ATHC 1 Assessment 3: Clinical Reasoning - Mr. Smith's Case

This assignment presents a student's comprehensive analysis of Mr. Cyril Smith's case, utilizing the clinical reasoning cycle to assess his condition and plan care. The student details observations, gathers and interprets data, identifies problems, and synthesizes information to formulate nursing diagnoses. The assignment also addresses critical thinking questions, exploring factors contributing to safe medication practices and the importance of effective therapeutic communication in person-centered care. The student reflects on their learning, emphasizing the significance of clear communication, clinical reasoning, and patient-centered approaches to minimize medication errors and enhance patient outcomes. The assignment incorporates relevant references to support its arguments and findings.

ATHC 1 Assessment Three (3) template
Student Name:
Student Number:
Tutor Name:
Patient Name: Mr. Cyril Smith
Complete the following table using information from Mr Cyril Smith’s story
Clinical Reasoning Cycle
Consider the patient situation
In this section, providea
relevant and concise
description of your
observation of the context
and patient situation.
The patient, Mr. Smith is 72 years old has recently been diagnosed with
bowel cancer and has been admitted to the surgical ward of the hospital. He
is scheduled for a bowel resection surgery tomorrow. Mr. Smith was active
and jovial, and he used to enjoy bowling but became lonely since his wife
and youngest child died in an accident. The GP noticed his weight loss,
decreased appetite. Also, the patient needs encouragement for fluid intake.
Mr. Smith feels weird, woozy and his mouth became dry.
Collect cues and/or information
Review / Gather / Recall
Record current information,
new information, knowledge
On the A-H assessment it was found that his airway was patent. His pulse
and respiratory rate is a little high and BP is low. He had a normal arthritic
pain however, his temperature was normal and his blood glucose level was
also under control as the assessment held at 14:00 hours when his meal
was over. He was last voided at 9:00 hours and bowel not opened. His
daughter will visit in the afternoon. Mr. Smith is using Metformin 500mg BD,
paracetamol1gmTDS, ibuprofen 400mg BD and salbutamol 4 puffs PRN as
medicine to control his chronic COPD, osteoarthritis and type II diabetes.
He was a smoker but since last 10 years he is not smoking. He uses
walking stick for mobilising as he had an ankle fracture 15 years ago.
Process Information
Interpret
Analyse data and come to
understanding of
signs/symptoms
On analysing the result found in the assessment it is clear that the normal
pain he is experiencing is due to osteoarthritis. Also, his mouth is becoming
dry as he needs encouragement with fluid intake. According to literature,
bowel cancer requires hydration (Currow et al. 2015). It is also causing
issues like loss of appetite and weight as a consequence.
Discriminate
Distinguish relevant from
irrelevant information
Information regarding the profession of his children is quite irrelevant in the
treatment procedure. Also, as is temperature is normal, it is not required to
consider in the treatment. Information related to the pupil is also irrelevant in
this case.
Relate &Infer
Cluster cues, make
deductions or form opinions
His weight and appetite loss is related to the bowel cancer. The other
symptoms such as shortness of breathing and pain are related to his
chronic health issues.
Match
Match current situation to
past situations
The assessment revealed that his respiratory rate is 22bpm which is more
than normal. However, the O2 saturation is 95% which is almost normal, as
he is taking salbutamol to control his chronic COPD. 15 years ago he had
an ankle fracture and his left leg is weaker due to that. He is taking
paracetamol and ibuprofen to control his pain of chronic osteoarthritis. In
1

order to control blood glucose level (BGL), he also takes metformin and
upon assessment after meal his BGL was 7.2mmol which was normal.
Predict
Predict an outcome
His COPD and Blood sugar can cause issue after surgery if left
unmanaged.
Identify problems / issues
Synthesise facts and
interferences and make a
definitive nursing diagnosis
Synthesizing the facts found in the assessment it is clear that oral nutrition
and hydration is essential as his mouth is dry skin is also flaky. It is
important for patients with bowel cancer. His low blood sugar and breathing
issues should also be controlled prior to the surgery. Considering the
chronic diabetes, it is important to suggest proper diet which will be
beneficial for a patient with bowel issues.
2

Critical thinking questions
Identify and discuss two factors that can contribute to safe medication practices (provide
references) 100 words
1 Medication error is a failure in the treatment process and accurate diagnosis is essential to
reduce error in medication and literatures mentioned that due to imperfections in diagnosis
many patients suffer and sometimes it threatens the life as well (Karavasiliadou and
Athanasakis 2014. Therefore, proper and accurate diagnosis can contribute to safe
medication practice.
2 Another factor that can contribute in the safe medication practice is the use of clinical
reasoning by the nurses. According to the authors of literatures, clinical reasoning practice
promotes medical safety prior to, during, as well as after medication administration (Rohde
and Domm 2018). Nurses work closely for the patients and integrating clinical reasoning
reduces medication errors.
Outline the importance of effective therapeutic communication and how it relates to person centred
care (provide references) (200 words)
Communication defines the exchange of feelings, thoughts and information which is essential
while providing care otherwise it may cause gap in care. Through communication patients convey
their fear and concern to the nurses and caregivers which supports correct nursing diagnosis.
Effective therapeutic communication in healthcare is important as it helps in developing trust
between the patient and the healthcare professionals which encourages confidence as well as
autonomy. According to the studies, establishment of therapeutic communication in healthcare
emphasizes the holistic view. The complexity of patient care and the collaborative working
requires establishing an effective therapeutic communication which supports person-centred care
as well. According to the literatures, nurses must collaborate with the patients to integrate their
values and preferences in care (Kourkouta and Papathanasiou 2014). They should establish
person-centred care to improve quality and safety of the patient. In a study, authors also indicated
that collaborative approach to emphasize therapeutic communication in the care makes it more
holistic as well as person-centred. The hospitals of Australia have implemented variety of care
programmes aiming to establish person-centred care and in this regard researchers mentioned
the role of maintaining a therapeutic relationship with the patients. Therefore, person-centred care
fosters a better healthcare outcome which is possible through the development of effective
therapeutic communication while providing care (Delaney 2018).
What have you learned from this assessment? What actions will you take into clinical practice as a
result of what you have learned?(provide references) (200 words)
Being a nursing student this assessment helped me to gain knowledge which is essential in
nursing practice. I have also learned that the role of caregiver is highly important to establish a
patient-centred care otherwise it may incur medication errors (Santana et al. 2018). When,
Cameron, the RN asked me to take care of the patient in the afternoon, the patient complained to
me that he cannot understand the words of Cameron. Therefore, I realize that building a
therapeutic communication is extremely important to have a better understanding about the issues
and experiences of the patient. I learned that if the communication is clear then the trust between
3

patient and the nurse is established which is important in care. The learning I gained from this
experience will help me in clinical practice and I will also use clinical reasoning practice while
providing care to the patients in order to reduce medication error. I have learned that diagnosis is
most important to reduce error and patient-centred care also can be considered as an important
factor for safety in medical practice (Fix et al. 2018). However, I will also maintain a clear
communication with my seniors and fellow workers and take suggestions from them if I face any
issue in my working settings.
4

References
Currow, D.C., Quinn, S., Agar, M., Fazekas, B., Hardy, J., McCaffrey, N., Eckermann, S., Abernethy,
A.P. and Clark, K., 2015. Double-blind, placebo-controlled, randomized trial of octreotide in
malignant bowel obstruction. Journal of pain and symptom management, 49(5), pp.814-821.
Delaney, L.J., 2018. Patient-centred care as an approach to improving health care in Australia.
Collegian, 25(1), pp.119-123.
Fix, G.M., VanDeusen Lukas, C., Bolton, R.E., Hill, J.N., Mueller, N., LaVela, S.L. and Bokhour,
B.G., 2018. Patient‐centred care is a way of doing things: How healthcare employees conceptualize
patient‐centred care. Health Expectations, 21(1), pp.300-307.
Karavasiliadou, S. and Athanasakis, E., 2014. An inside look into the factors contributing to
medication errors in the clinical nursing practice. Health Science Journal, 8(1).
Kourkouta, L. and Papathanasiou, I.V., 2014. Communication in nursing practice. Materia socio-
medica, 26(1), p.65.
Rohde, E. and Domm, E., 2018. Nurses’ clinical reasoning practices that support safe medication
administration: An integrative review of the literature. Journal of clinical nursing, 27(3-4), pp.e402-
e411.
Santana, M.J., Manalili, K., Jolley, R.J., Zelinsky, S., Quan, H. and Lu, M., 2018. How to practice
person‐centred care: A conceptual framework. Health Expectations, 21(2), pp.429-440.
5