Integration of Clinical Reasoning Skills

This report explores the significance of integrating clinical reasoning skills in healthcare professionals, particularly nurses. It examines a case study of laparoscopic treatment for peritonitis, illustrating how following clinical reasoning stages can enhance patient diagnosis and care. The assignment emphasizes that clinical reasoning is essential for ensuring quality health services.

CLINICAL INTEGRATION -
MEDSURG

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
A. ANALYSIS OF PATIENT'S SITUATION ...............................................................................1
B. COLLECTING INFORMATION ..............................................................................................1
C. INTERPRETATION AND ANALYSIS OF COLLECTED INFORMATION.........................3
D. IDENTIFICATION OF ISSUES ...............................................................................................3
E. ESTABLISHING GOALS..........................................................................................................4
F. TAKING ACTIONS....................................................................................................................5
G. EVALUATION AND INTERPRETATION..............................................................................6
CONCLUSION................................................................................................................................6
REFERENCES................................................................................................................................8

INTRODUCTION
Clinical reasoning is known as the process through which nurses apply their knowledge
and experiences to clinical situations in order to provide effective health care services. The
integration of nursing practices with this process, the quality of health services can be improved.
These practices lead to accurate diagnosis of medical complications and thus, appropriate
remedies can be taken by the nurses (Clinical Reasoning: An Important Aspect of Clinical Skills,
2017). Report will apply various stages of clinical reasoning to the case study of Ms Melody
King who is suffering from lower abdominal pain and requires laparoscopic surgery. Report will
interpret the situation of Ms Melody King and will analyse her health status by analysing clinical
reasoning practices.
A. ANALYSIS OF PATIENT'S SITUATION
Ms Melody King is 36 years old lady. From the last few days, she has been experiencing
extreme pain in her lower right quadrant abdominal. She is suffering from peritonitis and
appendicitis which is causing inflammation in inner walls of her abdomen and appendix.
B. COLLECTING INFORMATION
The patient requires laparoscopic surgery so that ruptured appendix can be removed. The
following information is essential to develop better understating of treatment procedures and its
impact on the patient.
Medical history of Ms Melody: In the past, she had depression and asthma. These factors must
be considered in the treatment. The surgery can cause stress and infections to her. There are
possibilities that asthma may get triggered due to infections or stress. She has complaints of
ruptured appendix. The delay in its diagnosis has led to appendix burst that was caused due to
Peritonitis.
Current observations of the patient: It is also observed that her abdomen is distended or
swelled. The blood pressure of Ms Melody King is measured as 95/45mmHg. After surgery, the
patient may feel tired due to blood loss and post-surgery, the variations in blood pressure are
observed generally. This should be monitored periodically to avoid any complications related to
it. To control the blood pressure, medications can be given to her if required. Appendicitis can
raise the count of white blood cells. For the patient, heart rate is 120 bpm and temperature is

normal and around 38.0 degree Celsius. Her pain level is high, i.e. 8/10 thus pain killers can be
given and monitoring must be done to control the pain. The ruptured appendix of Ms Melody has
caused infection in her tissues and as a result, she is diagnosed with Peritonitis.
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Treatment plan: The laparoscopic surgery is required for the patient. As compared to the open
surgery method, this treatment methodology will have lower risks of infections and will offer
quick recovery options.
C. INTERPRETATION AND ANALYSIS OF COLLECTED
INFORMATION
Problem evaluation on the basis of collected information
Ms Melody King had depression in the past. The peritonitis can trigger the shock in
patients. So history of emotional disturbance and depression can lead to possibilities of these
shocks for her. Vomiting and nausea can also complement this situation and this patient may feel
more restlessness (Cohen and et.al., 2015). Ms. Melody has also been diagnosed with raised
white blood cells which can be because of low immune system. Respiratory rate is noted at 22
bpm which is quiet low because of the asthma (Dalton, Gee and Levett-Jones, 2015). Generally,
patients suffering from this disease face shortness in breath. It also in future can give rise to
disorder such as COPD, bronchitis, etc. Blood pressure is being analysed at 95/45 that is lower
than normal rate. It can cause severe weakness, clumsiness or drowsiness to Ms. Melody.
Nursing care plans
Post laparotomy surgery is required to monitor several factors like consciousness level,
respiratory tract, temperature and respiratory sounds of the patient. The peritonitis surgery can
cause breathing shortness as the respiratory tract can be disturbed. As patient is already prone to
asthma attack, it becomes the major priority to monitor these factors.
Post-surgery, she may feel anxious and emotionally imbalanced that can lead to
symptoms of depression. To avoid such instances, the registered nurse requires in providing
psychological help to the patient. This can be achieved by involving the participation of carers in
decision making with psychological counselling. Peritonitis also has vulnerabilities to infections
which can be avoided by monitoring the healing progress, and along with, checking and
observing the symptoms of infection and drainage.
D. IDENTIFICATION OF ISSUES
Peritonitis can lead to infections in bloodstreams which can result in organ failure. Thus,
it is significant to address this issue by regularly watching that patient and must avoid any
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infections. The movement of bowel content is restricted by peritonitis so it may be possible that
paralytic ileus can be caused which blocks the bowel.
For controlling the shock possibilities, fluid infusion will be provided. The laparoscopic
surgery will help Ms Melody King to repair the abdominal tissues which are damaged as well as
in draining the peritoneal cavity of the patient (Laparoscopy, 2017).
After laparoscopic surgery patient can also see with pus at the site of surgery and urine
may include instances of blood as post-surgery impact. The suppuration can be observed in the
post-operative recovery. There are very fewer possibilities for the progressive peritonitis and
abscesses in abdomen. But these issues cannot be tolerated. Therefore, suitable antibiotics and
medications for healing the wounds should be provided to her. Patient can also suffer from acute
or chronic pain after surgery However, these effects can be cured after few days. In some cases,
after the surgery patient is also analysed with signs like organ damages and so, it is important for
health professionals to monitor these aspects as well because the timely evaluation of these risks
can minimise their impact.
Earlier the pain level of Ms Melody King was very high. The extreme pain can be
accomplished by fever and septic shocks. It can result in severe damage to nervous system of the
patient and formation of intra-peritoneal scar tissues can occur (Forsberg and et.al., 2016). These
apprehensions are resolved by observing the pain level of the patient. If it is extremely high, then
health professionals must take suitable actions and give effective medications. Any irregular
checking of these effects can cause huge harms and are life threatening for the patient.
E. ESTABLISHING GOALS
Post-operative care holds equal importance for the patient. To help Ms Melody King for
speedy recovery, the following nursing issues are needed to be prioritise and resolved.
Nursing issue 1: Careful and periodic monitoring of body symptoms after treatment
Goal: To avoid the vulnerabilities of infection post-surgery
The most prior issue for the nurse is to eliminate the possibilities of infection risk. Post-
surgery, suppuration and pressure on blood vessels can cause infections. Nurses must accomplish
the goals to avoid this risk. It can be achieved by evaluating the issues like urine output, signs of
progressive or unresolved hypotension and drainage from wounds. Nurses can achieve them and
resolve these concerns by using sterile technique and catheter care (Jensen and et.al., 2015).
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Nursing issue 2: Requirement of multi-disciplinary health groups such as psychologists
Goal: To control the pain level and anxiety of the patient
Another issue is to minimise pain and anxiety in patients due to post-operative weakness.
Nurses can provide comfort measurements like massage or medications for achieving their
objectives. They can establish an emotional connectivity with the patient so that they can express
their apprehensions openly. For resolving this issue, nurses can also seek psychological help.
Nursing issue 3: Post-operative care as well as after discharge concerns
Goal: To establish balance with nutritional requirements
Ms Melody King has undergone surgery so her body has observed changes and lacks
nutrition. One of the critical aims for the nurses is to establish nutrition balance in patients. To
achieve this goal, they face problems like intake restrictions with medicines or lack of regular
interaction with the patient. After discharging patient, it usually avoids instructions for health
care (Cohen and et.al., 2015). Thus, for resolving this issue, nurses can encourage nutritionist to
provide supervision to Ms Melody.
F. TAKING ACTIONS
To reduce the impact of various problems faced by nurses, they can undertake various
actions in order to improve patient’s conditions.
Holistic approach
Holistic approach can be used by health-care professionals which include that treatment should
be provided according to the needs and demands of patients (Haak and et.al., 2014). Evidence
based practice includes that multi-disciplinary team can also be used in order to improve
patient’s outcomes. For example: Ms. Melody is a patient of depression and so, for improving
her well-being, psychiatrist can help. Communication barrier can be removed by using proper
gestures which can help nurses in effective interaction. This practice can also allow in
implementing more professionalism in carers.
Ethical approach
Ethical measures must also be followed like for instance, Ms. Melody should not be
asked with any personal question by health-care providers (Dalton, Gee and Levett-Jones, 2015).
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Act should be cared out by professionals which could benefit users and they should be
encouraged to make their own decisions.
Evidence based approach: In order to address the post-operative issues and surgery related
complexity, the registered nurses must use evidences in decision making. For instance, the
periodic measurement of records like blood pressure, respiration rate will assist them to avoid
possibilities of asthma attack or shocks in case of Ms Melody King.
G. EVALUATION AND INTERPRETATION
Nurses can use various approaches like evidence based practice, holistic method, etc.
These strategies may also be implemented in a better way. Like for knowing patient’s condition,
better person centred approach can also be used. This method helps in effective understanding of
service users’ needs and demands (Goudreau, Boyer and Létourneau, 2014). This practice
motivates the patient to share their views and beliefs to nurses. Health-care professionals should
enhance autonomy in their culture. They should allow service users to make their own decision
without any fear or threat. The active participation of Ms Melody and her carers will improve the
quality of care services and will permit health professionals to take better decisions as well as
judgements.
Better software and methods should be utilised in order to preserve Melody's personal
data. Complete information related to service user must not be shared by health-care
professionals to anyone. For improving their quality of treatment, carers should use non-
judgemental practice (Jensen and et.al., 2015). No discrimination should be done by them
regarding patient's age, caste, religion or sex. In order to avoid post-operative complications,
regular intensive care and recording of health parameters were prepared. It helps the service
providers to eliminate all possible health related risks. If these parameters were not monitored
then, it could have led to various side effects of laparoscopic treatment of peritonitis.
CONCLUSION
From the report, it can be concluded that integration of clinical reasoning skills is
essential and an effective approach for the health care professionals. It helps registered nurses to
identify valid cause of critical situation so that reasonable and qualitative measurements can be
taken to improve the health condition of patient. Report has analysed the medical situation of
patient given in case study and has shown that implementation of clinical reasoning stages is
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very crucial for health care providers. The diagnosis of care seekers is more accurate when these
stages are followed. Hence, it can be said that integration of these practices is essential for
ensuring the quality of health services.
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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.
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.
Haak, D. & et.al. (2014). Simplifying electronic data capture in clinical trials: workflow
embedded image and biosignal file integration and analysis via web services. Journal of
digital imaging. 27(5). 571-580.
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.
Online
Clinical Reasoning: An Important Aspect of Clinical Skills. 2017. [Online] Accessed through
<http://cliniciantoday.com/clinical-reasoning-an-important-aspect-of-clinical-skills/>.
Laparoscopy. 2017. [Online] Accessed through
<https://www.healthline.com/health/laparoscopy>.
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