Practice Portfolio of Evidence | Study

Running head: PRACTICE PORTFOLIO OF EVIDENCE
PRACTICE PORTFOLIO OF EVIDENCE
Name of the Student:
Name of the University:
Author’s Note:

PORTFOLIO OF EVIDENCE1
In my recent clinical placement, a patient named Mr Johnson was admitted to the
hospital by his nephew, Sam, as his uncle had experienced difficulty breathing while he was
watching a cricket match. Mr. Johnson has had a history of Diabetes Mellitus for the past15
years; however, recently, he has forgotten to monitor his sugar level on time. Mr. Johnson
became anxious with his breathing difficulty, and his oxygen saturation level dropped below
95% leading to unconsciousness.
Mr. Johnson regained consciousness, where he demonstrated mental confusion and a violent
flare-up. After some time, he regained his composure and attained a stable mental status. He
was identified to have a condition where he forgets necessary details; for example, he forgot
his room number while returning from the toilet and had difficulty in conveying his emotions
and feelings to the healthcare professionals. After a thorough evaluation, medical
examination and consultation with family members, it was inferred from his behaviour,
which included agitation, aggression, confusion and disorientation that he was suffering from
delirium – this was misdiagnosed (Mukaetova-Ladinska et al., 2017). Mr Johnson was
confirmed to be diagnosed with dementia as both disorders (delirium and dementia) have
similar symptoms and affect the normal behaviour and functioning of the brain. According to
Caprio, Morrison and Poduri (2019), there is a subtle distinction between delirium and
dementia; therefore, in many cases, doctors and nurses are found to misjudge the condition
frequently.
Due to Mr. Johnson’s condition, the management of his blood sugar level is hampered
as he forgets to take his medicine on time. Another problem that was demonstrated by Mr
Johnson was the risk of injury to himself self as well as others that lead to compromising of
health. These two fundamental nursing problems in the case study form the basis for the goals
and nursing actions related to Mr. Johnson. These explicitly supported the patient and family
to address and mitigate the issues and thus improve the patient’s quality of life. Based on the

PORTFOLIO OF EVIDENCE2
case study, I have observed that there are two clinical reasoning errors, anchoring and
overconfidence bias. From my initial assessment, it was found that Mr. Johnson has delirium
because of a misdiagnosis of behavior. Later, we confirmed that he had dementia, indicating
that an anchoring error had occurred because of a nurse’s misdiagnosis.
From the case study demonstrated above, there has been the presence of clinical errors
that have affected the optimal quality of care of Mr. Johnson in the healthcare setting.
According to Norman et al. (2017), 5% to 14% of acute admission in hospitals were found to
have clinical errors such as missed or delayed care. Medical errors affect the delivery of
health care over a decade that include inaccurate or delayed diagnosis in offering care for
avoidance of unacceptable outcomes (Makary & Daniel, 2016). It is important to understand
the implications of such errors as in worst-case scenarios, which may lead to permanent
injury or even death. Most of the time, healthcare professionals do not intentionally commit
such mistakes; instead, they are caused due to a range of complex environmental or cognitive
factors that increase the possibility of their occurrence (Forsyth et al. 2017). The different
types of clinical reasoning errors are anchoring, confirmation bias, ascertainment bias,
premature closure, diagnostic momentum, overconfidence, fundamental attribution errors,
unpacking principles, and psych-out errors (Norman et al., 2017). Therefore, it is important to
address the issue in an appropriate manner for improving the quality of care in a care setting.
According to Richie and Josephson (2019), the tendency of focusing on the salient
features of the presentation of patient at a very early stage in the process of clinical reasoning
and failure to adjust the initial nursing judgement, in the light of new information, is
considered as anchoring. It is stated that the first impression influences all the practice, and
thus, its impact has a profound effect on the thought process as well as the actions that need
to be taken (Holmes 2016). After assessment and testing, it was later identified that the
condition was dementia, and an action plan related to this was formulated on an immediate