Reflecting on Clinical Reasoning and Mental State Examination

This report reflects on the application of the clinical reasoning cycle in assessing a patient, Allison, diagnosed with a depressive disorder. The report details the steps involved, including learning the patient's situation, collecting evidence through a biopsychosocial approach and mental status examination, processing data to recognize problems, planning objectives, implementing interventions like therapeutic communication, and evaluating results. The case study emphasizes the impact of financial stress and uncertain future on Allison's mental health, highlighting the importance of a recovery-oriented approach and the role of a registered nurse in providing support and facilitating positive outcomes. The reflection covers the learning from the case study and the importance of spreading awareness about depression and its effects.

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Running Head: Integrating Practice
INTEGRATING PRACTICE

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Contents
Introduction......................................................................................................................................2
Step 1: Learning the patient's present patient situation...................................................................2
Step 2: Collecting supporting pieces of evidence............................................................................2
The biopsychosocial approach to read her:..................................................................................2
Mental status examination:..........................................................................................................3
Step 3: Processing data....................................................................................................................3
Step 4: Recognizing problems.........................................................................................................3
Step 5: Planning objective...............................................................................................................4
Step 6: Implementation....................................................................................................................4
Step 7: Evaluation of results............................................................................................................4
Step 8: Reflection through encounter..............................................................................................4
Conclusion.......................................................................................................................................5
Reference list...................................................................................................................................6

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Introduction
Clinical reasoning cycle is a process undertaken by healthcare professionals to diagnose
the health condition of patients. This project is based on a lady, named Allison who is a 38yrs old
and single mother of two children. She is recently suffering from low feeling for no good reason
behind. She visits a clinic and there it is discovered that a few factors such as financial stress and
thoughts about an uncertain future are troubling her. She was examined with the help of clinical
reasoning cycle and was diagnosed with depressive disorder. The steps involved in the clinical
reasoning cycle are analyzing the present scenario, collecting evidence and clues, recognizing of
patient problem to implement intervention followed by outcome evaluation. This paper intends
to provide a reflection upon the case study of Allison.
Step 1: Learning the patient's present patient situation
Allison is a 38-year-old lady who raises her kids as a single mother. She stays with her
sister and works in a supermarket. She visits a psychiatric clinic with all her clinical symptoms
for depression, feeling demotivated and lack of energy every time. Her sister noticed her
condition and sends her to the clinic for consultation. The clinical counseling process discovers
that her wages are cut down at her workplace that is the big factor to trouble her since her kids
are too young and raising them in good upbringing will cost money.
Step 2: Collectingsupportingpieces of evidence
When Allison entered the chamber, I found her brooding over several thoughts. I started
with basic conversations to move onto the following process:
The biopsychosocial approach to read here:
Allison was bulky in appearance that never looked straight into my eyes while speaking.
She was very emotional and became tearful often. Moreover seeing her I predicted she was much

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obese than her age so hormones are other factors to influence her mood swings. She loves her
husband but continuous circumvented from his side keeps her sad all the time.
Mental status examination (MSE):
I found her representing her symptoms in a much-distorted fashion. I encouraged her to
open herself and speak up but initially, she was feeling shaky and reluctant to disclose necessary
facts. She started speaking with her financial stress while she abruptly recalls incidents that made
her tear full. Little and minor incidents such as the spilling of sugar make her feel sad. From this
particular incident, it can be derived that her sense of alertness is to week (Blevinset al., 2015).
Perhaps while indulging into any activity she ponders over other thoughts.
Step 3: Processingdata
After encountering Allison with several questionnaires I suspected her to be the victim of
depressive disorder with mixed features. This is a kind of mixed state of mind followed by
agitated depression. This type of depression falls within the 5th edition of the diagnostic and
statistical manual of mental disorder also known as DSM-5. This medical condition is dominated
by both mania and depression(Lilienfeld et al., 2015).
In the case of Allison clinical symptoms mostly manifested to depression where the
manic symptoms included racing thoughts about her kids. However there is no cause for the
disease has been identified so far, the patient experience secondary symptoms such as fatigue,
overweight, feeling of worthless, lack of concentration and difficulty to sleep. Allison even talks
about her appetite going loose; this is also a vital symptom for DSM-5. She is likely to increase
the risk of more deterioration that will require medications such as antidepressant and mood
stabilizer combined with a sedative.

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Step 4: Recognizing problems
The major problem in Allison behind developing DSM is her immense financial stress
with her less paid job. Cutting of wage might put an impact on her children. Dave seldom rings
her; she received nothing more than physical torture from him. All these thoughts bother her
every time that she developed mild cognitive impairment as she suffers from forgetfulness over
minor issues.
Step 5: Planning objective
The initial steps of the treatment plan involve multiple session of counselling process so
that Allison overcomes from the brooding thoughts.
Attitudes and rights:
All these come under recovery oriented approach when healthcare professionals support
patients focusing on their strengths. Recovery oriented approach recognizes patients as
individual, prioritizing their choices.the purpose of the therapeutic communication will develop
social and vocational activities meaningful to her.
Real choices:
Allison is suggested to cooperate so that things can be improved. The plan is to keep her
busy with activities She loves her kids focusing more on them will help her. If things go well
there is no need for medications at this moment. It will involve time duration of 2-3months.
Step 6: Implementation
As a registered nurse I would perform therapeutic communication as the evidence-based
treatment on Alison to treat major depression. As discussed in the preceding section, it is a talk
therapy that would help to extract the good thought and skills within her (Lilienfeld et al., 2015).
As for example, I would encourage her to apply for other jobs so that she can earn a good living.

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She confessed that she likes watching soaps the rest of the time she spends lying on the sofa, so
that will be the ideal time to look for jobs in portals. Allison was sound in her academics so
suggesting her to guide her children regularly will help. I would also ask her to accompany the
children to swimming class so that she can communicate with different people there.
Moreover I would call Dave during the session and ask him to give her time so that she
does not feel depressed. I would talk to Dave if he can take responsibilities of children equally so
that the financial stress can be minimized. Improving personal relationship would also help her
to recover. As a nurse I can talk to her and discuss how to keep oneself healthy so that it
becomes easier to find another job that would support financialy.
Step 7: Evaluation of results
In order to evaluate the effectiveness of therapeutic communication, I would ring her
every after 3 days initially to record her improvements. I would arrange the counseling session
for her at the clinic biweekly. The other means of evaluation could be preparing a checklist of
regular activities for her (Blevins et al., 2015). Through the communication process I can
monitor her improvements and see whether things are better than before. I will collect feedback
even from Dave to justify the findings. I would also prepare a check list for myself that would
help me to identify the differences between her.
Step 8: Reflection through encounter
Through the case study and assessment of Alison, I have learned that there are several
degrees of depression. Severe depression can prove fatal sometimes with a feeling of self-
harming. However, Allison was diagnosed with depressive cognitive impairment at her
preliminary stages and things were quite under control. She understood her symptoms well and
the risk factors might get involved if left untreated. After encountering Alison I would like to

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spread awareness on ill effects of on depression so that people can break taboo and comes
forward to speak (Johnsen et al., 2016). I believe more people communicate and engage in
activities, the more one can overcome racing thoughts.
Conclusion
This paper embedded steps of the Clinical Reasoning Cycle for the purposes of reflecting
upon the scope, nature, and rationale for assessment of Allison in this case study. The entire
process of clinical reasoning cycle works on critical evaluation and philosophical perceptions
unlike process on continuous clinical encounters. Such a clinical practice has helped me to set
the competency standards of a registered nurse. The encounter has given me an opportunity to
implement my skills of nursing expertise. Clinical reasoning skills help every nursing
practitioner to manage clinical scenarios under deadlines to set relations between evidence and
outcomes. Clinical reasoning requires active learning to provide effective practice outcomes.

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Reference list
Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The
posttraumatic stress disorder checklist for DSM‐5 (PCL‐5): Development and initial
psychometric evaluation. Journal of traumatic stress, 28(6), 489-498.
Johnsen, H. M., Fossum, M., Vivekananda-Schmidt, P., Fruhling, A., &Slettebø, Å.
(2016).Teaching clinical reasoning and decision-making skills to nursing students:
Design, development, and usability evaluation of a serious game. International journal of
medical informatics, 94, 39-48.
Lilienfeld, S. O., Watts, A. L., & Smith, S. F. (2015). Successful psychopathy: A scientific status
report. Current Directions in Psychological Science, 24(4), 298-303.