Nursing and Critical Thinking Relationship

This assignment delves into the crucial relationship between nursing practice and critical thinking abilities. It requires you to analyze several research articles that investigate the correlation between learning styles and critical thinking in nursing education. Specifically, it examines how different learning approaches influence a nurse's ability to think critically and apply that knowledge effectively in patient care settings.

Nursing priorities using clinical reasoning model 1
Nursing priorities using clinical reasoning model
Student's Name:
Instructor's Name:
Date:

Nursing priorities using clinical reasoning model 2
Nursing priorities using clinical reasoning model
Introduction:
Nursing is a profession that involves a considerable amount of responsibility and proactive
provision of care. Nurses play a vital role in the intervention and training provided to patients
and their families (Hunter, 2016). Nurses provide the necessary information about the case,
the diagnosis, and the ongoing treatment procedure to the patients and their carers (Hunter,
2016). They play the role of bridging the gap between the physicians and the patients
(Levett-Jones, 2013). In cases of patients with terminal illnesses that limit the activities of
daily life of the patient, the nurse plays a major role in the establishment of the specific
problems of the patient and identifying the priorities that need to be addressed whilst caring
for that patient (Levett-Jones, 2013). The current essay primarily aims to identify the
priorities in nursing care with respect to a specific case study of a patient with Parkinson’s
disease (Levett-Jones, 2013). The essay follows the pattern of logical reasoning in nursing to
identify the specific problems and considerations of the patient and proceeds to identify the
priorities of nursing care (Hunter, 2016). The current essay establishes the need for the
patient to be aware of his treatment protocol and the role the nurse plays in enabling the
patient to perform their activities of daily life and work around the problems and limitations
caused by the disease (DeMaagd & Philip, 2015).
The following essay uses the approach suggested by the Miller’s theory of functional
consequences (Hunter, 2016). It essentially provides a framework for the appropriate method
for the promotion of wellness in older adults in nursing methods (McMahon & Fleury, 2012).
It is important for caring nurses to identify the potential of an individual to overcome the
disease limitations and to utilize various diagnoses in nursing care (Levett-Jones, 2013). This
helps to provide the dignity of the elderly patient (Hunter, 2016). Dignity and integrity are

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critical considerations for patients with limiting chronic illnesses such as Parkinson’s,
Alzheimer’s, or dementia (Hunter, 2016). Miller’s theory urges nurses working with geriatric
patients to adapt a holistic approach in treatment. They need to functionwith inter-related
functionality of spirit, thoughts, and mind whilst handling older adults (Levett-Jones, 2013).
The current essay follows the critical thinking model of reasoning in nursing education
(Levett-Jones, 2013).
Part A
1. Considerations for the patient:
The present essay discusses the case of Mr. Ratin Bhai, an 87-year-old immigrant
from India, diagnosed with Parkinson’s disease. He has a history of hypothyroidism
that has been controlled by continuous medication. Ratin Bhai is a widower and has
his brother’s family for support when required. However, Ratin expresses a strong
desire to be independent and refrain from involving his brother’s family and burden
them with the care procedure. Therefore, the primary considerations for Ratin are his
independence and treatment for his motor and non-motor functions (Levett-Jones,
2013). In the case of Ratin, the Miller’s theory becomes functional whilst protecting
his dignity in terms of providing him basic support for overcoming the limitations
caused by Parkinsonism (Levett-Jones, 2013). Since he is particular that he must not
be a burden to others, it is crucial for the nurse to enable him to perform his activities
of daily life. Mr. Ratin reports difficulty in making coffee or cooking due to tremors
caused by Parkinson’s disease.
2. Collection of information and cues from patient history and presentations:
Mr. Ratin has slight tremors in both his hands. The primary reason for this is the
effects of Parkinson’s disease on the motor functionality of the central nervous system

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(DeMaagd & Philip, 2015). Parkinson’s disease has been initially described as
“shaking palsy” by Dr. James Parkinson (Levett-Jones, 2013). It is characterised as a
chronic condition with progressive degeneration of neurological functionality
(DeMaagd & Philip, 2015). Mr. Ratin experiences difficulties in making coffee,
cooking, and doing up his buttons. He has a history of hypothyroidism and has been
taking constant medication and had been controlled (Amore, James, & Mitchell,
2012). His history of medication includes thyroxine for hypothyroidism (100 mg per
day). He also takes levodopa/carbidopa/entacapone formulation as medication for
Parkinson’s disease. The patient needs to be supervised for the timely intake of
medication due to slight fatigue and forgetfulness common in Parkinsonism.
3. Analysis and processing of the obtained information:
The patient has been on a constant medication of thyroxine at 100 mg per day for
several years as part of the treatment for hypothyroidism. However, levothyroxine for
hypothyroidism has several implications and side-effects in health of the elderly (El-
Gilany & Abusaad, 2013). Levothyroxine has a half-life of approximately 7 days
when the dosage is taken on an everyday basis (Mann, 2012). In older adults,
especially with chronic ailments such as dementia or Parkinson’s, the requirements of
daily dosage of levothyroxine decreases heavily (El-Gilany & Abusaad, 2013). The
degradation of the drug levothyroxine is reduced in the elderly, due to which the
dosage needs to reduce with the progress of age. In the elderly, high dosages of
levothyroxine may result in the occurrence of myocardial infarction and may even
cause angina or cardiovascular complications (El-Gilany & Abusaad, 2013).
Levothyroxine has negative interactions with several factors such as dietary
supplements of iron, cholestyramine, calcium, and aluminium (Mahmoud, 2012).

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Levothyroxine, in older adults, may lead to compromises and limitations in
performing activities of daily life. The levothyroxine treatment may interfere with the
medication dosages of levodopa formulations (El-Gilany & Abusaad, 2013). Thus, in
the case of Mr. Ratin, constant monitoring of the daily dosages of levodopa and
thyroxine need to be performed (Andreou, Papastavrou & Merkouris, 2013). Since the
dosage of levothyroxine has not been reduced for Mr. Ratin, there may be adverse
influences on the tremors that he has been experiencing.
4. Identification of specific problems:
The pathophysiology of Parkinson’s disease plays an essential role in the
determination of the various complications that specifically play a role in the case of
Mr. Ratin and lead to several complications. Parkinson’s disease has the second-
highest rate of aetiology across the globe and affects a significant number of the
geriatric population (Iranfar, K., Iranfar, S. & Mohammadi, 2012). Parkinson’s
disease is traditionally characterised by the dysfunction of movement and motor
functions. Therefore, it is considered a limiting disease (Morrall & Goodman, 2012).
Due to the pathophysiological, neurological, and anatomical alterations in the input
striatum and output regions of the basal ganglia and the accumulation of neuronal
inclusions in the subthalamic nucleus, there are several implications such as
bradykinesia, characterised by a functional malfunction of the various voluntary
movements of the body leading to slowness in movement (DeMaagd & Philip, 2015).
Parkinson’s disease is characterised by the presentation of various kinds of tremors in
the hands (Magrinelli et al., 2016). Although the pathophysiology of freezing of gait,
rigidity, and bradykinesia are widely researched upon, the mechanism of development
of tremors is largely unknown (DeMaagd & Philip, 2015). The most likely reason is
believed to be the loss of dopaminergic factors in the mid-brain (Magrinelli et al.,

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2016). The decrease in the receptor binding of median rapheserotonin significantly
contributes to the elevation in the severity of the tremors present (DeMaagd & Philip,
2015).
Impairment of motor functions is one of the most common presentations of
Parkinson’s disease (Brodell, Stanford, Jacobson, Schmidt, & Okun, 2012). There are
several mechanisms of the peripheral and central nervous system that adversely affect
the normal physiological functioning of the motor neuronal functionality of the brain
Kong, Qin, Zhou, Mou, & Gao, 2014). The primary mechanisms of the central
nervous system for motor-neuronal impairment include the progressive degeneration
of the nigrostriata leading to decreased capacity of dopamine storage; elevated level
of conversion of levodopa to dopamine and aberrations in the release by the
serotonergic neurons in the striatum; modifications in the receptors of dopamine; and
elevated glutamatergic activity as observed in the striatum (Brodell et al., 2012).
Part B:
5. Establishment of nursing goals:
The primary goals of nursing are established based on the patient needs. In the case of
Mr. Ratin, the most important consideration is to enable the patient to be self-
sufficient and be able to manage his medications. Therefore, the primary goals that
are identified in his case are as follows:
a. The management of tremors and motor functional impairment. Ratin must be
able to perform the activities of daily life such as doing up his shoelace and
buttons, making coffee, or cooking without the limitation by tremors in his
hands.

Nursing priorities using clinical reasoning model 7
b. The activities of his life and self-reliance for activities of basic cognition and
dexterity must become simpler and his ability to handle the various activities
must increase.
c. The level of fatigue, anxiety, rigidity, and slowness caused by Parkinson’s
disease must be controlled. Ratin must be able to manage his own medication
patterns.
The goals for the nursing care provided to Ratin are based on the patient needs
and specifically involve the analysis of his presentations in the clinical scenario.
The goals are established with the primary and consolidated aim to increase the
ability of the patient to carry out the activities of daily life with complete self-
reliance.
6. Action and execution:
The provision of nursing care for Mr. Ratin involves the identification of the specific
problems that he is facing due to the pathophysiological developments of Parkinson’s
disease. The highest priority of the three listed priorities was identified as the
management of the slight tremors in both his hands and analysing the influence of
thyroxine and levodopa formulations on the development of the disease mechanism.
The timely administration of the medication patterns is essential for the patient and it
remains one of the primary responsibilities of the nurse to monitor the timely
administration of drugs in the patient.
7. Outcomes of the action and evaluation:
The following are the resultant outcomes of the nursing action plan in the case of Mr.
Ratin:

Nursing priorities using clinical reasoning model 8
i. The tremors are now more controlled and do not hamper activities of daily life.
The patient has increased ease in the activities such as cooking, making coffee,
pouring water, or doing up his buttons and shoe laces
ii. Ratin has increased memory and reduced fatigue or tiredness
iii. Stiffness of gait, difficulty in walking, and impaired posture are largely absent.
iv. Ratin’s medicine intake cycle is balanced and timely.
v. The dosages of his levothyroxine and levodopa/carbidopa/entacapone formulations
are timely and well-monitored. There is no incidence of adverse reactions.
vi. The behaviour, cognition, and emotional stability of the patient have significantly
improved.
The above-mentioned results indicate that the medical intervention is having a
positive impact on the patient and there is symptomatic control. The primary reason
for this is the nursing care intervention that has ensured timely and appropriate
medication cycle along with providing significant care and self-reliance in the patient.
8. Reflections of the nursing experience:
The case of Mr. Ratin has provided the experience of geriatric nursing for me. I
believe that geriatric nursing, especially in patients with chronic and progressive
degenerative disorders provide severe challenge and difficulties in the management
and intervention cycle. It is an emotionally-trying experience as it involves the life of
an older adult who is vulnerable to the society and is concerned about the
maintenance of social dignity. Mr. Ratin’s concern about not being a burden to his
brother’s family was an aspect that had a considerable impact on my perceptions of
neurodegenerative disorders and persons living with them. I believe that in all my

Nursing priorities using clinical reasoning model 9
future interactions with patients of such disorders, I will ensure that they feel
empowered to live in the social setting and remain self-reliant.
Conclusion:
Geriatric nursing has a considerably different scope when compared to the other areas of
nursing. Since it involves providing nursing care to the older adults suffering from
neurological degenerative disorders, it implies dealing with a vulnerable population.There are
several challenges involved in providing effective nursing care to individuals. Therefore, the
incorporation of logical reasoning in nursing is essential for the nurse dealing with older
adults of neurodegenerative disorders. The primary considerations involve the empowerment
of the individuals to manage their everyday activities and medication cycles. The
identification of the specific problems of the patient and the inclusion of pathobiological
reasoning are important ways to monitor the disease development.

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References
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nursing and midwifery students: a cross-sectional survey utilizing the Kolb Learning
Style Inventory. Nurse Education Today, 32, 506–515
Andreou, C., Papastavrou, E., & Merkouris, A. (2013). Learning styles and critical thinking
relationship in baccalaureate nursing education: A systematic review. Nurse
Education Today.
Brodell, D.W., Stanford, N.T., Jacobson, C.E., Schmidt, P., & Okun, M.S. (2012).
Carbidopa/levodopa dose elevation and safety concerns in Parkinson’s patients: a
cross-sectional and cohort design. MJ Open 2012;2:e001971. doi:10.1136/bmjopen-
2012-001971
DeMaagd, G. & Philip, A. (2015). Parkinson’s Disease and Its Management, Part 1: Disease
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El-Gilany, A., Abusaad, F., (2013). Self-directed learning readiness and learning styles
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