Health Outcomes Measurement & Clinical Reasoning

This assignment examines the crucial role of measuring health outcomes in nursing practice. It explores different methods for assessing patient health, including critical care considerations, dementia management, and pain assessment. The assignment also delves into clinical reasoning skills, emphasizing their importance in effective patient care. It highlights the use of simulations and interventions to enhance clinical reasoning abilities and improve patient outcomes.

Assessment 1 – Case Study Template
1) Consider the Patient
ISBAR is one of the most important tools that is used by healthcare team in order to safely transfer
the patient information in a clinical handover. ISBAR refers to completion of five important steps for
proper jotting down and referring the information to the others staffs for safe delegation, proper
decision making and correct planning for intervention procedures. These would help in assuring the
patient of a service which is high on patient safety as well as in quality (Salminen et al., 2014). Isbar
stands for identification, situation, background, assessment and recommendations. by applying the
principle, it is important to jot down the information of the patient so that each and every member
of the healthcare team are aware of the condition of the patient and how he arrived in the
healthcare (Koivisto et al., 2016). Mr. Jones is a 86 year old male who has been found wandering on
the stress of the neighborhood. He has been recently widowed with other family members living in
close proximity but are seldom visitors. He was limping avoiding on the left side and he was also
seen to have blood stains on his clothes. His left leg shin has a category three skin tear and has pain
in the hip region. Other important information is that he is not having a proper balanced diet after
the death of his wife he is leaving on frozen meals or takeaway meals. He is staying at home and
does not go out as he often feels sad.
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2) Collect cues/Information
This step mainly comprises of three important sections which are reviewing, gathering new
information and then recalling.
Review: He was suffering from too much pain mainly due to the fall on his hip but since he had no
factures, therefore the nurse would not have to consider any surgical procedures with him. His blood
pressure is found to be high and his pulse rate is also quite high. The respiration rate is also much
higher than the normal level of 19 to 20 beats per minute. His BMI is also quite high for about 43
which gives an obese status to him. His tear is of category three and he has a high fall risk about 17.
His Glasgow coma scale is 14.
Gathering new information: in this case, it is seen that the patient is having pain in his hip region and
for this it is extremely important to know whether he has developed a fracture or not. This is
extremely important as the development of the nursing interventions will depend on whether he
had developed fractures (Owens et al., 2014). Moreover, it is also important to conduct an analysis
of his cognitive power to confirm whether he is also suffering form any neurological problems or not.
Recall: It is important to know the main reason of his withdrawal from food and society as these are
harming his overall health. Moreover his heavy weight is also seen to be one of the reason
associated with restricted movement and arthritis is making the situation worse. He has been
identified with large number of co morbidities like Hypertension, Asthma, Arthritis and Type 2
Diabetes. Such a huge number of complex and co morbid diseases often create a very poor life
quality (Liou et al., 2016). In handling such a patient with so many chronic disorders, the nurse here
needs to develop a patient centered care by development of a therapeutic relationship with him.
From his symptoms, it seems that he is also having symptoms of dementia or Alzheimer’s as patients
often tend to forget facts and are found wandering on roads due to loss of memory of previously
known things. Therefore, the care of the patient is very critical and all the information gathered from
the report should be assessed before developing a care plan.
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3) Process information
This step mainly contains the important parts of interpreting the different information provided
form the handover report, followed by discriminating the steps between the relevant information as
well as the irrelevant information. This then gets followed by relating the information to the
patient’s situation and then inferring that main reasons for the occurrence of the disorder followed
by correct predictions (Forsberg et al., 2016). From the above steps, it is seen that the patient has
fallen on his hip portion somewhere for which he is experiencing terrible pain. The pain after
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assessment was found to be 7 which is quite high and needs interventions. Secondly, he has a
category three skin tear which is mainly characterized by the complete absence of the skin flap
which along with the loss of certain amount of tissues. With the growing ages, pathological skin
chances occur such as flattening as well as thinning of the epidermis, loss of collagen as well as
elastic followed by atrophy and contraction of dermis (Pennaforte et al., 2016). These cause wrinkles
and folds to appear. Often decreased levels of sweat glands activity as well as decreased sebaceous
gland results in drying out of the skin. Moreover arteriosclerotic changes also occur in different types
of larger and smaller vessels which cause easy thinning of vessel wall s as well as reduction of blood
supply in the extremities. The skin becomes fragile and therefore also becomes more prone to skin.
This situation makes the skin more prone to tear by any sort of accidents, falls, conflicts and several
such occurrences. Hence, this can be related with the patient’s condition in this case study and
therefore his skin tear had taken place by the fall. His fall had mainly resulted from his restricted
mobility which had been mainly occurred due to arthritis. Arthritis must have occurred in the patient
because of his excessive travelling in his younger years due to his business trips (Shah et al., 2015).
Moreover, he is living on takeaway food as well as frozen food which are low in nutrients and also
higher in calories. Lack of the ability to perform different exercises also resulted in the increase of his
body weight which had resulted in increased rate of BMI. Moreover, researchers are of the opinion
that increased obesity often creates excess pressure on the conditions of arthritis. Arthritis occurs
when the cartilage of the bones gets degraded and bones rub against each other causing pain. Often
huge bodyweight results in increased pressure on the bones and these add to the burden of the
restricted mobility in arthritis (Moorhead et al., 2014). His condition of hypertension is also found to
be not managed properly by the patient and this is known from the blood pressure of 165/ 95 mmHg
when his vital signs were taken. He also had a high respiratory rate of about 29 beats per minute and
this shows that his arthritic conditions are also not managed. Moreover, from the present symptoms
which were seen in the case, it is highly possible that he is gradually developing the symptoms of
dementia as his age is highly probable to the occurrence of the disorder. Moreover, loss of memory,
problems in recognizing roads, wandering attitude, forgetfulness, development of depression and
many others are intricately associated with the occurrence of dementia (Gelinas et al., 2013).
Therefore, the nurse should also be careful in developing interventions which will be directed to
these symptoms as well.
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4) Identify
problems/is
sues
What is the issue for
the patient?
5) Establish
Goals
What do you want
to do here for the
patient
6) Take
Action
What will you do
here in the way
of care for the
patient?
7) Rationalise your nursing
action
Why have you chosen the actions
you want to do for the patient?
First Nursing
Problem
A large number of
nursing issues are
identified in the case
of Mr.
Jones. Mr. Jones has
a very high paying
score which shows
the marks to be 7
out of 10. This high
amount of pain can
we contribute into
two important
factors. First of all
he has fallen on his
portion which has
One Nursing Goal –
The first goal which
should be set for the
patient by the nurse
would be to
maintain his pain
effectively as he is
having pain mainly
due to two
important factors.
Firstly due to the fall
on his hip region and
secondly due to the
skin tear that he is
having in his leg.
The nurse should
First action –
In order to
reduce the pain,
the first
intervention that
the nurse should
take is to reduce
the additional
stress or sources
of discomfort
whenever
possible. It has
been stated by
researchers that
patients often
show better
coping method
Rationale -
This would relieve him form the
pain in his hip region and will
allow to manage the pain with
the best outcomes
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resulted in high pain
in the Hip region.
Moreover he is also
having a category 3
skin care in his leg.
This might be at
another cause of his
high level of pain.
Therefore the nurse
on duty should first
provide intervention
for management of
the pain (Kozlowski
et al., 2014).
effectively manage
both the symptoms
with the correct
goals so that the
patient may become
free from pain. The
main goals that
should be set for the
patient would be to
reduce the score
from 7 to 3 or 4 out
of a rating scale of
zero to 10 (Schreiber
et al., 20140. It
should be also cared
by the nurse that the
patient should
display improved
well being in case of
the baseline levels
for blood pressure
respiration pulse and
relaxed Muscle Tone
as well as body
posture. The nurse
should also use
appropriate
pharmacological as
well as non
pharmacological
pain relief strategies
and also help the
patient to improve
his mood as well as
cope with the pain.
Correct strategies
for handling the
wound should be
taken by the nurse
so that the wound
get healed up
properly without
causing an infection.
to pain if the
nurses are being
able to handle
the
environmental,
interpersonal
and intrapsychic
factors or
stressors
effectively. The
nurse should also
make sure that
she provides rest
periods to the
patients in order
to promote relief
and sleep in the
patient and also
to give him
relaxation
(Brwon et al.,
2016).
Researchers
suggest that pain
often results
fatigue in a
patient which
may in turn lead
to a feeling of
exaggerated
pain. Developing
a peaceful as
well as a quiet
environment for
the patient
would help the
patient to
overcome his
feelings of pain
in a much better
way. The nurse
may contain
pharmacological
interventions by
the using of non
opioids like that
of
acetaminophen
or non selective
NSAID or a
selective NSAID.
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It has been found
that the letter
work in
peripheral
tissues by
blocking the
synthesis of
prostaglandins
which in turn
help in the
stimulation of
nociceptors
(Briggs et al.,
2013). This is
usually provided
when the patient
would be
suffering from
mild to moderate
pain in the
patient is
suffering from
severe pain then
the nurse may
provide opioid
analgesics
intravenously
systematically by
PCA system or
also as
epidurally. The
Nurse may also
use local
anaesthetic
agents which
might block the
transmission of
the pain (Boltz et
al., 2014). The
knots me also
use cognitive
behavioural
strategies as non
pharmacological
methods. this
may include
using imagery
distraction
techniques,
relaxation
exercises, music
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therapy,
breathing
exercises and
many others.
These techniques
usually help in
diverting the
patient's five
senses away
from the painful
stimuli and also
help in increasing
his concentration
which helps to
decrease his pain
experience
(Eichler et al.,
2014). The nurse
may also
massage the
affected area as
a massage helps
in tracking the
pain
transmission and
also helps in
increasing
endorphin levels
and also helps in
minimising tissue
oedema. The
nurse may also
provide hot or
cold compress to
decrease the
pain by the
development of
blood flow to the
area and also
helps in
reduction of pain
reflexes. After
providing all the
interventions for
his pain in the
Hip region the
nurse should set
her plans to us
the treatment of
the skin care.
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Second action –
. In order to
manage the
category 3 skin
tear the nurse
should first apply
pressure and
elevate the leg in
an appropriate
Position to
control the
bleeding
(Scherrrer et al.,
2014). Following
this manner
should take
initiatives to
clean the wound
using warm
saline or water in
order to irrigate
the wound and
move if any sort
of residual
Hematoma or
debris are
present. Then
she should make
the surrounding
skin tissue try to
avoid any sort of
other injury. As
the patient is
having a
category treat
skin tear, the
skin flap will not
be present and
therefore the
nurse should
overlook the
step of fixing up
the skin flap and
directly move on
Rationale -
This would help in healing of the
wound of the category three skin
tear with positive outcomes.
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to the dressing
part. The nurse
should then
provide
appropriate
dressing
considering the
correct
utilisation of
addition wound
closure strips. It
should be done
in such a way so
that it can
facilitate
drainage and
also helps in
avoiding tension
over flexure
sites. Usually in
most cases she
tools and staples
are not used but
as the skin cut is
quite deep and
has full thickness
therefore
sutures and
staples can be
used by the
nurse in this case
(Scott et al.,
2016) . The nurse
would review
and reassess the
dressing
changes. In
expressing the
nurse should
monitor the
changes in the
wound and also
take care for
maintaining the
skin integrity it is
important for the
nurse to assess
the wound every
24 to 14 hours.
She should also
assess whether
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any sort of
infections
symptoms are
appearing or not
along with
assessing the
pain exudates,
erythema and
malodour.
Second Nursing
Problem
He is also seen to
suffer from
restricted mobility
and the main reason
for this is arthritis.
As Mr. John used to
take long business
trips he might have
gone through
toilsome days which
had resulted in the
occurrence of
arthritis. Arthritis is
mainly ascertained
by the wear and tear
of the cartilage in
between the bones.
Moreover, his obese
condition is also
having an effect on
his Arthritis
symptoms as it is
creating more
pressure on the
bones resulting in
restricted mobility.
Therefore the nurse
should take
interventions which
would help in
promoting his
movement and
One Nursing Goal –
. Apart from the
goal of reducing the
pain of the patient
for the two factors ,
the second goal
would be to develop
his mobility so that
he can experience
freedom and
independence in the
activities he takes
and his mobility is
developed (Perme et
al., 2013) . The nurse
should make sure
that the patient
performs physical
activity
independently and
also demonstrate
measures to develop
mobility. He may
also use adaptive
devices to increase
mobility along with
the up taking of
different safety
measures to
minimize potential
for injury from fall..
Then she should also
set goal that the
First action –
In order to
develop the
mobility of the
patient the nurse
should first
introduce muscle
exercises which
will mainly
include
abdominal
tightening
exercises and
events, hop on
foot and
standing on toes.
She should also
take
interventions to
reduce the risk
for fall by
introducing bed
rails, bed in
down position
and placing
important items
close by
Rationale –
This should help him to overcome
his restricted mobility.
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locomotion. He
should be properly
educated about the
beneficial effects of
exercise we should
help him to control
his body weight as
well as is Arthritis
symptoms.
patient should be
free from
complications of
immobility and
therefore she should
check the evidences
of the saint goal by
assessing intact skin,
normal bowel
pattern, absence of
thrombophlebitis
and clear breathing
sounds. Apart from
this then she should
also care for his
obese condition,
unmanaged
symptoms of
arthritis situation as
well as hypertension
and also handle the
preliminary
symptoms of
dementia carefully
(Wallace et al.,
2014).
Second action –
The nurse should
also promote
and facilitate
ambulation and
at the same time
have the patient
with dangling
legs sitting on
chair and others
(Orrell & Brayne,
2015). This will
help the patient
by increasing his
self esteem
about the
acquiring
independence.
The nurse should
also teach him
the use of
different mobility
devices such as
crutches or
walkers.
Rationale –
This would hep him to increase
independence of the patient and
develop his self esteem
8) Evaluate
Evaluation is one of the very important steps of the clinical reasoning cycle where the nurses need to
evaluate whether the interventions taken by her are providing beneficial outcomes or not. In order to
evaluate the result of his first intervention of pain management, the nurse should conduct the the
pain assessment at every interval of 8 hours of the day in order to assess that whether the pain of the
individual is decreasing or not. She should then make documentation on it to follow the effects of
the intervention. She should also set up a time frame for her intervention after which she will be
mainly monitoring the response of the patient on the pain management score in order to understand
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whether both the pharmacological and non pharmacological interventions are acting on the patient.
For the second intervention the nurse should mainly try to read the gesture and body language of the
patient to develop an understanding of the developed mobility of the patient. The nurse at the same
time should encourage the patient to take a walk or movement by himself in order to understand the
stiffness of the movement of the Limbs as well as other parts of the body. The nurse should also try
to understand the patient satisfaction level in order to assess the effect of the interventions, In this
case she should also set up a time frame for evaluation after which she should assess the result of
the intervention (Chen et al., 2015). After properly documenting the evaluation reports, she should
try to understand whether the reports are depicting betterment of the patient or far better
interventions are required or not. If evaluation report is positive she should try to continue the
interventions which she had planned before. If the reports are not satisfactory then she should
communicate with the mentors and come to a conclusion about changing the interventions so that
the second setup interventions will bring down the positive results for the patients.
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9) Reflect on process and new learning
It was a very complicated case which I had handled in my professional year. This is because the
patient was not only quite old with a very poor management of hypertension and asthma; he also
had several other issues. He had fallen somewhere and had been hurt in his hip portion which had

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