Discuss about the Clinical Reasoning Cycle To Elderly Patient.
The clinical reasoning cycle provides the nurses with the opportunity to analyze the patient situation, collect cues of care needs, identify the care needs, process information, and identification of care priority based on which the interventions will be provided and the nurses will also be able to reflect on their own practice to understand the mistakes that they are making and how it can be rectified (Morton, Fontaine, Hudak & Gallo, 2017). This assignment will take assistance section 1, 2, 3 and 8 of clinical reasoning cycle in order to interview a particular elderly patient and understand their understanding healthy aging and impending death.
For this interview I had the opportunity to interact with a 89 year old patient named Hilda who is living with her husband and children in her house. Hilda is a catholic and she was suffering from pain in the right knee and big toe in her left foot. The primary data about her revealed that she is mobility restricted due to acute osteoarthritis and pain in the knee, and hence I decided to conduct the interview in her own house so that the environment will be comfortable for her and she will be able to relax and participate completely in the interview procedure. When I approached the house she welcome to me inside with a warm smile. Her living room was slightly cluttered and she had been walking with walking support. Hence with the primary assessment office of her we agreed to setup the interview in the outside porch where arranged for two chairs in her garden setting for het to sit comfortably and began with the interview. The tools utilized in the interview were a voice recorder to record her speech, RLT questionnaire for the interview, patient assessment data sheet, and pen.
The next step of the critical reasoning cycle is collection of cues so that the information can be sorted, processed and synthesized to arrive at the most probable care needs of the patient. Hence I attempted to collect the dues and required information from Hilda as per the questionnaire of RLT model I had taken with me. First and foremost, I attended to help Hilda understand the purpose of this interview and how it will help him understand the concept of healthy aging and whether she is following the required activities to promote healthy aging. According to the Bacsu et al. (2012), taking consent before approaching the patients with any care activity or patient assessment is a very important aspect of healthcare law and legislations. Hence, the consenting procedure was extremely important and I made a point to help her understand the interview and the questionnaire crucial detail and also taken her permission to record the entire interview in the speech recorder. Non verbal communication traits are very important while conducting any interview with the older patients (Kerr, Rosenberg & Frank, 2012). hence I attempted to maintain a comfortable and get professional body language while communicating with the patient all the while maintaining eye contact and responding with compassionate and empathetic phrases as she continued to share the information with me. According to the Lima, Newall, Jordan, Hamilton and Kinney (2016), while sharing their life details with the healthcare staff it is very natural for the elderly patients to become uncomfortable and embarrassed while talking to a complete stranger. Hence I begin with sharing my own personal details my background my educational qualifications my journey as a Healthcare provider and my personal perception of healthy life and aging. This immediately helped him to become comfortable with me and helped him share her own personal details with me with much more ease. Researchers are of the opinion that it is crucial for the care professionals to maintain basic communication comfort and decency while communicating with elderly patients (Odell, 2015). Hence, during the entire course of interview I made honest effort to remain calm and patient while speaking to Hilda and repeated to him my questions as many times as he required so that he understood what she is being asked and can provide accurate information.
In this step of the clinical reasoning cycle analyzing the information is very important so that care priorities can be identified and adequate interventions can be applied. RLT questionnaire mandates asking information regarding her environment, her communication, breathing, eating and drinking, eliminating, personal cleansing and dressing, body temperature, mobilizing capabilities, working and playing, expressing her sexuality, sleeping and lastly about dying. Regarding the safe environment the patient was asked whether he is able to prevent accidents have from happening or if she was under any risk from infections, if he was aware of safe taking or receiving any medication, whether she was under any stress and anxiety, idea of safe living and availability of resources. Hilda explained that she attempted to keep her house very clean so that there are no risk of infection or any other accidents from happening however head pain and hand knee respected her from working out too much and she also had unsteady gait due to the pain in her knee. Regarding ADLs, Hilda was asked whether she could actively perform the personal hygiene such as bathing, washing and dental care. Hilda stated that she is very able to walk due to her paining me and Arthritis however with the help of a children she is able to complete activities of daily living also when her children are not present at home she suffers from not being able to complete her activities of daily living and the and cleanliness and lack of hygiene bothers her. In case of communication factors the patient was asked from the questionnaire whether she is able to communicate effectively, her native language understanding and that she is experiencing a acute pain or speaking disability. Hilda had no communicational complications however she had acute pain in her knee due to her arthritis and arthritis problems. For her dietary patterns, she was asked whether she understands what is a healthy diet, her current diet, Whether he is capable of preparing a nutritious diet for herself, and her cultural understanding of healthy eating and drinking. Hilda stated that she understand what a healthy diet is however she has always found of spicy food health children to indulge her with spicy food. And you too my age and paining me she is not able to cook at her home so most of the days they rely on takeout food. Lastly, she was asked about her normal sleeping and waking routine followed by her idea and concepts regarding death and dying. Her sleep patterns were fine with 8-9 hours of sleep throughout the night and she had an uncertain take to death.
Reflecting on a procedure. I would like to mention that health had a very positive understanding of aging. She was living a happy life with her husband and 3 children and was happy however her health restrictions such as her paining knee and big toe restricted her mobility and her age derived weakness and fatigue restricted her from participating in the activities of daily living completely. Her knee pain and big toe increased her risk for fall, and as her husband is also very old and her children are generally out of the house, she will require the assistance of a full-time community care worker who will not only health held up with activities of a daily living but will also help in personal care (Sørensen & Brahe, 2014). Hilda will also require assistance of occupational therapist and Arthritis care plan for her pain so that she can be relieved from the acute pain that she has been feeling. The family will also required pension from a dietician who will help them with nutritious healthy food habits (Sasaki, Torigoshi & Kondo, 2018).
Conclusion:
On a concluding note it has to mention that this assignment give me a excellent opportunity to explore and understand the concept of healthy aging with respect to the clinical reasoning cycle which is important tool in patient assessment and care designing. And with respect to the recommendations I have an outline in the reflection it can be hope that held and her family can be able to live a healthy and content life along with a clear and positive concept of healthy aging.
References:
Bacsu, J. R., Jeffery, B., Johnson, S., Martz, D., Novik, N., & Abonyi, S. (2012). Healthy aging in place: Supporting rural seniors’ health needs. Online Journal of Rural Nursing and Health Care, 12(2), 77-87. Retrieved from https://rnojournal.binghamton.edu/index.php/RNO/article/view/52
Kerr, J., Rosenberg, D., & Frank, L. (2012). The role of the built environment in healthy aging: community design, physical activity, and health among older adults. Journal of Planning Literature, 27(1), 43-60. Doi: 10.1177/0885412211415283
Lima, S., Newall, F., Jordan, H. L., Hamilton, B., & Kinney, S. (2016). Development of competence in the first year of graduate nursing practice: a longitudinal study. Journal of advanced nursing, vol 72(4), pp 878-888. https://doi.org/10.1111/jan.12874
Mauk, K. L., & Mauk, K. L. (2017). Gerontological nursing: Competencies for care. Jones & Bartlett Learning. Retrieved from https://www.jopan.org/article/S0001-2092(09)00689-9/pdf
Morton, P. G., Fontaine, D., Hudak, C. M., & Gallo, B. M. (2017). Critical care nursing: a holistic approach (p. 1056). Lippincott Williams & Wilkins. Retrieved from : https://www.just.edu.jo/ar/CoursesAndLabs/Advanced%20Adult%20Health%20Nursing%20(Theory)_NUR%20415/NUR%20415.doc
Odell, M. (2015). Detection and management of the deteriorating ward patient: an evaluation of nursing practice. Journal of clinical nursing, vol 24(1-2), pp 173-182. https://doi.org/10.1111/jocn.12655
Robert, R. R., Tilley, D. S., & Petersen, S. (2014). A power in clinical nursing practice: concept analysis on nursing intuition. Medsurg Nursing, 23(5), 343-350. retrieved from: https://go.galegroup.com/ps/anonymous?id=GALE%7CA389798016&sid=googleScholar&v=2.1&it=r&linkaccess=fulltext&issn=10920811&p=AONE&sw=w&authCount=1&isAnonymousEntry=true
Salminen, H., Zary, N., Björklund, K., Toth-Pal, E., & Leanderson, C. (2014). Virtual patients in primary care: developing a reusable model that fosters reflective practice and clinical reasoning. Journal of medical Internet research, 16(1). Doi: 10.2196/jmir.2616
Sasaki, K., Torigoshi, C., & Kondo, M. (2018). Requirements for promoting the transition of aging patients with cognitive and physical disorders to home care: A new case analysis design. Clinical Nursing Studies, 6(3), 79. DOI: https://doi.org/10.5430/cns.v6n3p79
Sørensen, E. E., & Brahe, L. (2014). Interruptions in clinical nursing practice. Journal of clinical nursing, vol 23(9-10), pp 1274-1282. https://doi.org/10.1111/jocn.12329
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