Case Study: Situated Clinical Decision-Making Framework for Bea

This case study examines the clinical decision-making process in the context of a ten-year-old boy Billy's grandmother, Bea, who suffers from diabetes and has a wound on her leg. The analysis utilizes the Situated Clinical Decision-Making Framework, considering factors such as context, thinking process, foundational knowledge, and the decision-making process itself. The study highlights the importance of understanding pathophysiological concepts, such as glucose regulation and infection processes, in informing clinical decisions. It emphasizes the need for nurses to apply their skills and knowledge to address the patient's health issues, considering cultural, social, and economic factors. The case concludes that appropriate observation, judgment, and medication are crucial for ensuring patient safety and quality care, with ongoing evaluation of outcomes to guide further actions. The study underscores the significance of the nurse's role in managing diabetes-related complications and promoting wound healing through informed clinical decision-making.

Nursing

Table of Contents
Introduction................................................................................................................................2
Pathophysiological concepts......................................................................................................2
Situated Clinical Decision-Making Framework.........................................................................2
Conclusion..................................................................................................................................3
References..................................................................................................................................4
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Introduction
A ten years old boy named Billy lives in Junjawa with his mother, grandmother, one older
sister, and three siblings. The financial condition of Billy's family was not good as his father
and older brother is in jail and his mother cannot work due to chronic renal failure. Billy's
grandmother is also a patient of diabetic (type one) and she required regular care. Billy and
her sister Lina are responsible for caring for her grandmother because of that their school
attendance is poor. During the visit to Billy's home, I noticed that Billy's grandmother was
mumbling. Billy told me that she has not eaten anything since his mother left home. Her left
leg seemed to be swollen in compare to the right one and there was an open wound that was
oozing purulent discharge. There was another issue that Billy has forgotten the process of
taking blood glucose (Elsevier Levy, 2011).
Pathophysiological concepts
Glucose is considered to be the main resource for energy for the cells as it can help in making
muscles and tissues. The main source of glucose is food and liver and Bea is out of glucose as
she has not eaten anything since morning that may become a reason for low blood glucose
level. The body releases glucagon in response to low blood sugar. If an individual has not
eaten in a while then glucose level goes down and in response liver breaks down the stock of
glycogen into glucose to keep the glucose levels within a normal range (Norman, 2019).
There are six elements for the process of infection and all of these required to be presented
for the infection to be developed, pathogen, reservoir, susceptible host, mode of transmission
and portal of entry. The people with diabetes generally face problems in the healing of
wounds. It makes the healing process slow. It is common of getting scratches and blisters
anywhere in the body. Increased glucose level might become a restriction for the blood
vessels that can cause slower healing and increase the risk of infection. High blood sugar and
diabetes can also cause damage to the nerve which is known as diabetic neuropathy and it
may lead to numbness and tingling that creates problems in healing woods (Carter, 2017).
Situated Clinical Decision-Making Framework
The situated clinical decision-making framework includes context, thinking process,
foundational knowledge, and decision-making process.
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Context
The cultural, social, ideological, physical and economic factors need to be considered before
making the clinical decision. The understanding of the behavior and health of the
grandmother is considered to be very much important.An appropriate communication can
assist to determine the condition of the grandmother and also taking into account the
condition of Billy (Giddens, 2017).
Foundational Knowledge
The decision making should be within the scope of the nursing practice. The use of nursing
skills and abilities can assist the grandmother to overcome her health issue. Self-awareness is
considered to be important for using the skills after understanding strengths and weaknesses.
The collection of adequate information is significantly related to the patterns in the responses
from the patient and pathophysiology(Gillespie, 2010). The determination and evaluation of
the patient's situation can assist to carry out the clinical decision-making process. It is being
depicted that the grandmother is diabetes 1 type patient and also suffering from the sore leg.
Clinical decision-making process
An appropriate observation can assist to recognize the health issue of the grandmother. Her
left leg was swollen in comparison to right and there was an open wound that was oozing
purulent discharge. The judgment is to be taken on the basis of patient safety and quality care.
The most appropriate medication need to be provided to thegrandmother(Ankner, 2012).The
decision should be based on the need for care after collecting information about the health
situation of the grandmother. The use of nursing skills should be applied to cure the swollen
leg. The outcome of the actions also need to be evaluated and if it does not work then an
alternative step should be taken.
Thinking
The thinking process assists to determine and evaluate whether the clinical decision-making
process was being followed or not. The factors that would have influenced the process,
collecting information and managing the health issue of the grandmother need to be taken
into account in order to measure the effectiveness of the decision.
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Conclusion
Bea was suffering from diabetes and unfortunately, she had wound on her leg. The main
source of glucose is food and liver and Bea is out of glucose as she has not eaten anything
since morning that may become a reason for low blood glucose level. The people with
diabetes generally face problems in the healing of wounds. It makes the healing process slow.
In this situation, a nurse required to show the skills and knowledge which he or she has
learned or experienced in their study.
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References
Carter, A. (2017). Insulin and glucagon: Health, regulation, and issues caused by diabetes.
Retrieved from https://www.medicalnewstoday.com/articles/316427.php
Ankner, G. (2012). Clinical decision making. Clifton Park, NY: Delmar, Cengage Learning.
Elsevier Levy, D. (2011). Type 1 Diabetes. New York, NY: Oxford University
Giddens, J. (2017). Concepts for Nursing Practice (2nd ed.). St Louis, MS
Gillespie, M. (2010).Using the Situated Clinical Decision-Making framework to guide
analysis of nurses’ clinical decision-making. Nurse Education In Practice, 10(6), 333-
340. doi: 10.1016/j.nepr.2010.02.003
Norman, J. (2019).Normal Regulation of Blood Glucose. Retrieved from
https://www.endocrineweb.com/conditions/diabetes/normal-regulation-blood-
glucose
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