Analysis of Clinical Reasoning Cycle for Mrs. Williamson (Nursing)

This report provides an analysis of the clinical reasoning cycle in the context of a nursing assignment, specifically focusing on a case study of Mrs. Williamson, a 76-year-old patient admitted to the orthopaedic ward with a metatarsal fracture and a history of hypertension. The report explores the application of the Levett-Jones clinical reasoning cycle, which includes collecting cues, processing information, identifying problems, establishing goals, planning actions, evaluating outcomes, and reflecting. The report addresses various aspects of patient care, including pain management, assessment of hypertension and depression, and the importance of communication and empathy. It also covers nursing diagnoses, interventions, and evaluations, including Gibbs' reflective cycle. The assignment emphasizes the importance of critical thinking, clinical skills, and professional judgment in providing effective patient care, as well as the need for nurses to adhere to the Nursing and Midwifery Board of Australia (NMBA) standards.

Running head: NURSING
Levett Jones Cycle
Name of the Student
Name of the University
Author’s Note

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Table of Contents
Question 1.............................................................................................................................. 2
Question 2.............................................................................................................................. 2
Question 3.............................................................................................................................. 3
Question 4.............................................................................................................................. 3
Question 5.............................................................................................................................. 4
Question 6.............................................................................................................................. 5
Question 7.............................................................................................................................. 5
Question 8.............................................................................................................................. 6
Question 9.............................................................................................................................. 6
Reference-............................................................................................................................. 7

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Question 1
According to Levett-Jones et al., (2010) stated that in acute care settings, to manage
emergent conditions a nurse must assess the situation carefully to recognise deteriorating
conditions and apply clinical reasoning skills to manage the situation. Clinical reasoning
composes of steps such as “collecting cues”, “processing information”, “identifying
problems”, establishing goals”, “action plan”, “evaluate outcomes” and “reflection”. Hunter
and Arthur (2016) suggested that an emerging nurse must have proper psychomotor skills to
judge a situation and act likewise. They interviewed various clinical educators whose ideas
varied considerably, but most were of the opinion that student’s reasoning skill can be
assessed efficiently with the Levett-Jones clinical reasoning cycle. The clinical reasoning can
help the professionals to make appropriate decisions by diagnosis, prevention and proper
treatment protocol of the patients by application of the clinical skills. An inefficient clinical
reasoning skill can lead to failure of diagnosis, and implementation of proper medical
interventions, and management of complicated cases. With proper reasoning skills, the
quality of patient-based approach is enhanced. The Nursing and Midwifery Board of
Australia (2019), standard 1.2 emphasizes that a nurse must fulfil the duty of care while
examining the patients and efficiently should intervene with the situation. Critical thinking and
analysing is a very important aspect of nursing education. Levett-Jones, Courtney-Pratt and
Govind (2019) revealed that nurses with proper clinical reasoning skills have positive patient
outcomes. Clinical reasoning is often associated with the clinical skills, critical thinking,
professional judgement, scientific reasoning along with scholarly rationality and basis.
Therefore, the implementation of a proper clinical reasoning based skills, can improve the
traditional methods of medicine practice. It can generate new scientific ideas, based on
evidences, which can improve the comprehensive care of the patients. Some other aspects
of critical reflection while reasoning is not only logic or ideas, but also deduction, analysis,
evaluation and application for patient safety.
Question 2
In case of Mrs. Williamson the primary focus area will be her metatarsal bone
fracture in her left foot and excessive pain. Cenatiempo et al., (2019) revealed that pure
dislocation or proximal fracture in the tarsal bones can cause weaker ligaments, and
decreased mobility of the individual. Nencini and Ivanusic (2016) suggested that pain
associated with bone fractures can be due to stimulation of periosteum or bone marrow by
sensory neurons. They informed that peripheral sensory neurons intervening bone are
actively associated with the pain symptoms. The additional factor that might be considered

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here is her history of hypertension, which is not resolving even being under anti-hypertensive
medication.
Question 3
Massey, Chaboyer and Anderson (2017) revealed that patient safety is heavily
dependent on the nurse’s instant action and critical thinking ability. They were of the belief
that noticing the vital signs and symptoms to detect the deteriorating condition of the patient,
to escalate the level of care. They revealed that nurses being the front-line medical
personnel should notice the changing symptoms immediately, or it will further aggravate the
situation of patients, leading to the elevation of the physical and physiological conditions,
even leading to death. The Nursing and Midwifery Board of Australia NMBA), (2019)
standard 10.2 suggested that communicating properly with the patients and the
multidisciplinary team is necessary while collecting information. The nurse must show
empathy and be approachable to the patients, so that the patients can feel free and cosy,
and share all the details without hesitation. Mrs. Williamson is presented with left foot
metatarsal fracture and hypertension. Her blood pressure is 145/90, temperature 36.80C,
pulse rate 110pm, respiration rate 18breaths pm, and oxygen saturation is 95%. She is
prescribed 1000mg of Panadol every 6 hrs, and Avapro 150mg/day. She is admitted in the
orthopaedic ward for examining her aggravating pain and redness in the left foot, as she is
unable to bear any weight. Mrs. Williamson is presented with high blood pressure inspite of
consuming anti-hypertensive medication, which can be an indication for resistant
hypertension syndrome. Doroszko et al. (2016) revealed that resistant hypertension can be
diagnosed when the patient despite being treated with antihypertensive medication, does not
respond. So, to confirm resistant hypertension, tests needs to be performed. Mrs. Williamson
is experiencing excessive pain despite of taking pain meds. So, pain assessment can be
performed in the patient. Fillingam et al., (2016) revealed that to classify the level and nature
of pain, pain assessment can be necessary. It quantifies the kind of pain and pain
assessment tool can be helpful to intervene in the situation. The patient does not socialize
after her husband’s death and is restless in the hospital. So, depression assessment can be
done in the patient. Bauer et al., (2018) highlighted that routine symptom monitoring and
measuring the level can be effective in treatment of depression.
Question 4
Samadbeik et al., (2017) revealed that in nursing practice information processing
from the observation is a very essential part in diagnosing the medical condition of the
patient. For patient-centred approach, the correct processing of the data is very necessary to

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evaluate the process correctly. The pain level of Mrs. Williamson is not within the normal
limit despite consuming the analgesics for controlling the pain. Sanzone (2016) suggested
that in normal bone fractures, to soothe the sensory neurones, pain meds taken twice a day
of 1000mg dosage is sufficient in adults. However, in case of Mrs. Williamson, the pain level
was escalating even after consuming medications at every 6hrs. Again, the blood pressure
level of Mrs. Williamson is not within the normal limits. Even after consuming angiotensin I
blocker as an anti-hypertensive medicine, her blood pressure is 145/90. Will et al., (2016)
suggested that medications to treat hypertension can ameliorate the high blood pressure
condition considerably by vasodilation. The pain management issue in the patient is the
primary concern, because primarily the metatarsal bone fracture is the source or cause of
hospitalization. Makhni et al., (2017) suggested that metatarsal fractures in the foot can
cause symptoms such as swelling, pain and sprain in the foot. Due to the traumatic pull in
the tendons or ligament, the condition aggravates increasing the pain level. So, initial
diagnosis and the treatment of the condition is very necessary at the very initial stage.
Question 5
According to Doenges, Moorhouse and Murr (2016) an actual nursing diagnosis
comprises of the active problem of the patient. In case of the patient, it can be detected as
metatarsal bone fracture and pain of the individual. It is considered to be the source of
hospitalization. Potential problem is other associated risk factors of the patient that
aggravates her situation. In the case of Mrs. Williamson, it can be considered as her allying
factors of hypertension and depression. Mrs. Williamson is having problem in lifting weight
and intense pain related to prospective metatarsal bone fracture evidenced by her ongoing
dose of Panadol 1000mg at a 6 hourly basis. Her pulse rate is 110 beats per min related to
hypertension evidenced by her blood pressure level. Mrs Williamson is restless to go home
related to her social isolation and depression evidenced by her discontinuation of socializing
post her husband’s death. The actual nursing diagnosis for Mrs. Williamson is her pain
related to the metatarsal fracture issue evidenced by the increasing level of pain. Dineen et
al., (2017) revealed that fractures in the proximal metatarsal is very common that can be
treated with a variety of treatment modalities. Pain assessment tools can be used to assess
the kind and level of pain, and diagnostic tools like X-Ray can be helpful to detect the
fracture accurately. The other potential problem can be managing her social isolation issue
related to depression evidenced by her lifestyle. Courtin and Knapp (2015) suggested that in
older individuals with growing age, loneliness is the more primary cause of depression that
affects an array of health issues. Due to loneliness, they tend to be isolated and depression

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and anxiety grasps them. The NMBA standard 7.5 suggests that delegating the level of care
is very important as a nurse, by providing proper intervention strategies and assessment.
Question 6
S (Specific) 1. To manage pain a nurse can
distract the patient.
2. The nurse can contact a
dietician to prescribe low-
sodium diet for hypertension.
M (Measurable) All the above can be done within one
day for proper intervention.
A (Attainable) The nurse can contact the dietician
in a day for better outcome and can
assist the patient.
R (Realistic) The interventions can help ease her
situation.
T (Time) The patient condition should improve
in one week duration.
Question 7
According to NMBA, a nurse must intervene properly for better outcome of the
patient in a professional and therapeutic manner. The nurse can monitor closely the
duration, location, characterisation and quality, nature of pain. Assessment is the very first
step in nursing intervention for managing pain. William and Craig (2016) suggested that
measuring the rate of pain, and the nature of pain is the most essential part of intervention in
pain-related disorders. Mrs. Williamson can be educated regarding the self-management
protocol for reducing pain. She can be motivated to do any desirable light activities to
distract her from the pain. She can be helped to watch her favourite program in television, or
every possible information regarding her pain must be imparted to her. O’donnell (2015)
revealed that better patient outcome can be noticed in patients during the pain management
procedure after imparting education about the process. Cooper et al., (2017) stated that the
patient can be administered with morphine as a medication for excessive pain management.

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Morphine can help in hyperpolarization of neurons, as an endogenous analgesic and thus
help in pain cessation. The nurse can document the pain-relief process, use music therapy,
relaxation exercises to intervene in the pain relief procedure. Leng et al., (2016) revealed
that distracting the patient with various therapies can help in the pain management
procedure.
Question 8
Evaluation of the procedure can be done by monitoring the pain level of the patient,
and tracking the prognosis of her recovery from the metatarsal fracture. Her blood pressure
level can be routinely checked and updated in the sheet. It can be considered that with the
low-sodium and low trans-fat diet, her blood pressure level will be controlled to a
considerable extent. Graudal et al. (2017) suggested that a low-sodium diet can help in
maintaining the osmotic balance of the blood, by decreasing the level of blood pressure. The
therapies used along with the administration of the morphine can be useful in controlling the
excessive level of pain in the patient. Ahmadi et al. (2016) revealed that morphine
administration can soothe nociceptive pain and the therapy additionally helps with the
procedure. These interventions will help with improving the condition of the patient.
Communicating effectively with the patient, and showing empathy can be helpful to treat her
loneliness and she can be motivated to stay in the hospital.
Question 9
Gibbs reflective cycle can be used as an efficient method to delineate the reflection
(learning) process from the whole procedure.
Description- Mrs. Williamson was admitted with metatarsal fracture and pain. She was
hypertensive, elevating pulse rate and was facing issues of depression.
Feelings- I was feeling tensed during managing the situation, as the patient was very
anxious, and restless. I was confident while intervening to relieve the patient from her pain.
Evaluation- The situation could have been better, if the patient was co-operative. I came to
learn about pain management protocol and controlling hypertension and depression in a
patient.
Conclusions- The process was helpful, as I dealt with an orthopaedic condition, along with
some additional disorders.

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Action- In future, I will be more confident while handling such patients, and will intervene
immediately without hesitation or tension.

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