Clinical Reasoning Essay

In today’s society, there is a focus on excellent healthcare services delivery as a result of increasing incidence of poor patient health outcomes in Australia as well as the whole world (Stempsey, 2009). Acute health care settings have recently catered to a larger proportion of patients with complicated health conditions who become gravely ill during their hospital stay (Charlin, Lubarsky, Millette, Crevier & Audetat, 2012). At the forefront of these dynamic health systems are nurses who provide direct care to patients. Experienced nurses are able to rise to the ever-changing patient conditions and challenges. On the other hand, novice nurses have a difficult time coping with these complex health situations (Pinnock & Welch, 2014). In the
Because of its continuity, Clinical Reasoning does not happen in a linear manner but remains to be cyclical (Marcum, 2012). Nurses who exhibit good clinical reasoning skills have the capacity “to collect the right cues and to take the right action for the right patient at the right time and for the right reason” (Levett-Jones, Hoffman, Dempsey, Yeun-Sim Jeong, Noble, Norton, Roche & Hickey, 2010). In contrast, nurses with less developed clinical reasoning skills usually fall short in detecting imminent deterioration of patient’s status. Flaws in clinical reasoning continue to account for majority of patient mortality and morbidity despite the sophisticated technology and evidence-based practices. Hence, it is vital for nurses to develop effective clinical reasoning skills (Norman & Eva, 2009). This can be done through practice and constant feedback in the way they think and address patient problems. The guidance of expert nurses and teachers is critical in cultivating clinical reasoning skills of novice nurses (Salminen, Zary, Bjorklund, Toth-Pal and Leanderson,
J’s health problem, it is important to use the clinical reasoning cycle. According to Levett-Jones, et al. (2010), the first step is to describe and consider the patient’s situation. Mr. J was admitted to the hospital due to acute abdominal pain, increased abdominal girth and general weakness. He had been diagnosed with COPD five years ago. He underwent laparoscopy to determine the cause of his abdominal pain and was then transferred to the Recovery Room. The second step is collection of information and cues (Levett-Jones, et al 2010). The student nurse received a handover from the operating room nurse that Mr. J tolerated the surgery well and his observations were stable. However, when she checked his oxygen saturation it was 88% in room air. Reviewing his previous vital signs charts, Mr. J’s oxygen saturation sits between 95%-97% in room air. She checked Mr. J’s fingers if they were too cold and she also rechecked the functionality of the pulse oximeter but it was working properly. She then assessed Mr. J’s breathing. It was shallow with mild nasal flaring. Upon chest auscultation, she heard wheezing over both lung fields. Recalling her previous readings, the student nurse remembered the risk factors of hypoxemia and realized that Mr. J had most of them. Ehrenfeld, Funk, Van Schalkwyk, Merry, Sandberg and Gawande (2010) stated that patients who have increased age, obstructive lung disease, raised intra-abdominal pressures (e.g. after