Discuss about the Levett Jones Clinical Reasoning Cycle.
Mr Henry, 68-year-old, agreed for an interview on the weekday evening. I explained to him that the purpose of the interview was to understand the perspective of aging. He then appreciates that he is the focus of the interview and that his thoughts and opinions would be recorded. He grew up in a small town in Victoria. He is the youngest of his brother and two sisters and currently lives with his brother. He lost both of his parents at the age of 30. He lost his mother to tuberculosis. He recalled that last year of her life was painful with intense medication and she was quarantined. I asked him his thoughts of aging. He replied it is the “natural phenomena set by God”. He tolerates his pain in knees and aches. He perceives it as normal part of aging. He talks about living each day like a gift and yet after a while his concerns on aging is evident from narration of financial issues. He complained of having low paid job and that he is not living the healthy lifestyle. I further asked if his thought on ageing have changes in last 20 years. He replied, “I failed, financially”. He recollected his strong financial position long ago and lived in the present with no savings. He is scared about his retirement as he needs to pay for his apartment. On requesting Henry to detail his present situation and feelings, he demonstrated a resentment and guilt for his divorce and bad decision making. He expressed unhappiness with his inability to take good care of himself. On asking Henry about his health habits, he explained, taking mostly fast food, excessive smoking and alcohol consumption. He described himself as overweight individual with history of stroke and hypertension. On receiving such candid response, I further asked him about his perception of health care professionals’ support in healthy lifestyle. He replied that health care providers should ensure quality time to patients and listen to their concerns. He emphasised that the older adults should be respected and given autonomy in health decisions. Lack of self-concept among patients admitted in nursing home results in decline of health. At this point, I asked him if he adopted any strategies to promote healthy ageing as he was guilty of unhealthy lifestyle. The patient narrated, that he had earlier engaged himself in a moderate level exercise on a regular basis but later quit. He also spoke about his fail attempts of quitting alcohol even after joining rehab program. However, he showed the willingness to improve his activities of daily living and mobility.
Healthy ageing is the process of maintaining and developing the functional ability that ensures wellbeing in old age (World Health Organization, 2018). In an effort to learn about healthy aging, I had interviewed a 68-year-old man, to whom I will refer as Mr Henry for protecting the privacy. Based on the interview the essay presents the patents situation, cues presented and the information processed from the data collected. This is based on the framework of Levett Jones clinical reasoning cycle. Lastly, the essay presents the reflection on the whole interview process and new learning.
Considering the patient’s situation is the first step of the Levett Jones clinical reasoning cycle. It involves the description of the list, facts and objects of people (Levett-Jones, 2018). Henry 68-year-old man agreed to interview at his home. I agreed as it will help him to be relaxed and comfortable and arrived on time. His home environment was unclean and messed up. He preferred to communicate in the garden which is his favourite place in the house. I arranged for two chairs and table to have coffee with his permission. I ensured that there was adequate light on his face and the atmosphere was calm. When starting the interview, the patient was nervous. I had explained him the purpose of the interview and assured him that the information would be private and confidential. It helped the interviewee relax and appreciate the process. I informed him about the use of voice recorder. I started the conversation with bright smile and positive speech of voice and attitude. The interview progressed from light conversation to discussing serious health matters. I carried with me sample questions for the interview to prevent any hindrance (RLT model) (Holland, Jenkins, Solomon & Whittam, 2008). I have mainly asked the open-ended questions. While I completed my interview, I had a list of actual and potential barriers prepared with me. I had clearly observed the environmental factors of her house.
Collection of cues is the second step of the clinical reasoning cycle and is the process of collecting history of the patient’s health and current assessment. It also involves collecting new information (Levett-Jones, 2018). It was a good experience communicating with the older adults. Excellent communication skills and a positive attitude are vital for interviewing the older adults (O’Toole Gjyn, 2016). At times it was difficult for me repeating the same questions over and over again and asked in the simplest way possible. There were incidences where the interviewee would deviate from the main topic and was too slow in responding. I would very politely deal with it to come back to the same point. The overall experience was satisfactory as I could collect the desired data.
I looked directly into the eyes of the patient while interviewing to avoid distractions. The information gathering and clarifying technique used in this process are encouraging, summarising and rephrasing (Trenoweth, Pearce, & Moone, 2017). I encouraged the client to speak more about personal life, health and social life. I had used minimal verbal responses such as “I understand, what you are saying” and non-verbal minimal responses such as nodding. I intervened briefly such as “yes, tell me more”. I paraphrased the information given by him to ensure that I heard it correctly and the summarised the information that was given in long excerpts. I was actively listening to prevent any missing of information (Crisp, Taylor, Douglas & Rebeiro, 2016).
Processing of information relates to the interpreting the data and distinguishing the relevant information from the irrelevant information. Further, this process involves making deductions from subjective and objective cues (Levett-Jones, 2018).
In case of Henry, the facilitators of healthy ageing are the strong communication skills of the patients. The patient can well communicate his health issues and verbalises his feelings. The patient well expressed his physical, sociocultural, environmental and psychological problems. He communicated his strong faith in God which is the facilitator of healthy aging; he respects his body and accepts the “changes as a part of God’s Gift”. Mobility is the other main facilitator of the interviewee. He currently does not demonstrate the risk of fall (Forbes & Watt, 2015).
The barriers to healthy ageing were poor eating and drinking habits and poor personal cleansing and dressing habits. Such self-care defects are considered to be the risk factors for infections and malnutrition. The poor nutritional healthy going may increase his obesity and risk of diabetes (Tabloski, 2013). Another barrier to healthy ageing is the realisation of financial problems and loneliness. He expressed that mental health deteriorates rapidly than the physical health in mental health hospital. He is worried about limited money as well as lack of autonomy in hospital. It is evident from guilt expressed by the patient about his unhygienic living habits and divorce. He fears death as he is addicted to alcohol and smoking and fails to quit. He can continue to be the active member of the society if assisted with financial problems, educating in personal care, balanced diet, and support with activities of daily living. As Mr Henry is enthusiastic about rehab program and exercises, he shall be encouraged to continue. It will improve his activities of daily living and strengthen mobility. Rehabilitation program for alcohol and smoking addiction may be encouraged to reduce the future risk of stroke and cardiovascular disease. The interviewee may be referred to older people centre and clubs to promote socialisation and reduce isolation (Tabloski, 2013).
Reflective practice helps nurses to self-evaluate the strength and weakness during the learning process (Bulman & Schultz, 2013). The overall interview process for me was a learning experience as it helped me demonstrate my key communication skills. I could build good rapport with the interviewee. Use of ethics, values, and nursing standards such as patient dignity and respect helped me build a relationship of trust with the patient. There is a change in the clinical practice since last two decades with the emergence of various policies and professional standards (DiCenso, Guyatt & Ciliska, 2014). However, I have learned from the interview that there is no 100% implementation of nursing guidelines such as maintaining of patient autonomy. I believe that there should be adequate nursing training program to teach effective communication with older adults.
Conclusion
It can be concluded from the essay that the healthy ageing encompasses the functional ability and environmental factors. It comprises of physical, social and mental capacities. The environments comprise of the relationships, values, health and social policies. All the factors if present contributes to healthy ageing else leads to decline in health as evident from Henry’s interview.
References
Bulman, C. & Schultz, S. (2013). Reflective Practice in Nursing (5th ed.). Chichester, Sussex: WileyBlackwell. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=2qV0ZIjJ3eAC&oi=fnd&pg=PA1939&dq=Reflective+Practice+in+Nursing+&ots=8S8sA_2HJL&sig=55UuU0Fci_SuGI7rb-LqiGY-spo#v=onepage&q=Reflective%20Practice%20in%20Nursing&f=false
Crisp, J., Taylor, C., Douglas, C., & Rebeiro, G. (2016). Potter & Perry’s Fundamentals of Nursing (5th ed.). Sydney, N.S.W.: Mosby/Elsevier Australia. ISBN: 9780729581103
DiCenso, A., Guyatt, G., & Ciliska, D. (2014). Evidence-Based Nursing-E-Book: A Guide to Clinical Practice. Elsevier Health Sciences. retreived from: https://books.google.co.in/books?hl=en&lr=&id=bHqjBQAAQBAJ&oi=fnd&pg=PR29&dq=Evidence-Based+Nursing-E-Book:+A+Guide+to+Clinical+Practice&ots=M3HnNfCkVR&sig=6292CxH2vpZTug0cuIbJcdTjppQ#v=onepage&q=Evidence-Based%20Nursing-E-Book%3A%20A%20Guide%20to%20Clinical%20Practice&f=false
Forbes, H., & Watt, E. (201). Jarvis’s physical examination and health assessment (2nd Australian and New Zealand ed.). Chatswood, N.S.W.: Churchill Livingstone/Elsevier. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=clZ3CwAAQBAJ&oi=fnd&pg=PP1&dq=Jarvis%E2%80%99s+physical+examination+and+health+assessment+&ots=7SnRSZn3-4&sig=NhTQwEGCpQxyg-J0fx4sv1eASPQ#v=onepage&q=Jarvis%E2%80%99s%20physical%20examination%20and%20health%20assessment&f=false
Holland, K., Jenkins, J., Solomon, J. & Whittam, S. (2008). Applying the Roper-Logan-Tierney Model in Practice. London: Churchill Livingstone/Elsevier. ISBN: 9780702060069
Levett-Jones, T. (2018) Clinical Reasoning: Learning to think like a nurse (2nd ed.). Frenchs Forest, N.S.W.: Pearson. ISBN: 9781488616396
O’Toole, Gjyn. (2016). Communication: Core interpersonal skills for health professionals (3rd ed.). Chatswood: Elsevier. Retrieved from: <https://search.informit.com.au/documentSummary;dn=326450638057684;res=IELHEA>
Tabloski, P. A. (2013). Gerontological nursing. Pearson Higher Ed. Retrieved from: https://www.pearson.com/us/higher-education/program/Tabloski-Gerontological-Nursing-3rd-Edition/PGM214081.html
Trenoweth, S., Pearce, R., & Moone, N. (2017). Assessment Approaches and Methods. Psychosocial Assessment in Mental Health, 14. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=dWowDgAAQBAJ&oi=fnd&pg=PA14&dq=summarising,+paraphrasing+and+encouraging+in+interview&ots=g1F6FPDEGW&sig=e0SamzXj0F_1AwPBv-f5FMPObwU#v=onepage&q&f=false
World Health Organization. (2018). What is Healthy Ageing?. World Health Organization. Retrieved 26 April 2018, from https://www.who.int/ageing/healthy-ageing/en/
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