Development of Clinical Reasoning Paper
For this assignment, you will complete a Aquifer case study based on the course objectives and weekly content. Aquifer cases emphasize core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, you will use the Aquifer case studies to promote the development of clinical reasoning through the use of ongoing assessment and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.Development of Clinical Reasoning Paper
After you complete the Aquifer case study for the week, please print out the summary of your case session and submit as a PDF file to the Submissions Area. Note that the summary of your case session has your name in the top-right corner. You need to submit this document as evidence that you have completed the case.Development of Clinical Reasoning Paper
The Aquifer assignments are highly interactive and a dynamic way to enhance your learning. Material from the Aquifer cases will be present in the weekly quizzes, the midterm exam, and the final exam. You must have all Aquifer assignments completed in order to successfully pass the course.
Use this link for information on how to access and navigate Aquifer.
This week, complete the case entitled “Case #18: 24-year-old female with headaches – Ms. Payne.”Development of Clinical Reasoning Paper
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All nurses use clinical opinion to do determinations while caring for patients. These determinations have an consequence on the actions of the healthcare professional and the bringing of wellness attention the patient receives Jones and Beck ( 1996 ) . It ‘s the nurse ‘s duty to do clinical determinations based on their learnt cognition and accomplishments. Simple determinations such as, would a bed pan or toilet be more appropriate? To doing speedy, on the topographic point determinations, such as what steps to take if a patient began to quickly deteriorate. Nurses rely on sound determination doing accomplishments to keep positive results and up to day of the month attention. Orme and Maggs ( 1993 ) identified that decision-making is an indispensable and built-in facet of clinical pattern. Nurses are accountable for their determinations, therefore it is important that they are cognizant of how they make these determinations Muir ( 2004 ) . This essay will discourse two determination devising theoretical accounts, factors that may better or interfere with clinical logical thinking and determination devising in patient centered attention and how they vary across the different Fieldss of nursing. The determination devising theoretical accounts that will be discussed are Risk Analysis and Evidence Based.Development of Clinical Reasoning Paper
Hazard appraisal plays a major portion in the procedure of back uping patients and it greatly helps to keep safety in hospital scenes. Its chief intent is non merely to place possible hazards but besides take and forestall them. Appraisal is considered to be the first measure in the procedure of individualized nursing attention Neno and Price ( 2008 ) . Risk analysis provides information that is critical in developing a program of action that can assist better personal wellness. It has the possible to diminish the badness of chronic conditions, assisting the person to derive control over their wellness through self-care RCN ( 2004 ) . Not merely is risk analysis for the patients safety but it ‘s besides at that place to guarantee staff safety Kavaler and Spiegel ( 2003 ) . It is imperative that nurses usage suited hazard appraisal tools as a usher to enable them to do effectual determinations. Once the tool has been implemented, utilizing the gathered information and utilizing their ain clinical opinion, the nurse will so be able to supply the right safety safeguards for patients Holme ( 2009 ) . There are many different types of hazard appraisal tools available for patients and staff within the clinical scene. For patients there is the Waterlow mark – hazard of force per unit area sores and ulcers, the MUST tool – Malnutrition Universal Screening Tool, FRAT – Falls Risk Assessment Tool and Pain Assessment Tools are merely to call a few and they are normally used in clinical pattern. Staff have Infection Control Assessments and Discharge Risk Assessments merely to call a twosome but they should be kept up to day of the month and reassessed on a regular basis Daniels ( 2004 ) .
The force per unit area ulcer hazard assessment/prevention policy tool, is often used in clinical pattern. Coerce risk-assessment tools have been described as the anchor of any bar and intervention policy Waterlow ( 1991 ) . The Department of Health set one-year marks for an overall decrease of force per unit area ulcers by 5-10 % over 1 twelvemonth ( DoH, 1993 ) , so it is critical that nurses accurately determine which patients are at hazard of developing force per unit area ulcers.Development of Clinical Reasoning Paper
A force per unit area ulcer is an country of localized harm to the tegument and implicit in tissue caused by force per unit area, shear, clash or a combination of these EPUAP ( 1998 ) . The purpose of the Waterlow force per unit area sore hazard appraisal is to recognize service users who are extremely at hazard of developing force per unit area sores, to avoid them going worse and/or even developing them at all, to function as an early prognostic index before the development of force per unit area harm Nixon and McGough ( 2001 ) . It is imperative that patients are assessed utilizing this tool, particularly patients with Intrinsic hazard factors such as restricted mobility and /or are confined to their bed for long periods of clip, patients with hapless nutrition, aged patients, patients with implicit in wellness conditions such as diabetes and patients who are urinary incontinent and intestine incontinent are besides extremely at hazard of developing force per unit area sores, this due to the wet, damp tegument can be weak and susceptible to breakdown Andrychuk ( 1998 ) . Harmonizing to the NICE clinical guideline 29 ( 2005 ) force per unit area ulcer classs should be recorded utilizing the European Pressure Ulcer Advisory Panel Classification System. There are four phases that force per unit area ulcers are graded at and it is down to the nurses ain clinical opinion to make up one’s mind what present the ulcer is. Depending on the class of the force per unit area sore, it will depend on the type of mattress that will be needed. There are factors to be considered before choosing a mattress for the patient which include, doing certain the mattress does non promote the patient to an insecure tallness and to guarantee the patient is within the recommended weight scope for the mattress NICE ( 2005 ) .Development of Clinical Reasoning Paper
Using their learnt accomplishments, experiences and ain clinical cognition, nurses have to make up one’s mind what dressings should be used in the intervention of force per unit area ulcers. They have to take into consideration the class of the sore, any maker ‘s indicants for usage and contraindications, old positive effects of certain dressing and penchant for comfort or lifestyle grounds Bouza et Al ( 2005 ) . Specially designed dressings and patchs can be used to rush up the healing procedure and assist protect force per unit area sores such as hydrocolloid and alginate dressings which will be used at the nurse ‘s aside NHS Choices ( 2010 ) .
Nurses should ever be cognizant of any possible hazard factors that may decline or add to the development of force per unit area ulcers when utilizing any force per unit area hazard appraisal tool. The nurse will hold to make up one’s mind the frequence of re-positioning the patient, implementing a turning chart to maintain times and day of the months documented and to pass on to other members of staff what clip the patient needs turning. This involves traveling the patient into a different place to take or redistribute force per unit area from a portion of the organic structure Walsh and Dempsey ( 2010 ) . By analyzing the grounds on the effectivity of shifting this can assist to cut down patient agony and better their quality of life, buoy up the work burden of staff and aid cut down the fiscal load on the wellness service Luoa and Chub ( 2010 ) .
In pediatric nursing, a kid is to be assessed within six hours of being admitted and so reassessed daily. Most pediatric force per unit area ulcer hazard appraisal graduated tables were developed utilizing clinical experience, or by modifying grownup graduated tables Bedi ( 1993 ) . The Glamorgan Paediatric Pressure Ulcer Risk Assessment Scale was developed utilizing elaborate pediatric inmate informations Willock et Al ( 2008 ) . It is a clinical tool designed to assist nurses measure the hazard of a kid developing a force per unit area ulcer, it uses a marking system that takes things like mobility, equipment, hemoglobin degrees and temperature into history and guides the nurse as to what intercessions need to be put in topographic point, such as what type of mattress or dressings will be needed.
In larning disablement and mental wellness nursing, a scope of force per unit area sore appraisal tools are used such as the Norton, Braden and Waterlow hazard appraisal graduated tables, these are chiefly used for patients who are non really nomadic as in the grownup field. Nursing is more concentrated on their patient ‘s psychological wellness O’Tuathail and Taqi ( 2011 ) .Development of Clinical Reasoning Paper
It is the nurse ‘s responsibility to supply the best possible attention for their patients and this involves utilizing Evidence-based pattern. EBP enables the nurse to do determinations about patient attention based on the most current, best available grounds. It allows the nurse to supply high quality attention to patients based on cognition and research Rodgers ( 1994 ) . Principles of evidence-based pattern and the important elements involved in the procedure are explained by Cleary-Holdforth and Leufer ( 2008 ) in five stairss. Stairss are at that place to fit nurses with the necessary cognition and accomplishments to utilize evidence-based pattern efficaciously and to do positive parts to patient outcomes. The five stairss Ask, Aquire, Appraise, Apply, Analysis and Ajust are to merely steer health care professionals in doing effectual clinical determinations when job resolution.
Early on Warning Score ( EWS ) is an grounds based method. Carberry ( 2002 ) identifies that the intent of EWS is to supply nursing and medical staff with a physiological mark generated from recordings of critical marks. NICE Clinical Guideline 50 ( 2007 ) suggests that physiological path and trigger systems should be implemented to supervise all grownup patients in acute infirmary scenes, supplying counsel on the standardisation of EWS. Physiological marks that should be monitored and recorded are bosom rate, blood force per unit area, respiratory rate, O impregnation, temperature and degree of consciousness. Critical marks should be recorded upon admittance, at regular intervals during a patient ‘s stay and besides earlier, during and after certain processs Castledine ( 2006 ) and the frequence of monitoring, if unnatural physiology is detected should increase. EWS uses a marking system 0, 1, 2, and 3 and color codifications white, xanthous, orange and ruddy, figure 3 and the coloring material red being the highest hazard indexs Morris and Davies ( 2010 ) .Development of Clinical Reasoning Paper
Nurses should accommodate to following guidelines the Early Warning Score offers, to assist do clinical determinations that are best for their patients. Factors that may better or forestall effectual determination doing while utilizing the EWS could be down to capableness, cognition and ignorance. If wellness attention professionals are good able and confident in entering and documenting patient ‘s critical marks, so any alterations can be observed and prevented or dealt with rapidly. The EWS execution adds automated qui vives hours before a rapid response would be initiated and can diminish intervention holds by up to three hours Subbe et Al ( 2003 ) . It merely takes one nurse to miss competency when utilizing the EWS, hence seting patient ‘s life ‘s at hazard.
Early on Warning Score is besides used in the Mental Health and Learning Disability Fieldss of nursing although it may non be used every bit frequently as in Adult nursing, it is imperative that patients who are physically or mentally ailing, require monitoring of their critical marks in an acute scene. Nurses may hold to utilize their cognition to improvize different ways of obtaining critical marks from some patients with learning disablements or mental wellness jobs, such as turning it into a game or deflecting them particularly if they lack the mental capacity and are unwilling to follow Hardy ( 2010 ) Medicine can hold serious effects on a patient ‘s wellness. Indications of these effects may be noticed in their EWS, combined with the cognition and clinical opinion of wellness attention professionals NIMH ( 2008 ) . If the EWS tool is non used as it should be in these Fieldss so it will be difficult for the wellness attention professionals to obtain the needful grounds to do accurate clinical determinations.Development of Clinical Reasoning Paper
In the child field of nursing a similar tool to the EWS is used called PEWS, Paediatric Early Warning Scores. There are presently four PEWS charts used within the NHS for different age groups, 0-11months, 1-4 old ages, 5-12years and 13-18 old ages, the difference being the scopes for kids ‘s critical marks NHS ( 2013 ) . A cardinal factor that may impede accurate PEWS marking could be due to the fact the kid is scared when it comes to look intoing their critical marks, besides really immature kids can be unwilling or fidgety Kyle ( 2008 ) , this is where the nurse would hold to utilize their cognition to get the better of such jobs. The nurse could do it fun for the kid, explain the equipment and what they are traveling to make and why. It is critical that the nurse additions consent from the kid ‘s parent before transporting out any process. It is of import that the household play an of import function in the attention of the kid DOH ( 2001 ) .
I have learnt assorted things while researching into the chosen determination devising theoretical accounts and methods. I have been made cognizant of possible hazard factors that may originate while utilizing both tools in all Fieldss of nursing and what could be done to forestall them. I feel confident in looking out for any hazards affecting the EWS and Pressure ulcer hazard appraisal tools while out in pattern and believe that utilizing these tools right can finally salvage lives.Development of Clinical Reasoning Paper