Clinical Reasoning Discussion Paper

CLINICAL REASONING
DISCUSSION PAPER
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Discussion paper on clinical reasoning
Introduction
In critical care nursing, close attention must be paid to the patient’s present status Most
errors in clinical reasoning are not due to inadequate or incompetent knowledge but to the
weakness of human thinking when there are uncertainty, complexity and pressure of time.
To minimize such perception error we need to understand its causes. Generally nurses use
clinical decision making during patient care. These decisions may affect the actions of
healthcare professionals favourably or adversely and also the health care that the patient
gets (Google Books, 2019). It’s the responsibility of the nurse to make clinical decisions
based on whatever knowledge and skills acquired so far. To make quick, instantaneous
decisions, such as steps to be taken if the condition of the patient starts deteriorating at a
rapid pace.. Nurses rely on sound decision-making skills to maintain positive outcomes
and up to date care. According to Orme & Maggs (C, 2019), decision-making is part and
parcel of clinical practice. If a number of nurses are involved and each has been given
different roles, then proper co-ordination and understanding are required for successful
treatment otherwise if there is lack of coordination between different nurses, there will be
communication gap and the patient is going to suffer. This paper will discuss why the
steps are taken did not go according to plan and discuss two critical reasoning errors.
CASE DETAILS
A patient was admitted to the emergency ward of a clinic with symptoms of severe chest
pain, sweating and other side effects. The necessary emergency measures were taken like
supplemental oxygen therapy through a nasal cannula and ECG was done to monitor the
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Discussion paper on clinical reasoning
heart condition of the patient. Sublingual nitroglycerin along with morphine was
administered to the patient to give relief of chest pain. He was given ticagrelor (an oral
antiplatelet drug used with a low dosage of aspirin generally applied to patients having
acute coronary ), to prevent any blood clotting. Instead of improving, the condition of
the patient took a serious turn with all sorts of complications like a substantial drop in
blood pressure, severe nose bleeding, breathing problem aggravated and a noticeable
drop in pulse rate was observed in ECG.
Because of the critical condition, earlier medical records of the patient and the history of
cardiac data were considered. ECG report was available and clinical handover reports of
shift nurses were available As per the reports the medications and diagnosis were in line
with earlier records The medical records showed that the patient had allergy due to
aspirin, administration of drugs like nitro-glycerin(Takx et al., 2015), morphine was in
accordance with the patient’s past medical records. The dosage of the drugs might have
some connection with the worsening condition of the patient.
Analysis and interpretation
While analysing the case a number of shortcomings on account of improper supervision,
lack of communication and also lack of knowledge to deal with such critical case were
observed.
In the emergency department, many nurses were engaged for management of diagnosis,
treatment, medicine and follow up measures. The main concern was the communication
gap between the nurses and their handover responsibilities during changeover routine at
the change of shifts. The follow-up actions of the nurses were not well documented as a
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