Clinical Reasoning Essay: Applying the Clinical Reasoning Cycle

This essay discusses the application of the clinical reasoning cycle in clinical decision making for a patient with high systolic pressure. It covers the first seven stages of the cycle and highlights the importance of evidence-based practice in nursing.

Running head: CLINICAL REASONING ESSAY
Clinical reasoning essay
Name of the student:
Name of the university:
Author note:

1CLINICAL REASONING ESSAY
Clinical reasoning cycle has been coined by Tracy Levett Jones as a model or framework
for the nurses to implement into practice in order to amplify the level of clinical decision making
and reasoning skills of the nurse (Levett-Jones, 2013). Clinical reasoning skills are imperative
for the nurses as they have also been reported to be having positive impact upon the patient
outcomes and recovery potential (Levett-Jones et al., 2010). This essay will attempt to apply the
first seven stages of the clinical reasoning cycle with respect to clinical decision making for the
patient in the case study.
Considering the patient situation:
The patient under consideration for this assignment had been an elderly lady whose
personal details were not revealed in the case study. She had ordered the student nurse to record
her BP which showed excessively high systolic pressure (200/90 mmHg). The patient had not
been diagnosed for hypertension before and claimed never taking any mediction for hypertension
before. However, as the blood pressure of the patient is higher than 180, the patient is at high risk
of going through hypertensive crisis.
Collection of cues:
The second step of the clinical reasoning cycle is the collection of cues, where the nurse
is expected to collect all the relevant information and care cues available about the patients. The
student nurse collected cues from handover reports patient history, patient charts, results of
investigations and nursing or medical assessments previously undertaken (Marcum, 2012). In
this case, the patient had been stating that she did not have any issues with hypertension before
and had been very thin; hence the pressure cuff had been very loose on the patient and the
reading had been taken over the light jumper that the patient had been wearing. Hence, the nurse
performed the reading again which revealed the similar results again which led the nurse to be

2CLINICAL REASONING ESSAY
taking the assistance of an automatic monitoring system which led to similar results again. Along
with that, the patient had also been suffering from severe headache, severe anxiety and an
instance of nosebleed as well. The readings that the nurse had been successful in discovering
revealed the fact that the patient can be having cardiac complications and inexplicable weight
loss as well (Wang et al., 2013).
Processing of information:
The third stage of the clinical reasoning cycle is where the nurses interpret, discriminate,
relate, infer and match the care cues identified and the possible health conditions that the patient
might be suffering from and then predict the most applicable care outcome for the patient (Hur &
Roh, 2013). In this case study, despite the patient suggesting that she did not have a problem of
hypertension, the sphygmomanometer reading and the automated monitoring system reading
indicated extremely high systolic pressure for which the patient required immediate
pharmacological attention in order to avoid the chances of a cerebrovascular accident (Wang et
al., 2013). Hence, depending on the risks of the patient and according to the evidence based
practice, the decision of the nurse to recommend the patient to a general physician had been
absolutely correct. Furthermore, the collected cues by the nursing professional reveals the fact
that the patient had also been suffering from nosebleed, severe headache and severe anxiety from
the past couple of weeks. Hence, the nursing professional in the case study took the assistance of
evidence based practice and discovered that systolic pressure going over 200 mmHg is very
severely linked with the possibility of acute hypertension crisis and it was very likely for her to
go through a cerebrovascular accident if therapeutic interventions are not carried out to lower her
blood pressure (Wang et al., 2013). Overall, from the processed information it can be clearly
mentioned that the patient had unnaturally high blood pressure and she had been in need for a

3CLINICAL REASONING ESSAY
thorough medical checkup so that the underlying reason behind the hypertension crisis can be
discovered and adequate treatment measures can be implemented.
Identifying the problem or issue:
As per the data that had been discovered regarding the patient and the cues detected on
her examination, the nurse discovered a few risks associated with the patient due to her
extremely high systolic pressure which included the chances of a cerebrovascular accident
(Wang et al., 2013). Hence, the problem associated with the patient had been identified to be the
high systolic pressure which can be due to many health conditions including coronary arterial
diseases (Spence & Hammond, 2016). Hence, she had been in acute need for further
investigation and subsequent treatment under the guidance of a registered medical practitioner
such as a general physician.
Establishing goals:
This is the fifth stage of the cycle where the nurse, with collaboration of the patient or the
next of kin, establishes the care goals for the patient that addresses the care priorities of the
patient (Forsberg et al., 2016). In this case, the patient had been in acute need for a thorough
check up under the guidance of a general physician and receive a diagnosis for her abnormally
high BP. However, the nurse in this case just recommended her to a general physician to be
checked out immediately. However, the student nurse did not establish any goal or routine with
the patient for her subsequent checkups with GP and dietician, neither did the nurse provide any
sound patient education to explain to her the need for the GP visit and what she may expect from
the visit. Hence, according to the requirement of this step of the clinical reasoning cycle, the call
of the student nurse had not been adequate or sufficient.

4CLINICAL REASONING ESSAY
Taking action:
In this sixth step of the cycle the nurse is required to select the most effective course of
action with the collaboration of the patient among the different options available (Alfaro-
LeFevre, 2012). In this case the attending nurse did not collaborate with anyone for the most
plausible course of action and neither did she accommodate the point of view of the patient, and
went ahead to recommend her to take an immediate visit with a GP without proper patient
education and communication. Hence, this step had not been in accordance with the
requirements of clinical reasoning cycle either (Levett-Jones et al., 2010).
Evaluating outcomes:
This is the step where the nurse re-considers the care needs of the patient and evaluates
the effectiveness of the course of actions taken in the previous step (Levett-Jones, 2013). In this
case, the student nurse did not contact the patient to evaluate the outcome of the care action taken
by her and did not try to collect follow up information for the same. Instead, the student nurse
met with me and discussed her dilemma regarding the efficacy for the actions that she had taken
which does not comply with the requirements of this step of clinical reasoning cycle either
(Levett-Jones et al., 2010).
On a concluding note. I would like to mention that clinical reasoning cycle is one of the
most crucial practice models that provides the nurses with the opportunity to be as scientific and
rational in the clinical decision making and integrate evidence based practice in the care delivery.
It can be hoped that this opportunity will help be apply the clinical reasoning process with clarity
in my practice and avoid making the errors that I have identified in the case study in order to
provide safe and effective care to the patients.

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References:
Alfaro-LeFevre, R. (2012). Applying nursing process: the foundation for clinical reasoning.
Lippincott Williams & Wilkins.
Forsberg, E., Ziegert, K., Hult, H., & Fors, U. (2016). Assessing progression of clinical
reasoning through virtual patients: An exploratory study. Nurse education in
practice, 16(1), 97-103.
Hur, H. K., & Roh, Y. S. (2013). Effects of a simulation based clinical reasoning practice
program on clinical competence in nursing students. Korean Journal of Adult
Nursing, 25(5), 574-584.
Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse. Pearson
Australia.
Levett-Jones, T., Hoffman, K., Dempsey, J., Jeong, S. Y. S., Noble, D., Norton, C. A., ... &
Hickey, N. (2010). The ‘five rights’ of clinical reasoning: An educational model to
enhance nursing students’ ability to identify and manage clinically ‘at
risk’patients. Nurse education today, 30(6), 515-520.
Marcum, J. A. (2012). An integrated model of clinical reasoning: dual‐process theory of
cognition and metacognition. Journal of evaluation in clinical practice, 18(5), 954-961.
Spence, J. D., & Hammond, R. (2016). Hypertension and stroke. In Hypertension and the Brain
as an End-Organ Target(pp. 39-54). Springer, Cham.

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Wang, Y., Xu, J., Zhao, X., Wang, D., Wang, C., Liu, L., ... & Wang, Y. (2013). Association of
hypertension with stroke recurrence depends on ischemic stroke subtype. Stroke,
STROKEAHA-111.