient
to reduce gap between them.
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REFERENCES
Books and Journals
Cohen, D. J. & et.al., (2015). Understanding care integration from the ground up: Five
organizing constructs that shape integrated practices. The Journal of the American
Board of Family Medicine.28(Supplement 1). S7-S20.
Dalton, L., Gee, T. & Levett-Jones, T. (2015). Using clinical reasoning and simulation-based
education to'flip'the Enrolled Nurse curriculum. Australian Journal of Advanced
Nursing, The.33(2). 29.
Ethier, J. F. & et.al., (2015). Clinical data integration model. Methods of information in
medicine. 54(01). 16-23.
Forsberg, E. & et.al., (2016). Assessing progression of clinical reasoning through virtual patients:
An exploratory study. Nurse education in practice. 16(1).97-103.
Goudreau, J., Boyer, L. & Létourneau, D. (2014). Clinical nursing reasoning in nursing practice:
A cognitive learning model based on a think aloud methodology. Quality Advancement
in Nursing Education-Avancées en formation infirmière.1(1).4.
Hunter, S. & Arthur, C. (2016). Clinical reasoning of nursing students on clinical placement:
Clinical educators' perceptions. Nurse education in practice.18. 73-79.
Jensen, R. E. & et.al., (2015). The role of technical advances in the adoption and integration of
patient-reported outcomes in clinical care. Medical care.53(2).153.
Liou, S. R. & et.al., (2016). The development and psychometric testing of a theory‐based
instrument to evaluate nurses’ perception of clinical reasoning competence. Journal of
advanced nursing. 72(3). 707-717.
Martel, M. M. & et.al., (2015). Integration of symptom ratings from multiple informants in
ADHD diagnosis: A psychometric model with clinical utility. Psychological
assessment.27(3). 1060.
McBee, E. & et.al., (2015). Consequences of contextual factors on clinical reasoning in resident
physicians. Advances in Health Sciences Education.20(5). 1225-1236.
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Rizvi, N. A. & et.al., (2014). Safety and clinical activity of MK-3475 as initial therapy in patients
with advanced non-small cell lung cancer (NSCLC).
verka, P. A. & Dreyfus, J. C. (2014). Clinical integration of next generation sequencing:
coverage and reimbursement challenges. The Journal of Law, Medicine &
Ethics.42(1_suppl).22-41.
Yang, Y. M. & et.al., (2014). Instinctive clinical teaching: erasing the mental boundary between
clinical education and patient care to promote natural learning. Journal of graduate
medical education.6(3). 415-418.
Online
Nursing care plan for olderly adults. (2017). [ONLINE] Available through:
<https://www.nursebuff.com/nursing-care-plan-for-elderly/>
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