Nursing Care Provision: Prioritizing Issues and Using Clinical Reasoning Cycle

Running Head: NURSING CARE PROVISION 1
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Name
Institution affiliation

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Introduction
Clinical reasoning has been used interchangeably with other terms including problem-
solving, clinical judgment, critical thinking, and decision making(Gee, Dalton & Levitt-Jones,
2015). This learning package term will be explained or defined as the process nurses and other
clinicians use in collecting cues, processing the information, coming to an understanding of
patient's problems or issues, planning and implementing interventions, evaluating the outcomes
while reflecting and learning from the process(Lin, Watson& Tsai, 2013). Clinical reasoning
skills with nurses are important because it helps them to have a positive impact on the outcomes
of the patients(Gee, Dalton & Levitt-Jones, 2015). Nurses with deficiencies of/poor clinical
reasoning skill fail to rescue patients from their impending deteriorating health(Lin, Watson &
Tsai, 2013). This essay will identify and prioritize the most important nursing care issues for the
patient(s) using Millers’ Functional Consequence Theory to identify the influence impacting on
the older persons and their level of function, and Levitt-Jones’ Clinical Reasoning Cycle as the
tool to drive the process of identifying and assessing, implementing and evaluating care(Gee,
Dalton& Levitt-Jones, 2015). It will contain part A involving identification of the nursing
priorities and part B will choose the top priority of care(Michaud et al., 2013).
Clinical reasoning cycle was introduced in 2012 by the School of Nursing and Midwifery
and was developed by Universities of Western Sydney and Newcastle through an ALTC grant.
Authors of clinical reasoning cycle describe it with five rights of clinical reasoning. They include
reason, time, right cues, patient, and action.
Stages of the Clinical Reasoning Cycle
Consider the patient

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This is Mr. Dinh Nguyen an 83-year-old widower. He was diagnosed with Multiple
Sclerosis (MS) six years ago and was also diagnosed with Osteoarthritis four years ago-now
controlled on medication.
He currently lives alone in his home after his wife passed away 12 months ago. He is currently
undergoing feelings of grief and isolation. He lives an independent life and has noticed a marked
decline in his health with ongoing worsening exacerbations of his MS(Gee, Dalton & Levitt-
Jones, 2015).
Mr. Dinh and his wife Ngoc did not have children and this makes him have no immediate
family. He, however, has a brother, Bao, and family living by but he doesn't want to bother his
family with his life.
Dinh manages superannuation earning him a small income and he is very careful with his money.
This has enabled him the financial independence that only caters to his expenses and goes
for a holiday once a year(Gee, Dalton & Levitt-Jones, 2015).
There are negative consequences associated with the problems facing Dinh and includes;
physical- intracranial bleeding, bruising, lacerations, pain, scratches and other superficial
wounds, fractures, and hematomas (Gee, Dalton & Levitt-Jones, 2015).
Falls sometimes instills fear of falling resulting in; self-imposed limitation to activities,
and commencing a cycle of decreasing functional ability. Dinh did not manage a holiday this
year due to his altered mobility.
He’s been experiencing blurred vision, numbness in his face and an electric shock when
he tries to move his head and neck(Gee, Dalton & Levitt-Jones, 2015). This shock travels his

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back down to the legs which impact his movement and gait severely. The major cause of
blindness experienced by elderly is Age-related macular degeneration (AMD)(Latimer-Cheung
et al., 2013).
He has difficulty in doing chores like cooking, showering, and dressing more particularly
bending to tie his shoelaces.
He has also started experiencing some urinary incontinence.
Dinh has an Immune System deterioration which is a chronic, systematic low-grade
inflammation as a result of influence by chronic anti-genetic stimulation (Gee, Dalton & Levitt-
Jones, 2015).
The risk factors of the age include altered mobility, isolation and falls and risk.
Collect cues/information
Dinh had a history of Multiple Sclerosis (MS) in 6 years and Osteoarthritis four years and
is undergoing feelings of grief and isolation in recent times(Latimer-Cheung et al., 2013). He is
having feelings of some electric shock go through his back to his legs and he is unable to do his
normal cooking, washing, and also dressing now. His disease seems to worsen and he is very
uncertain about his future (Latimer-Cheung et al., 2013). He also feels isolated and grieved over
staying alone since the wife died 12 months ago.
Process information
Isolation and grief are related to overstaying indoor and lack of focus group discussion.
Blurred vision caused by old age or problem with the brain and cognitive impairment