Clinical Reasoning Cycle for Depression: A Case Study of Allison
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Added on 2023/03/20
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This paper discusses the clinical reasoning cycle for diagnosing and treating depression in a case study of Allison, a single mother. It covers the steps involved in the cycle and the implementation of a treatment plan. The paper also reflects on the importance of clinical reasoning skills in nursing practice.
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0 Running Head:Integrating Practice INTEGRATING PRACTICE
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1 Contents Introduction......................................................................................................................................2 Step 1: Learning the patient's present patient situation...................................................................2 Step 2: Collecting supporting pieces of evidence............................................................................2 The biopsychosocial approach to read her:..................................................................................2 Mental status examination:..........................................................................................................3 Step 3: Processing data....................................................................................................................3 Step 4: Recognizing problems.........................................................................................................3 Step 5: Planning objective...............................................................................................................4 Step 6: Implementation....................................................................................................................4 Step 7: Evaluation of results............................................................................................................4 Step 8: Reflection through encounter..............................................................................................4 Conclusion.......................................................................................................................................5 Reference list...................................................................................................................................6
2 Introduction Clinical reasoning cycle is a process undertaken by healthcare professionals to diagnose the health condition of patients. This project is based on a lady, named Allison who is a 38yrs old and single mother of two children. She is recently suffering from low feeling for no good reason behind. She visits a clinic and there it is discovered that a few factors such as financial stress and thoughts about an uncertain future are troubling her. She was examined with the help of clinical reasoning cycle and was diagnosed with depressive disorder.The steps involved in the clinical reasoning cycle are analyzing the present scenario, collecting evidence and clues, recognizing of patient problem to implement intervention followed by outcome evaluation.This paper intends to provide a reflection upon the case study of Allison. Step 1: Learning the patient's present patient situation Allison is a 38-year-old lady who raises her kids as a single mother. She stays with her sister and works in a supermarket. She visits a psychiatric clinic with all her clinical symptoms for depression, feeling demotivated and lack of energy every time. Her sister noticed her condition and sends her to the clinic for consultation. The clinical counseling process discovers that her wages are cut down at her workplace that is the big factor to trouble her since her kids are too young and raising them in good upbringing will cost money. Step 2: Collectingsupportingpieces of evidence When Allison entered the chamber, I found her brooding over several thoughts. I started with basic conversations to move onto the following process: The biopsychosocial approach to read here: Allison was bulky in appearance that never looked straight into my eyes while speaking. She was very emotional and became tearful often. Moreover seeing her I predicted she was much
3 obese than her age so hormones are other factors to influence her mood swings. She loves her husband but continuous circumvented from his side keeps her sad all the time. Mental status examination (MSE): I found her representing her symptoms in a much-distorted fashion. I encouraged her to open herself and speak up but initially, she was feeling shaky and reluctant to disclose necessary facts. She started speaking with her financial stress while she abruptly recalls incidents that made her tear full. Little and minor incidents such as the spilling of sugar make her feel sad. From this particular incident, it can be derived that her sense of alertness is to week (Blevinset al., 2015). Perhaps while indulging into any activity she ponders over other thoughts. Step 3: Processingdata After encountering Allison with several questionnaires I suspected her to be the victim of depressive disorder with mixed features. This is a kind of mixed state of mind followed by agitated depression. This type of depression falls within the 5thedition of the diagnostic and statistical manual of mental disorder also known as DSM-5. This medical condition is dominated by both mania and depression(Lilienfeld et al., 2015). In the case of Allison clinical symptoms mostly manifested to depression where the manic symptoms included racing thoughts about her kids. However there is no cause for the disease has been identified so far, the patient experience secondary symptoms such as fatigue, overweight, feeling of worthless, lack of concentration and difficulty to sleep. Allison even talks about her appetite going loose; this is also a vital symptom for DSM-5. She is likely to increase the risk of more deterioration that will require medications such as antidepressant and mood stabilizer combined with a sedative.
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4 Step 4: Recognizing problems The major problem in Allison behind developing DSM is her immense financial stress with her less paid job. Cutting of wage might put an impact on her children. Dave seldom rings her; she received nothing more than physical torture from him. All these thoughts bother her every time that she developed mild cognitive impairment as she suffers from forgetfulness over minor issues. Step 5: Planning objective The initial steps of the treatment plan involve multiple session of counselling process so that Allison overcomes from the brooding thoughts. Attitudes and rights: All these come under recovery oriented approach when healthcare professionals support patientsfocusingontheirstrengths.Recoveryorientedapproachrecognizespatientsas individual, prioritizing their choices.the purpose of the therapeutic communication will develop social and vocational activities meaningful to her. Real choices: Allison is suggested to cooperate so that things can be improved. The plan is to keep her busy with activities She loves her kids focusing more on them will help her. If things go well there is no need for medications at this moment. It will involve time duration of 2-3months. Step 6: Implementation As a registered nurse I would performtherapeutic communicationas the evidence-based treatment on Alison to treat major depression. As discussed in the preceding section, it is a talk therapy that would help to extract the good thought and skills within her(Lilienfeld et al., 2015). As for example, I would encourage her to apply for other jobs so that she can earn a good living.
5 She confessed that she likes watching soaps the rest of the time she spends lying on the sofa, so that will be the ideal time to look for jobs in portals. Allison was sound in her academics so suggesting her to guide her children regularly will help. I would also ask her to accompany the children to swimming class so that she can communicate with different people there. Moreover I would call Dave during the session and ask him to give her time so that she does not feel depressed. I would talk to Dave if he can take responsibilities of children equally so that the financial stress can be minimized. Improving personal relationship would also help her to recover.As a nurse I can talk to her and discuss how to keep oneself healthy so that it becomes easier to find another job that would support financialy. Step 7: Evaluation of results In order to evaluate the effectiveness oftherapeutic communication,I would ring her every after 3 days initially to record her improvements. I would arrange the counseling session for her at the clinic biweekly. The other means of evaluation could be preparing a checklist of regular activities for her (Blevins et al., 2015).Through the communication process I can monitor her improvements and see whether things are better than before. I will collect feedback even from Dave to justify the findings. I would also prepare a check list for myself that would help me to identify the differences between her. Step 8: Reflection through encounter Through the case study and assessment of Alison, I have learned that there are several degrees of depression. Severe depression can prove fatal sometimes with a feeling of self- harming.However,Allisonwasdiagnosedwithdepressivecognitiveimpairmentather preliminary stages and things were quite under control. She understood her symptoms well and the risk factors might get involved if left untreated.After encountering Alison I would like to
6 spread awareness on ill effects of on depression so that people can break taboo and comes forward to speak(Johnsen et al., 2016).I believe more people communicate and engage in activities, the more one can overcome racing thoughts. Conclusion This paper embedded steps of the Clinical Reasoning Cycle for the purposes of reflecting upon the scope, nature, and rationale for assessment of Allison in this case study.The entire process of clinical reasoning cycle works on critical evaluation and philosophical perceptions unlike process on continuous clinical encounters. Such a clinical practice has helped me to set the competency standards of a registered nurse. The encounter has given me an opportunity to implementmyskillsofnursingexpertise.Clinicalreasoningskillshelpeverynursing practitioner to manage clinical scenarios under deadlines to set relations between evidence and outcomes. Clinical reasoning requires active learning to provide effective practice outcomes.
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7 Reference list Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The posttraumatic stress disorder checklist for DSM‐5 (PCL‐5): Development and initial psychometric evaluation.Journal of traumatic stress,28(6), 489-498. Johnsen,H.M.,Fossum,M.,Vivekananda-Schmidt,P.,Fruhling,A.,&Slettebø,Å. (2016).Teachingclinicalreasoninganddecision-makingskillstonursingstudents: Design, development, and usability evaluation of a serious game.International journal of medical informatics,94, 39-48. Lilienfeld, S. O., Watts, A. L., & Smith, S. F. (2015). Successful psychopathy: A scientific status report.Current Directions in Psychological Science,24(4), 298-303.