Nursing Care Priorities and Clinical Reasoning Cycle Analysis Report

This report provides a comprehensive analysis of nursing care priorities, emphasizing the application of the clinical reasoning cycle to improve patient outcomes. The report begins by outlining the initial stages of the clinical reasoning cycle, including patient assessment and information gathering, and then progresses to the formulation of nursing care plans. A case study of Mr. Dinh Nguyen, an elderly patient with osteoarthritis and multiple sclerosis, is used to illustrate the practical application of these principles. The report highlights the importance of identifying patient needs, establishing effective interventions, and implementing care plans. The report then delves into the final stages of the clinical reasoning cycle, including setting goals, implementing actions, evaluating outcomes, and reflection. The analysis focuses on Mr. Nguyen's top priority of blurred vision, detailing specific goals, nursing interventions, and expected outcomes. The report concludes by emphasizing the significance of clinical reasoning in nursing practice and its impact on patient care, encouraging nurses to consider both physical and emotional aspects of patient health. The report highlights the importance of understanding patient needs and providing emotional support to improve patient outcomes.

NURSING

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
PART A ..........................................................................................................................................1
Nursing care priorities ................................................................................................................1
PART B............................................................................................................................................3
The top priority of care for Dinh Nguyen...................................................................................3
CONCLUSION ...............................................................................................................................5
REFERENCES ...............................................................................................................................6

INTRODUCTION
Nursing care practices help individuals to improve their health. In order to provide
effective care to patients it is necessary for nurses to develop better understanding of clinical
reasoning cycle. This cycle helps nurses to establish better understanding of patient's situation
and to act according to situation. Clinical reasoning cycle also helps nurses to prioritise their care
practices so that patient can recover at the earliest and risks can be minimized (Higgs and et.al.,
2018).
This report will analyse the priorities of nursing care practices by using the initial stages
of clinical reasoning cycle. It will also consider one of the top priority in relation with the given
case study of Mr. Dinh Nguyen. This report will also demonstrate the implementation of clinical
reasoning concepts in the nursing practices. This approach not only improves the quality of
health services but also helps nurses to identify the problems and their possible solutions in terms
of effective care practices.
PART A
Nursing care priorities using initial 4 stages of clinical reasoning
Nursing priorities depends on various number of factors such as resources available for
health service and acuity of the patients. For providing effective health care nurses must follow
the stages of clinical reasoning for giving priority to care practices (Levett-Jones, 2013).
Overview of patient:
(First stage: Patient consideration)
Mr. Dinh Nguyen lives alone in his house and is 83 years old. He is taking medications
for controlling osteoarthritis and is also suffering from multiple sclerosis. He does not have any
children or other family members. His wife died just one year ago. The loneliness is increasing
depression and grief that is having an adverse effect on his health. He lives in two storey building
and is finding difficulty in movement of legs. The multiple sclerosis is also affecting his vision.
He has complains of feeling electric shocks during movement of his head and neck. The
numbness and blurred vision encourages the possibilities of accidents. The certain factors like
weakened eyesight and weakness are result of age as well. At present he is 83 and with growing
age and lack of proper care his condition is continuously deteriorating. Due to prolonged
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weakness and depression he has isolated himself from social get together and leisure activities
like travelling.
The three nursing care practices which can be used for Dinh Nguyen are as follows:
1. Defining need for Dinh Nguyen
(Second Stage: Collecting information)
In order to provide effective care to Dinh Nguyen it is necessary for the nurse and other
health professionals to give first priority to identification of his needs. Nurses will be able to
provide effective solution only if they will properly identify the cause and intensity of the issue
(Hunter, 2016). The patient was diagnosed with osteoarthritis four years ago. It is difficult to
completely recover from this disease however it can be controlled with proper medication.
Since he is old and does not have any care taker who could look after him for 24 hours he
has to manage himself all of his routine work. This situation makes it difficult for him to focus
on health improvement strategies which can improve the situation. Osteoarthritis is prohibiting
his movement. His rapidly degrading health status and loneliness is affecting his will power and
thus requires emotional support along with the proper nursing care. The nursing assistance will
not only help him to build his will power and confidence but will also help him in performing his
routine tasks with ease (Strickland and Baguley, 2015).
2. Establishment of intervention:
(Third Stage: Processing collected information)
The second priority in nursing care must be intervention. The health situation of Dinh
Nguyen can be improved only if registered nurses and other professionals of health care will give
it the next priority after analysing the needs. The difficulty in leg movement is due to
osteoarthritis and weakness due to his age factor. The weakening of joint tissues in older age is
critical factor which prevents the surgical options for Dinh. The medicines he is taking for
controlling it will be more effective if he involves proper schedule for rest (4 Osteoarthritis
Nursing Care Plans, 2017).
This would be possible only if he asks his brother to help him or by hiring a professional
care taker for him. The major issues like blurred vision, electric shocks, urine incontinence and
numbness are due to sclerosis which is getting worsen. The depression and loneliness are adding
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to it (Lublin and et.al., 2014). The condition can be controlled by providing counselling for
depression and by improving food habits.
3. Care plan implementation:
(Fourth Stage: Identifying problems)
At last the third priority must be care plan. Care plan must consider all the issues and
requirements of the patient (Dubois and et.al., 2017). The major issues faced by Dinh Nguyen
are blurred vision, difficulty in movement due to osteoarthritis and electric shocks along with
numbness. In order to address these issues the nurses must make efficient care plan.
 To address the issue of blurred vision, shocks and numbness patient can be provided with
home care. It will be the best possible nursing plan as per the requirements. Plan care and
intervention must identify the density and provoking causes for these symptoms and
efforts like change in diet, rest, emotional stability can improve the situation (Urden,
Stacy and Lough, 2015).
 The nursing care plan for osteoarthritis must formulate the strategy for acute and chronic
pain as well as for the risk of injury. Nurse must identify the extent of pain and pain
removal strategies. The possibilities which can cause injuries such as downfall from stairs
or accidental exposure due to blurriness in vision must be identified and possible
solutions must be used.
PART B
The top priority of care for Dinh Nguyen by using last four stages of clinical reasoning cycle
(Fifth Stage: Establishing goals)
Among all the nursing care priorities the top priority for Dinh Nguyen is the blur vision
which is the foremost concern. For managing the issue following goals must be planned and
achieved by the coordination of nurse and Mr. Dinh Nguyen.
 With effective implementation of care plan the patient will be able to see the objects
clearly. He will be able to manage his routine tasks without risk of accidents. The clear
vision will allow him to do his tasks with more comfort. Within 2-3 weeks Dinh Nguyen
will try to minimize the number of shock events which are responsible for causing the
blurred vision.
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 Within one week the patient will be able to learn about attacks of multiple sclerosis, so
that in case if he experiences attack then he can stay calm and relax himself so that he
does not collide with the objects nearby due to invisibility. The patient must be able to
manage these attacks by gaining knowledge to mitigate the intensity of these attacks (Liu
and et.al., 2018). Another important goal for Dinh Nguyen which must be included in the nursing plan is
that when he experiences difficulty in visualising he must immediately inform to the
house nurse so that the patient does not meet with any accident. This goal achievement
will also help patient to accept the fact that by asking for the help he will not be
considered a burden (Adam, Osborne and Welch, 2017). He deserves care and can ask for
it. It will help him to interact with others and thus he will find it easy to move on from the
loneliness and grief.
(Sixth Stage: Implementing actions)
These goals will help nurses and Dinh Nguyen to follow use appropriate strategies which can
meet these objectives. Nursing intervention skills will be crucial for achieving these goals. Mr.
Dinh Nguyen must consult from the ophthalmologist so that nurse or carer can get the details that
if patient should wait for the situation to normalise or he should be given steroid treatment. The
steroid treatment will improve the condition of patient by shortening the time period of vision
blurriness. The registered nurse can provide steroid via injections or orally. Corticosteroids will
help the patient to recover quickly from attacks of multiple sclerosis (9 Multiple Sclerosis
Nursing Care Plans, 2014).
Another significant action strategy for Dinh Nguyen is to provide him disease modifying
therapy (DMT). These therapies reduce the severity of multiple sclerosis attacks and thus helps
in treatment of visual difficulties. The patient can also be provided with low vision devices.
These devices include computer modifications and magnification features. The situations like
stress, temperature can increase the sclerosis attacks and thus the psychological counselling will
help patient to avoid these factors which increases the visionary problems in him. The patient
may also be provided with non-pharmaceutical methods. For instance, using an eye patch will
help him to deal with double vision issues. He may also turn his head for achieving a better
alignment of vision.
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(Seventh Stage: Evaluating outcomes)
When these actions are involved in routine activities of Dinh Nguyen then, following
outcomes can be achieved which will ease his life.
 He will be able to manage the attacks and will lower the risks of accidents due to blur
vision. He will be able to perform his routine tasks with more ease and comfort. The visual difficulties will be minimised and less intensive so he will be motivated that
he is recovering and it can also help him to overcome his depression. His deteriorating
health is also increasing his worries so the achievement of these goals will encourage him
to hire a carer or full-time nurse so that along with visionary issues he can also deal with
others issues at the earliest (Næss and et.al., (2017).
(Eighth Stage: Reflection)
Reflective: From the given case study and analysis I have learnt that if I will give priorities to my
care practices then it will have better impact on health concerns of my patients. The prioritisation
of care practices will help me to develop better understanding of the requirements of my patient.
With this I will not only able to provide proper medication but will also assist them in providing
emotional support. With this analysis I will take care that in future I will not only analyse the
physical parameters of patient's health but will also consider their emotional and mental status.
CONCLUSION
From the report it can be concluded that the nursing priorities are effective for achieving
health care objectives at the earliest and with accuracy. Nursing care priorities cannot help
patients to recover until the patient's does not involve in decision making and care practices. It is
the responsibility of the nurses to accurately identify the need of the patient and then to guide
and motivate them so that they can participate in nursing practices and can recover as soon as
possible.
The report has explained about nursing care priorities which are considered by care
providers while providing care to the patients. These priorities help the nurses and health
professionals to address specific health issues with the help of which the individual are able
focus on prior health concerns. It has considered the impact of clinical reasoning in providing
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health care services to the patients. Thus, it is concluded from the report that clinical reasoning
plays key role in prioritising care practices.
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REFERENCES
Books and Journals
Adam, S., Osborne, S. & Welch, J. (Eds.). (2017). Critical care nursing: science and practice.
Oxford University Press.
Dubois, C. A., D'amour, D., & et.al., (2017). Which priority indicators to use to evaluate nursing
care performance? A discussion paper. Journal of advanced nursing. 73(12). 3154-3167.
Higgs, J., Jones, M. A. & et.al., (2018). Clinical Reasoning in the Health Professions E-Book.
Elsevier Health Sciences.
Hunter, S. (Ed). (2016). Miller’s nursing for wellness in older adults (2 and Australia and New
Zealand ed.) North Ryde, NSW: Lippincott, Williams and Wilkins.
Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse. Frenchs Forest,
NSW: Pearson.
Liu, M., McCurry, S. M., & et.al., (2018). Effects of Osteoarthritis Pain, and Concurrent
Insomnia and Depression on Health Care Use in a Primary Care Population of Older
Adults. Arthritis care & research.
Lublin, F. D., Reingold, S. C., & et.al., (2014). Defining the clinical course of multiple sclerosis:
the 2013 revisions. Neurology. 10-1212.
Næss, G., Kirkevold, M. & et.al., (2017). Nursing care needs and services utilised by home-
dwelling elderly with complex health problems: observational study. BMC health
services research. 17(1). 645.
Strickland, K. & Baguley, F. (2015). The role of the community nurse in care provision for
people with multiple sclerosis. British journal of community nursing. 20(1). 6-10.
Urden, L. D., Stacy, K. M. & Lough, M. E. (2015). Priorities in critical care nursing. Elsevier
Health Sciences.
Online
4 Osteoarthritis Nursing Care Plans. 2017. [Online] Accessed through
<https://nurseslabs.com/osteoarthritis-nursing-care-plans/>
9 Multiple Sclerosis Nursing Care Plans. 2014. [Online] Accessed through
<https://nurseslabs.com/9-multiple-sclerosis-nursing-care-plans/4/>
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