Care Planning: Clinical Scenario

Introduction

Nurses with useful clinical reasoning skills always end up with a positive impact on their patients' health, while those with poor clinical reasoning skills often result in poor detection of the impending patient deterioration. This observation has been linked to the increased amount of adverse events and escalating healthcare complaints. For instance, healthcare research in Australia found that cognitive failure resulted in almost 57 percent of adverse clinical events. For clinical reasoning to be effective at the clinical level, adequate education must begin from the undergraduate level (Avhandling, 2014). Clinical reasoning can also be described and clinical judgment, critical thinking, decision-making, or problem-solving as often used interchangeably in the healthcare environment. A process involves several stages that nurses and other clinicians, which is not a linear process but rather a twirl of connected and enduring medical encounters. This paper will examine Amalie, an 89-year-old woman, scenario and provide adequate intervention to improve her deteriorating health using the eight clinical reasoning cycle. The paper will also isolate three main nursing priorities, thereby applying Miller's Functional Consequences Theory to the most urgent nursing intervention.

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Clinical Reasoning Cycle

Clinical reasoning involves eight phases, which are, considering the patients situation, collecting cues and in order, dispensing the information, identifying the problem or issue, putting in place goals to solve the problems recognized, intriguing action, evaluating the efficiency of the output and in conclusion reflecting on the procedure and new learning (Levett-Jones, Sundin, & Bagnall, 2010). There is a high chance of older adults to be subjected to questioning assumptions whenever they go to the hospital due to preconceptions, and inaccurate assumptions such as older adults often have dementia. These kinds of assumption can often affect the clinical reasoning process. In this case, the scenario of the 89-year-old Amalie all the clinical method will be applied to try to find the nursing priorities needed to improve her health.

Consider the Patient

This is the initial stage in the process of clinical reasoning cycle, at this stage, I get an impression of the patient's situation. In this phase, the most vital information is the patient's current situation and her medical status (Levett-Jones T., 2013). The case scenario states that Amalie is an 89-year-old woman who lives alone in her single-story house. She has problems with mobility and is currently losing weight non-significantly. According to the referral letter from her GP, she shows symptoms such as joint stiffness, her feet are swollen and joints enlarged and painful, she experiences constipation and occasional dizziness and has a visual deficit. The letter also states that she might forget or skip to take her medication at times. The general impression of the patients does not include any diagnosis but rather the patient's current state. According to her state, there is not a specific illness that is established which leads to the second stage in the process where I try to develop a more profound knowledge about her status considering that she is elderly.

Collect Cues/Information

Gathering of the historical information about the patient's medical history and social setting happens at this stage. I will carefully consider the past medical history of Amalie, the history presenting complaint, current treatment plan, results of any diagnosis is done and current vital signs (Oostra, 2015). Amalie lives alone after she lost her husband two years ago; she has lived in Australia for the last 40 years after meeting and marrying her late husband. Therefore, she has established an intimate connection with the community, which prompted her to refuse the call from her son to return to German where she can be taken care of. She and her husband have been actively involved in their local Catholic Church as well as German association. She has developed dry macular degeneration and has a history of rheumatoid and osteoarthritis. She also has a medical history of arthritis, macular degeneration, and hypothyroidism. She is currently on medication that helps relieve pain to help her carry out her day to day chaos. The medications are slow release Paracetamol 665mg, Ibuprofen 400mg both three times a day, and Thyroxine 150mcg and Hydroxychloroquine 200mg daily doses.

Process Information

In this phase, I will use the information gathered in the previous stage and interpret, relate and match the data to predict an outcome. This is the solid information-processing phase where I will be in a position to understand the reason behind the patients' current state. Amalie's health deterioration has been more significant after she lost her husband. The development of dry macular degeneration has had the most significant effect in her life. Age-related macular deterioration (AMD) is the most frequent reason of vision loss in grown-up adults above the age of 50. Dry AMD in the case of Amalie develops slowly, and there is no treatment although certain food supplements that contain minerals, vitamins and carotenoids can help slow down the process. The visual loss is quite rapid that occurs within months rather than years (Nosek, 2005). The progression of AMD has caused the patients to give up driving, the early effect of AMD can also be attributed to her rapid weight loss since she can no longer drive to buy food, she has lost contact with most of her friends in the community. This problem has further been exaggerated by her difficulty with mobility caused by significant problems with rheumatoid and osteoarthritis.

Rheumatoid and osteoarthritis are both different types of arthritis that share some similar characteristics. They both affect the joints of the patients causing pain, swollen, aching of joints and stiffness. The first one generates morning stiffness that lasts longer than an hour while the later goes less than an hour. These forms of arthritis are the core reason for her limited joints movement, painful, stiffness and swollen feet and enlarged joints. On the social side, the effect has caused her to leave the house rarely and losing physical contact with the people she is known around (del Bueno, 2005). This has also resulted in her failure to tide up her home or even stock up her cupboards with healthy food. Regarding her social life, her connection to her community led her to refute her son's request to return to German where she has no close friends she is attached to. Her relationship with her stepdaughter, Tracy is not very tight considering she got married to Tracy's father way after Tracy had moved out of the homestead which is the reason why she does not feel the need to bother her and she is already putting up some effort to keep up with Amalie.

Identify Problems/Issues

In this stage, I will use the collected and processed information to establish the most significant patient problem or issue. I will identify three nursing care priorities that Amalie requires to help her cope with her condition. From the above clinical scenario, three nursing priorities need to be adapted in the care and treatment of Amalie. These priorities are ranked in order of physiological and psychological importance. The care will be adjusted in such a way that Amalie's condition is considered and involving her in shared decision-making so she can be motivated and have a feeling of control to achieve optimal health for her. I will adapt Maslow's hierarchy of needs approach, which will require the most life-threatening priority to, came before the less threatening ones (Kafedra).

Three Nursing Care Priorities

Amalie is at the verge of losing her independence due to diminished physical ability and loss of vision, the fear of a loss of autonomy can result to be highly stressful for her and her family as well. The priority is providing her with emotional support and reassurance through thorough patient education of the effects of her dry AMD. Amalie will be required to choose to live with a caregiver who will ensure that she takes her meds in time and eat healthy food on a daily basis as well as a nurse who can check her up regularly or choose to move in with a family member. The second priority will be to try and help the patients on how to cope with the loss of treatment, she will be given food supplements that can help improve her situation as well as other treatment such as laser treatment procedures during this period Amalie will be required to continually contact her specialist promptly for support and advice. The third nursing priority will be about her mobility that has been affected by arthritis. Medication is the best way to treat Rheumatoid Arthritis and Osteoarthritis. However, Amalie tends to forget to take her medicine when her pain becomes excruciating. Amalie needs to have a caregiver who can ensure that she takes her medication in time (Woodworth, Ranganath, & Furst, 2013). Other treatments about this issue will be strengthening the muscles, Exercise plan, and accessibility of the basic needs within the house.

Miller's Functional Consequences Theory

The concept of functional consequence theory draws from the methods that are pertinent to aging, holistic nursing, and older adults. The person, environment, nursing and health in the nursing domain is all related or linked to older adults. These are risk factors, effects of actions and age-related actions that improve the quality of life to the aging generation in their day to life. These actions include purposeful interventions that are either initiated by nurses, caregiver or older adults (Miller, 2012). This theory explains age-related adjustments and the factors that can add to the unconstructive results in an aged person excellence of life, nursing determinants that can help improve the course of action and wellness output that could help these old people function optimally. Amalie's case relates to this theory since she could benefit from a wellness outcome plan to help her understand the changes in her body and have the courage to ask for the help that she needs. Using the remaining four phases in the clinical reasoning process, I will apply the concept of functioning consequence theory to help Amalie adjust to her current lifestyle with the most critical nursing care priority listed above.

Establish Goals

The most important goals in Amalie's case is to behavioral intervention to help her overcome the barriers in her daily routine. She will receive visual rehabilitation where she will be provided with equipment's and taught how to go along with her daily activities. Since Amalie loves her independence, her family members will be advised to get a caregiver for her who will assist her with the difficult task while still allowed to do her primary routines. Secondly, the caregiver will be advised to ensure that she eats healthy and does not skip her medicine. Amalie will be given tips and instructions on how to cope with her illness with ease (Hunter, 2016). The caregivers will be advised to ensure to make sure things are easily accessible in the home. Lastly, an exercise plan will be drafted; this exercise plan will be informed of walking around or visiting her close friends, which will help in keeping her mental health in check and help strengthen her muscles and allow natural joints movements.

Take Action

The immediate actions that will be taken are Issuing of reading glasses and right lighting environment at her home, assistant by the caregiver to attend soci...