Clinical Reasoning Cycle for Mental Health Disorder Patient

Running head: CLINICAL REASONING CYCLE
3807NRS Advanced Clinical Decision Making
Name of the Student
Name of the University
Author Note

1CLINICAL REASONING CYCLE
Introduction
According to Smith and Connolly (2019) the present-day healthcare environment has
been identified to be a dynamic one, and encompasses enduring types of nursing practice that
continuously evolve, in order to meet the essential opportunities and challenges of changing
time. Apart from addressing the physical ailments of people who seek care at hospitals, nursing
professionals also have the responsibility of formulating and delivering support, nursing, and
medical care to individuals who suffer from a plethora of mental health issues as well. It is
imperative for registered nurses to work collaboratively with the patients, their families, and
communities, in order to assess their immediate mental health needs, while accurately applying
the nursing process for evaluating, diagnosing, and treating such people of mental disorders
(Townsend & Morgan, 2017). Clinical reasoning cycle has been developed by Levett-Jones, in
order to provide assistance in professional practice, particularly to novice nursing students and
newly registered nurse, for enriching their problem solving and critical thinking capability,
besides fostering continuous learning (Levett-Jones et al., 2010). This essay will elaborate on the
application of the aforementioned steps in a clinical scenario that involved a patient suffering
from mental health disorder, and will also contain correlate the nursing practice with the Nursing
and Midwifery Board of Australia standards of practice for registered nurses.
Considering the patient
The first step of the clinical reasoning cycle places an emphasis on considering the
health condition of the patient who is being provided care, in order to obtain an initial overview
of the case (Levett-Jones et al., 2010). The patient X was a 21 year old female who was a student
at the University. She had been admitted to the emergency department of the healthcare

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organisation following a failed suicide attempt. At the time of admission, she was unconscious
and was accompanied by her sister. She had a history of substance abuse since the age of 16, and
demonstrated impairment in effective communication. There was a family history of
schizophrenia in her grandfather.
Collecting cues
The second step of the clinical reasoning cycle focuses on conducting a thorough and
comprehensive review of existing information about the patient decide assessing patient chart
results of test previous assessments and patient history (Levett-Jones et al., 2010). The NMBA
standards highlight the importance of conducting comprehensive health assessment in the
patient, with the use of a plethora of assessment techniques. Upon admission of the patient, she
was administered the Brief Psychiatric Rating Scale (BPRS) for evaluating her psychiatric
symptoms related to unusual behaviour, hallucinations, depression, and anxiety. High scores of 6
and 7 were found in several domains such as, self-neglect, hallucinations, disorientation,
suicidality, hostility, emotional withdrawal, uncooperativeness, and suspiciousness (van Beek et
al., 2015). Following uses of the scale, she was also subjected to the positive and negative
syndrome scale (PANSS) for obtaining an exhaustive explanation on how severe were her
symptoms, regarding the mental disorder that she was suffering from. High scores in the
positive, negative, and general psychopathology skills were respectively 21, 22, and 37
(Østergaard, Lemming, Mors, Correll & Bech, 2016).
Taking into consideration the fact that several clinicians have recorded the presence of
abnormal pain sensitivity amid patients who has been diagnosed with schizophrenia, the patient
was also ask to provide response to the verbal Numeric Pain Rating Scale (NPRS), in order to
provide an idea about the intensity of pain that she was suffering from (Horan et al., 2016). On

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evaluating the responses obtained from the patient it was found that she reported a pain score of
7, thus suggesting that the intensity of pain was higher than moderate (Castarlenas, Jensen, von
Baeyer & Miró, 2017). Any kind of deviation in vital sign helps in the immediate detection of
clinical deterioration. An assessment of her vital signs was also conducted and although she did
not demonstrate any abnormality in her blood pressure, body temperature, and respiratory rate,
she demonstrated a heart rate of 106 beats per minute, which has more than the normal value
(60-100 beats per minute) (Mok, Wang & Liaw, 2015).
Process information
In the third stage of the clinical reasoning cycle, the nurses are expected to interpret the
health data obtained from the knowledge that has been acquired, after conducting health
assessment (Levett-Jones et al., 2010). This stage is conducted with the aim of accurately
identifying the clinical condition of the patient and preventing the onset of any adverse health
outcomes. The initial concerns for the patient were relatively high scores in the PANSS scale,
BPRS scale, NPRS scale, and an elevated pulse. Research evidences elaborate on the fact that
high scores obtained from schizophrenia assessment scale highlight the presence of psychotic
symptoms and also suggest that the patient finds it difficult to concentrate, and experiences
abnormal normal perceptions and thinking that make him/her lose direct contact with reality.
Owing to the fact that she reported problems in thinking clearly, felt uneasy around other, lacked
self-care, and heard voices that wanted to harm her, the assessment scores called for the
immediate need of implementing interventions that would prevent further deterioration of her
mental health status (Leucht et al., 2019). In addition, NPRS scores also suggested that she
required immediate attention for pain management. The increased pulse was another concern
since it might result in inefficiency of the heart to effectively pump blood to the rest of the body