Effective Clinical Reasoning

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POSITIVE PATIENT OUTCOMES: A CHALLENGE FOR THE CONTEMPORARY NURSING PROFESSIONAL. Introduction:
Despite technological and medical advances today, chronic disease and resultant co-morbidities are prevalent in the Australian Healthcare System. As a result, patients, especially in the acute care setting, have more complex care needs. The management and care of patients with these complex care needs present a challenge for the contemporary nursing professional. Positive patient outcomes will be dependent on a number of factors, such as the assessment of the patient’s condition, the identification of potential risks for the patient, the planning of appropriate care and the management of the subsequent interventions that may be required. To provide timely and appropriately managed care, the nurse will need to possess and develop clinical reasoning and effective communication skills. The significance of these skills will be outlined by discussing the importance of the identification and management of early warning signs. Then an insight into the value of clinical reasoning for the nursing professional will be addressed. Additionally, an overview of an effective communication technique between the nurse and other health care workers will be provided. Moreover, to emphasise the importance of the nursing actions, interventions and ability to timely manage and respond to these early warning signs, a reflection of the provided case study will be highlighted. Early Cues / Late Cues:

The identification and management of early warning signs are critical, especially in the acute care setting where patients have more complex care needs. According to Levett-Jones et al. (2010, p.515) Acute care settings are characterised by patients with complex health problems who are more likely to be or become seriously ill during their hospital stay. Although warning signs often precede serious adverse events there is consistent evidence that ‘at risk’ patients are not always identified or managed appropriately. It has also been noted in research studies that there are observable physiological abnormalities prior to adverse events occurring. The Australian Commission on Safety and Quality in Health Care (June 2008) background paper: Recognising and Responding to Clinical Deterioration, highlights this fact as well as the key safety and quality challenge for appropriate and timely care for the deteriorating patient. At the very core of the problem it has been found that observation charts and the recording of vital signs have had an impact on the early detection of a deteriorating patient. The NSW Department of Health has developed the Between the Flags Program to address this situation. The Between the Flags Program is designed to establish a 'safety net' in all NSW public hospitals and healthcare facilities that reduces the risks of patients deteriorating unnoticed and ensures they receive appropriate care in response if they do (NSW Government). A Standard Adult General Observation (SAGO) Chart for use in all facilities has been developed. The Key features are: the most sensitive indicators of deterioration are represented on the chart (respiratory rate, pulse, blood pressure, SaO2, oxygen requirement, BGL’s and neurological assessment); there are no overlapping observations and they are displayed graphically so trends can be monitored; trigger zones are colour coded to draw attention to when calling criteria are met and the calling criteria are clearly displayed and easily accessible (see appendix 1 and 2). The seriousness of accurately recording these observable signs in the acute care patient cannot be overstated. The initial nursing assessment that is undertaken is of primary importance and is part of the nursing role that will indicate the timely management and subsequent care that the patient requires. Clinical Reasoning:

Regardless of how well vital signs are recorded and how well observation...
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