Clinical Reasoning Cycle Case Study for Nursing Professionals

This case study explains how clinical reasoning cycle helps nursing professionals to handle critical nursing cases and provide quality care to patients. It also highlights the importance of culturally and ethically justified care.

Running head: CLINICAL REASONING CYCLE CASE STUDY
CLINICAL REASONING CYCLE CASE STUDY
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CLINICAL REASONING CYCLE CASE STUDY
Clinical reasoning cycle is one of the best frameworks that enable healthcare
professionals to identify various symptoms that are presented by the clients. This model has steps
which when by followed by professionals in a sequential manner, helps them to relate the
symptoms with the disorders understand their pathophysiology, identify the biological and social
determinants of health and thereby recognize the care priorities (Vlayeyen et al., 2015).
Following this, the professionals will set goals and plan their interventions that will e sure safety
and quality care of the patients. However, professionals should always focus on providing care
that is culturally and ethically justified so that the patient can be satisfied with the care they get.
This assignment will mainly portray the ways by which clinical reason cycle helps professionals
to handle a critical nursing case and help patents to get the best service.
The first step is considering the patient situation. Mrs. McKay is a 86 year old widow
who has been transferred to residential aged care named Sunset. She has faced a fall previously
that had made her undergo hip replacement in acute care hospital. She had also faced a skin tear
after bumping on her wheelie walker. She already has Alzheimer’s diseases and vascular
dementia in the early stage. She is intermittently incontinent as she fails to reach the toilet on
time.
The second step is called the collecting cues or information through the three steps of
reviewing, gathering and recalling information. Mrs.Mckay is currently under medication of
Paracetamol, aspirin and desmopressin. She is not compliant with the professionals in her
activities of daily life. She used to be a strong-minded person and had strong opinions. Although
she needs to walk with wheelie walker, she often forgets it. She is suffering from Alzheimer’s
diseases and vascular dementia that needs to be cared by the professionals.

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The third step is called the processing of information. It is seen that the patient Mrs.
McKay is suffering from early stages of Alzheimer’s disease and dementia. Researchers are of
the opinion that this disorder occurs due to two important abnormalities. Plaques are formed
when clumps of proteins called beta-amyloid causes damage and destruction of the brain cells in
different ways that mainly participate in cell-to-cell communication. Besides, tangles are also
formed when threads of tau protein that mainly helps in carrying nutrients through brain are seen
to form tangles (Alvarez et al., 2016). This results in failure of the transport system. These
factors both result in destruction of brain cells and result in shrinkage of brain. This affects brain
functions like memory and cognitive abilities. Moreover, patient Mrs. McKay had undergone hip
replacements following fall, which had compromised her mobility and had made her restricted in
her movements. She had always been independent and therefore taking support due to her
impaired mobility or inability to conduct ADL have made her agitated and affects her self-
respect. Therefore, she might be non-compliant with the professionals as taking helps affects her
dignity and self-respect. Another important aspect of care is to take care of her wound that might
affect her quality life by providing her with pain. Therefore, this should be taken care of in the
nursing care plan.
The fourth step is called the identification of the problems by synthesizing of facts. From
the above discussion, it becomes quite clear that the patient Mrs. McKay is suffering from a
number of issues that should be taken care of. She has developed restricted mobility and often
forgot to take up her wheelie walker. Therefore, the first care priority would be to develop
intervention for fall prevention so that the patient does not suffer from any falls (Santamaria et
al., 2015). The second issue is that she is suffering from early stage of dementia and Alzheimer’s
and therefore, she may be seen to suffer from memory loss, social withdrawal, mood swings,

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distrust in others, irritability, wandering activities, delusions and many others. Already some
form of symptoms are visible in her from now only. Therefore, nursing professionals should try
their best to care for her in ways by which she can develop her quality life (Breimaier et al.,
2015). Moreover, she has faced a skin tear that may be painful to her and may make her suffer
during healing of the wound, as she has grown old. Therefore, take these three-care priorities
should in consideration.
The fifth step is called the setting of goal. The first goal would be to conduct a risk
assessment of fall for the patient and thereby taking initiatives by which the environment may be
made safe for the patient from fall. Second goal would be to take care of her in way that would
help to ensure that her symptoms of Alzheimer’s and dementia are actively controlled and
maintained. The third goal would be her proper wound management so that her skin tear in her
knee can be managed effectively.
The sixth step is called the action taking stage where the nursing individuals need to take
interventions for the care priorities chosen. As she is at a risk of fall in the residential care, a
wristband should be first provided to patient Mrs. McKay to help so that the healthcare
professionals are aware of her risk for fall. Mrs. McKay should be then transferred near the nurse
station so that nurses can attend her immediately when called. As she is intermittently
incontinent, this would also help her to prevent her from wetting her bed (Gustavvson et al.,
2015). Items should be moved near her bed so that she can easily access them without the need
for covering a certain distance. This would reduce the fall hazards. The nursing professionals
should also position the beds at the lowest possible position. They should make the sleeping
position adjacent to the floor that reduces chances of falls. Moreover, the professionals should
allow use of bed rails as well as hand rails in the washrooms and other places possible so that the

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Mrs. McKay can seek support to when locomotion (Anderson et al., 2015). Moreover, proper
arrangement of bright room lighting should also be done. Mrs. McKay should be also
encouraged to take on slippers or soles that are non-skid. The patient should be familiarized with
the layout of the room and clutters should be removed from her pathways. No light furniture
should be which increases the risk of the patient tumbling down (Dowsett & Dowsett, 2015).
Too much loose clothes should be avoided as it may increase the chance of fall. The
professionals should also collaborate with physiotherapist and occupational therapists that would
be having physiotherapy sessions to develop her gait, provide her proper assistive service, and
teach het to do light free exercises (Boltz et al., 2016). The second priority would be
maintenance of her Alzheimer and dementia disorders. The nursing professionals should assess
her though process by evaluating her cognitive, disorientation, issues with communication or
changes in thinking patterns. Mrs. McKay is in her early stages, so these issues are not yet
pronounced. However, she gets irritated and does not allow anyone to help her in her activities of
daily life. Therefore, it is very important for the nurse to develop a therapeutic relationship with
the patient where the patient learns to trust and rely on the professionals. Effective
communication in a compassionate and empathetic manner may help in developing bond with
the patient. Mainly Mrs. McKay is frustrated and agitated as she used to be independent and
strong opinionated woman. As she has to depend on the professionals now, her self-esteem is
affected (Farina, Rusted & Tabet, 2014). Therefore, the nursing professionals should always
respect her dignity and autonomy and should always take her informed consent before
undertaking her for any activities of her daily life. The better the bond developed between them,
the patient will learn to rely the nurses and would accept help from her. However, the nurse
should never connect any activities that would overpower her presence over the client. The client

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should be treated in a way where she always feels respected and her consent is prioritized. The
better the emotional connection with the patient, Mrs. McKay will have better health outcomes.
For her skin tear, the nurse should first monitor the sights around the wound once daily for
identifying any color changes, redness, swelling, pain, warmth and others. Depending on the
status of the wound, care should be taken about the kind of dressing that it needs like whether the
wound is dry or wet. Accordingly, wet or dry dressing, lubricants, hydrocolloid dressings would
be provided. A sterile dressing technique would be adopted for preventing infection (Cabrera et
al., 2015). Care should be taken so that lessened exposure of the skin tear to moisture takes place
from incontinence, wound drainage and perspiration. Proper antibiotics should be given and the
patients should be advised to prevent rubbing or scratching. A nutritional diet should be
encouraged.
The last two stages are effective evaluation followed by reflection of the nursing
professionals after application of the intervention. The nurses should evaluate the walking
posture and the ability of the patient. The patient should be able to walk properly with a steady
gait and should be free from any risks of fall. Secondly, the patient would successfully
participate in her ADL activities conducted by the nurses after effective therapeutic relationship
development. The nurses should also evaluate the conditions of the wound and the ways it is
healing (Muller et al., 2017). After evaluation, the nurse should reflect on the interventions and
the ways the patient has responded to all the interventions. From these interventions, the nurses
should reflect on the experiences gathered and find out ways by which better quality care can be
ensured (Farlow et al., 2016).
From the above discussion, it becomes clear about how clinical reasoning cycle has
helped nurses to develop proper care plans for the patient named Mrs.Mckay. Moreover, it is also

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helpful in understanding the pathophysiology and determining the symptoms that need to be
treated. Therefore, every nursing professional should know the ways about how to conduct each
step properly. This would ensure developing of a care plan that would address all the symptoms
of the person and help her to develop better quality life.

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References:
Álvarez Barbosa, F., Pozo‐Cruz, B., Pozo‐Cruz, J., Alfonso‐Rosa, R. M., Sanudo Corrales, B., &
Rogers, M. E. (2016). Factors associated with the risk of falls of nursing home residents
aged 80 or older. Rehabilitation nursing, 41(1), 16-25.
Anderson, C., Dolansky, M., Damato, E. G., & Jones, K. R. (2015). Predictors of serious fall
injury in hospitalized patients. Clinical nursing research, 24(3), 269-283.
Boltz, M., Capezuti, E., Fulmer, T. T., & Zwicker, D. (Eds.). (2016). Evidence-based geriatric
nursing protocols for best practice. Springer Publishing Company.
Breimaier, H. E., Halfens, R. J., & Lohrmann, C. (2015). Effectiveness of multifaceted and
tailored strategies to implement a fall-prevention guideline into acute care nursing
practice: a before-and-after, mixed-method study using a participatory action research
approach. BMC nursing, 14(1), 18.
Cabrera, E., Sutcliffe, C., Verbeek, H., Saks, K., Soto-Martin, M., Meyer, G., ... & Zabalegui, A.
(2015). Non-pharmacological interventions as a best practice strategy in people with
dementia living in nursing homes. A systematic review. European Geriatric
Medicine, 6(2), 134-150.
Dowsett, C., & Dowsett, C. (2015). Breaking the cycle of hard-to-heal wounds: balancing cost
and care. Wounds International, 6(2), 17-21.

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Farina, N., Rusted, J., & Tabet, N. (2014). The effect of exercise interventions on cognitive
outcome in Alzheimer's disease: a systematic review. International
Psychogeriatrics, 26(1), 9-18.
Farlow, M. R., Borson, S., Connor, S. R., Grossberg, G. T., & Mittelman, M. S. (2016). Quality
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Gustavsson, J., Bonander, C., Andersson, R., & Nilson, F. (2015). Investigating the fall-injury
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Müller, C., Lautenschläger, S., Meyer, G., & Stephan, A. (2017). Interventions to support people
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