University Nursing Essay: Clinical Reasoning Cycle for Patient Care

This essay provides a detailed analysis of the clinical reasoning cycle, a crucial framework used by nurses in healthcare settings. The essay begins with an introduction to the cycle, explaining its purpose and importance in patient care. It then proceeds to break down the cycle into its seven phases: considering the facts, collecting cues, processing information, identifying the nursing diagnosis, establishing goals, implementing interventions, and reflecting on the process. The essay uses a case study of Mr. Williamson, a 76-year-old patient admitted to the hospital after a fall, to illustrate each phase of the cycle. The analysis includes assessment, diagnosis, goal setting (using SMART goals), interventions (medication, education, and physical activities), and evaluation. The reflection phase utilizes the Gibbs cycle to analyze the nurse's experiences, strengths, and weaknesses, highlighting the importance of updated clinical knowledge. The essay emphasizes the cycle's role in reducing patient deterioration and ensuring safe, quality nursing care. The importance of professional rapport, effective communication, and the use of evidence-based practices are also discussed.

Running head: FOUNDATION OF PROFESSIONAL PRACTICE
FOUNDATION OF PROFESSIONAL PRACTICE
Name of the student:
Name of the university:
Author note:

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Introduction:
Clinical reasoning cycle is demarcated as the process which is used in the healthcare
setting by the nurses in order to evaluate the health situation of the patient, and the outcomes will
be evaluated based on that (Dalton, Gee & Levett-Jones, 2015). The clinical reasoning is
described by levett-jones et al (2009), as a method in which nurses collect the cues from the
patient’s condition, practice the information, understand the complication of the patient, develop
and implement the intervention, evaluate the outcome and then reflects on it and then learn based
on that (Levett-Jones, 2017). Critical reasoning cycle aims to analyses the health condition of the
patient in order to reduce the patient deterioration and then maintaining the safe and secure
nursing practice. In the critical reasoning cycle, the well-being of the patient is analyzed which
help in the identification of the risk factors associated to the illness, to avoid the further
deterioration the patient’s health. Critical reasoning cycle also focusses on the planning of the
intervention and designing the person centered care plan which aids to provide safe and quality
care to the patient (Lavoie, Pepin & Cossette, 2015). The aim of the essay is to describe the
condition of Mr. Williamson by the help of the critical reasoning cycle.
Phase 1:
The phase 1 of the critical reasoning cycle includes the consideration of the facts about
the patient or the health situation of the patient and it vital as it helps in identifying the facts
related to the patient situation (Gummesson, Sundén & Fex, 2018). Mr. Williamson an elderly
woman of age 76, has been admitted to the hospital due to the fall at home. The patient has been
admitted to the emergency department, but later to ensure that patient did not have any fracture,
is referred for the investigation associated with the metatarsal bone fracture of the left food. The

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patient was an active member of the local church and the local bowling club before her
husband’s death. She does not want to stay at hospital and wants to go home.
Phase 2:
a. This is the second step of the critical reasoning cycle which involves the collection of the
cues or information related to the well-being of the patient that is further processes for the
evaluation. In the critical reasoning cycle, proper evaluation of the step is necessary for the
further treatment of the patient (Levett-Jones, 2017). All the cues and information which are
related to the health condition of the patient are collected appropriately at this stage and if not
done properly, it can hamper the further treatment and might delay the recovery of the
patient.
In order to collect all the related information of the patient’s health, a good
professional rapport between the patient and the nurse is required, which can be achieved by
the help of effective communication, so that the patient can trust the nurse and can share all
the information with the nurse without being uncomfortable.
b. All the cues and information that is collected from the given scenario includes:
1. Past medical history of high blood pressure
2. Redness and pain on her left foot
3. Pain level is 8/10
4. Not able to bear weight on the left foot.
5. Blood pressure level is 145/90
6. Body temperature 36.8 degree Celsius
7. Pulse rate= 110 beats/minute

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8. Respiration rate: 18 breaths/minute
9. Alert and oriented
10. 02 saturation level: 95%
11. Intakes Avapro 150 mg/day for hypertension
12. Administered 1000mg Panadol as analgesic
c. To gather new information regarding the patient following assessment should be conducted:
1. Magnetic Resonance Imaging to ensure, that whether the patient has fracture or only soft
tissues injuries (Jin, 2018).
2. Vital signs assessment after the assessment to gather information about the health
condition (Osborne et al., 2015).
3. Assessment to identify the reason of pain even after the administration of the pain
(Shetake, Lin & Mekel-Bobrov, 2018).
Phase 3:
a. This is 3rd step of the critical reasoning cycle which is done to process the information that
has been collected in the previous step. This step is important as it helps in the determination
of the details which are relevant to the condition of the patient based on the pharmacological
and physiological pattern (Levett-Jones, 2017). Based on that, the potential outcomes are
evaluated in order to make the possible decision. As a nurse, the main purpose of processing
the information is to identify the relevant information so that the outcome will be evaluated
to make the proper care plan (Hunter & Arthur, 2018).
b. From the collected cues and information, interpretation is done. The blood pressure of the
patient is 145/90, which is higher than the normal blood pressure (120/80) (Caselli et al.,
2016).

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The pulse rate of the patient is recorded as 110 beat per minute which is more
than the normal. The normal pulse rate of the healthy person should be between 70 and 100
beats per minute (Qadir & Tahir, 2019).
The pain score of the patient is 8/10, which is more than the usual pain score. In
the case of patient if the pain score is more than 5, the patient is supposed to be suffering
from acute pain (Farahpour et al., 2016).
Redness in the foot is not normal, hence if identified it can be due to the
internal injury which has resulted to redness of the foot and also contributes to the activation
of the pain (Schneiderhan, Clauw & Schwenk, 2017)
C. From the identified cues and information, it is evident that the patient had a fall which has
resulted into redness and pain in the left foot. This is identified as the priority cue as if it is
not treated properly; it can lead to moving disability and also resulted to internal injury
(Ouyang, & Sun, 2019). Hence, the pain and redness of the foot which is observed in the case
of Mr Williamson should be treated primarily.
Phase 4:
Actual nursing diagnosis is demarcated as the assessment of the signs and symptoms of
the pain that the patient is going through. The potential nursing diagnosis is termed as the
diagnosis, which is done to identify the potential risk factors that can cause further health
deterioration and hence can be prevented (Welton & Harper, 2016)
In the nursing diagnosis, the term “related to” and “evidenced by” are frequently used.
The term “related to” is used to denote the symptoms or signs that are directly related to the

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illness of the patient. The term evidenced by is used to denote the signs and symptoms which are
not directly related but is evidenced to give rise to the symptoms.
Pain and redness on the left foot- related to- pain is evidenced by –increase heart rate
(110 bpm) and pain score (8/10).
The potential nursing diagnosis in the case of Mr. Williamson is the bedsores- related to
the fall of the patient as the patient is not able to move due to the pain.
Phase 5:
The fifth phase of the critical reasoning skill is to establish the goal. The SMART goals
are described below:
Reducing the pain-score:
Specific: reducing the pain score below 3-5.
Measurable: The patient is able to bear weight
Attainable: The patient is able to walk properly, which can be done by administration of the pain
analgesics and involvement in the physical activity.
Realistic: The patient is advised to involve in physical activity and to take the medication as
prescribed.
Time-oriented: The pain of the patient is reduced within 2- 3 days.
Heart rate back to normal:
Specific: The heart rate of the patient is reduced from 110 bpm to the normal range

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Measurable: the heart rate is measured and if it is within 80-100 bpm, the goal is said to be
achieved.
Attainable: The pain of the patient is reduced and the patient is made calm.
Realistic: the pain of the patient is reduced by giving analgesics
Time-oriented: The pulse rate is reduced to normal within 12 hours of admission.
Phase 5:
This is the 5th step of the critical reasoning cycle, which aims to take the interventions
based on the actual nursing diagnosis.
Assessment: The assessment that is conducted in the case of Mrs Williamson is the physical
assessment of the left foot to determine, if the pain and redness has been reduced or not. The
heart rate of the patient is also assessed to ensure the reduction in the heart rate.
Education: The patient is educated about the physiotherapy exercise such as walking, breathing
exercise that helps to improve the condition of the patient. The patient is also educated about the
risk factor such as stress (Lu et al., 2015).
Medication: As observed the Panadol 1000 mg is not effective for the patient hence other
analgesic should be prescribed by the GP.
Intervention: To reduce pain, administration of analgesics is required. Apart from that to reduce
the pulse rate involvement in the physical activities, massage and deep breathing exercise is
needed (Perciavalle et al., 2017).

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Phase 6:
The sixth phase is the evaluation where the health outcome of the patient is evaluated.
The results which are expected in the case of Mrs Williamson is the reduced pain score, reduced
heart rate, decreased redness on the left foot.
The purpose of the evaluation is to assess the effectiveness of the nursing action or
intervention. In the evaluation, if the goals are achieved, the interventions are said to be effective
and if the goals are not achieved, the interventions are modified (Rossi, Lipsey & Henry, 2018).
The nurse should evaluate the nursing interventions after the time that has been provided
to achieve the goal to assess whether the interventions are effective or not.
Phase 7:
Reflection helps the nurses to identify their strength and weakness based on the
experience. The reflection is structured with the aid of the Gibbs cycle is one of the most widely
used model of reflection (Reljić, Pajnkihar & Fekonja, 2019).
Mrs Williamson is 76 year old women admitted to hospital due to fall. Initially I was
confident about my skill which is required to take care of the patient, but it is observed that even
after administrating the analgesics, the pain of the patient is not reduced which is the biggest
challenge I observed while taking care of her. The pain is also associated to increase the pulse
rate. I evaluated that; I need to gather more knowledge so that I will be able to avoid such
incident in future. From the case, it is analyzed that chances of fall in the elderly patient is high
and hence they should be provided with quality care. From the reflection, it is concluded that
updated clinical knowledge is vital in the treatment of the patient. In order to do that, I will
enhance y clinical knowledge by working with different patient.

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