Nursing Clinical Reasoning Cycle Case Study

This nursing case study discusses the application of clinical reasoning cycle to manage a patient with anxiety attack, hypertension, and diabetes. The patient's inability to communicate due to cultural incompetency and language proficiency hampered her health condition. The study explains the steps taken to create an effective communication process for patient improvement.

Running head: NURSING CLINICAL REASONING CYCLE CASE STUDY
NURSING CLINICAL REASONING CYCLE CASE STUDY
Name of the Student
Name of the University
Author note

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Introduction
As per Salminen et al. (2014), it is important for the healthcare professionals to manage
different complex healthcare situations with their ability to judge it and take a decision with their
critical thinking and reasoning ability to resolve it. The aim of this assignment is to describe one
such situation in which I applied my critical thinking ability to manage it. For this purpose, I will
be using the first seven stages of the clinical reasoning cycle by Levett-Jones et al. (2010).
Steps in Clinical reasoning cycle
Step 1: Consider the patient situation
As a registered nurse, I have developed my critical reasoning by experiencing several
critical situations that enhanced my ability to think according to the situation. In this case, the
patient Mrs. A was admitted to the hospital after a severe anxiety attack. While admitting her to
this healthcare facility her daughter revealed that she is a patient of diabetes and has mild
dementia. The situation that I first noticed is that the patient was unable to understand the
instructions and the interventions. I assumed that the patient is unwilling to respond to my
instructions and hence, I decided to talk to her daughter to collect further information.
Step 2: Collect Cues/Information
In the first step of the collection of information, it collects the patient's current available
information such as the handover report, electronic medical reports, social and medical history,
community preference and so on. Further, in the second step, nurses try to collect information,
which is responsible for patient’s current situation and as per the last step uses its knowledge to
provide a reason to the current patient situation (Delany & Golding, 2014). In this case, I

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reviewed the patient’s medical history and found that she was she was previously admitted to
another healthcare; however, she was discharged only after 2 days due to cultural incompetence.
Further, I checked her handover data and found she has high blood pressure (140/90), high blood
glucose level 135mg/dl and average urine output was 40mL/hr. I also communicated with her
daughter and came to know that their family follows the Greek traditions and due to this, she
always used community care facility for her mother's treatment for dementia as well as diabetic
condition. The night her mother had a major anxiety attack, she was given a diet, which is
against the Greek culinary tradition and hence was admitted to the healthcare facility nearby. I
recalled that cultural incompetency could be the reason of serious stress and anxiety attack the
patient faced the night she admitted to this hospital.
Step 3: Process information
In this step, the collected cues are arranged so that a cluster of a meaningful clinical
pattern is created and the aberration in the patient situation is identified (Piantadosi, 2017). My
previous experiences as a registered nurse helped me to collect the pieces and arrange them with
reference to my previous similar experiences. I found that the patient's BP was high due to the
anxiety attack, further due to the history of cultural incompetency she was suffering from
hypertension. However, I was more concerned about her inability to communicate, as she was
unable to take part in medical intervention process that was affecting her health. While her
community care process, she had to suffer from cultural incompetency as her trusted community
care nurse provided her with a diet which is against her cultural preferences. Hence, I inferred
that the communication between her and I was affected due to her inability to trust upon the
healthcare facility and the interventions applied by me to improve her health condition. The
alternative reason can be her inability to understand the communication language as her daughter

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mentioned that her mother does not understand English completely as they communicate in their
mother tongue. Further, these reasons can lead to a series of outcomes. Such as, due to the
inability to trust the healthcare process, she might refuse the nutritious diet provided to her as per
her cultural preference that can elevate her blood glucose level. Further, if the communication is
affected, I might not be able to apply the interventions for her health improvement (Garon,
2012).
Step 4: Identify the problem
The communication process in the healthcare intervention was affected due to the
previous cultural incompetency experience faced by the patient (Chassin & Loeb, 2013). Further,
as the patient was unable to communicate in English, she was unable to understand the
instructions and interventions conveyed to her. Hence, she developed the symptoms of
hypertension, that elevated her blood pressure and due to inappropriate diet, her blood glucose
level also increased. Black (2013) also mentioned that patients trust in health care intervention is
important to achieve health improvement.
Step 5: Establish Goals
I was determined to improve her trust in the healthcare process as well as wanted to
assure her that her healthcare and cultural needs will be taken care of while she stays in this
healthcare facility. Further, to create an effective communication with her, my goal was to
communicate her in her native language so that I can make a connection and apply interventions
to reduce her elevated blood glucose level and blood pressure primarily (Betancourt et al., 2016).

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Step 6: Take action
I will inform the healthcare facility supervisor about her situation and will ask for a
healthcare professional assistant who is able to communicate in the Greek language. Further, I
will also seek permission from the healthcare facility to include the patient's daughter in the care
process. This will help the patient in building trust in the care process (King & Hoppe, 2013).
Further, for the nutritional preferences, I will ask her daughter for suggesting several food
products as per the patient's cultural competency so that a holistic care approach can be achieved.
Step 7: Evaluate
As I was able to create a communication cascade, using a nurse who can communicate in
Greek and the patient's daughter, I witnessed a steep increase in the patient's health
improvement. She was able to communicate with me through her daughter and the assistant
nurse and consumed the diet provided to her without any hesitation. She also tried to
communicate in English with me while the application of intervention and within few days I was
able to control her anxiety and hypertension-related conditions followed by her diabetic
condition.
Conclusion
Clinical reasoning in an important tool to rationally discuss a situation and infer
important aspects with clinical reasoning and interpretations and hence, it is important for every
healthcare professionals. In this clinical reasoning assignment, I discussed a situation, when a
patients inability to communicate due to her previous trust issues and language proficiency
hampered her health condition. Further using the Levett-Jones clinical reasoning cycle I

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explained the goals, actions and evaluation process I undertook to create an effective
communication process for patient improvement.

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References
Betancourt, J. R., Green, A. R., Carrillo, J. E., & Owusu Ananeh-Firempong, I. I. (2016).
Defining cultural competence: a practical framework for addressing racial/ethnic
disparities in health and health care. Public health reports.
Black, N. (2013). Patient reported outcome measures could help transform healthcare. BMJ
(Clinical research ed), 346, f167.
Chassin, M. R., & Loeb, J. M. (2013). High‐reliability health care: getting there from here. The
Milbank Quarterly, 91(3), 459-490.
Delany, C., & Golding, C. (2014). Teaching clinical reasoning by making thinking visible: an
action research project with allied health clinical educators. BMC medical
education, 14(1), 20.
Garon, M. (2012). Speaking up, being heard: registered nurses’ perceptions of workplace
communication. Journal of Nursing Management, 20(3), 361-371.
King, A., & Hoppe, R. B. (2013). “Best practice” for patient-centered communication: a
narrative review. Journal of graduate medical education, 5(3), 385-393.
Piantadosi, S. (2017). Clinical trials: a methodologic perspective. John Wiley & Sons.
Salminen, H., Zary, N., Björklund, K., Toth-Pal, E., & Leanderson, C. (2014). Virtual patients in
primary care: developing a reusable model that fosters reflective practice and clinical
reasoning. Journal of medical Internet research, 16(1).

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References