Clinical Judgement is a Dynamic Process

Clinical Judgement is a Dynamic Process

Clinical Judgement is a Dynamic Process 150 150 Peter

Clinical Judgement is a Dynamic Process

As part of the clinical portion of your BSN Capstone course in your senior semester, you have the opportunity to attend a two-day seminar with senior nursing students from other academic institutions. The theme of this seminar is the application of clinical judgment to determine the best evidence-based solutions for nursing practice.

Instructions
For a clinical judgment roundtable with faculty and students that is sponsored by your academic institution, you must prepare one scenario based handout to promote robust discussion regarding the application of clinical judgment as an outcomes-based dynamic cycle of clinical reasoning and client needs. The handout must contain these components:

Describe a clinical situation where you applied an outcome-based cycle of clinical reasoning to select what you considered the “best” client intervention based on information available.
Include relevant external and internal cues and hypotheses
Discuss the outcomes based, iterative cycle of clinical reasoning you applied after the initial intervention to select the next “best” interventions appropriate for the particular situation based on client needs.
Rationales and evidence based findings were included to support choices for the next “best” interventions

Sample Paper

Clinical Judgment is a Dynamic Process

Describe a clinical situation where you applied an outcome-based cycle of clinical reasoning to select what you considered the best client intervention based on information available.

One of the clinical situations where I applied an outcome-based cycle of clinical reasoning was when I was attending to a 65-year-old patient who had been recently diagnosed with type 2 diabetes. During the past three months after his diagnosis, the patient had struggled significantly with glycemic control, which made it difficult for him to effectively control his condition. The patient was widowed and lived on her own with their daughter, only coming to visit them once a month. The patient highlighted that they took their insulin as per the physician’s instructions, although they ate a similar diet as they did before their diabetes diagnosis and were not involved in any physical activity. Relying on the outcome-based cycle of clinical reasoning, the first step was to consider the facts from the patient’s situation. Considering the patient assessment, two significant facts related to the patient’s condition could be explored, including that the patient was suffering from poor glycemic control after his type 2 diabetes diagnosis three months ago(Gruppen, 2017). The next phase would be collecting information related to the patient, which includes their past medical history and the patient’s current complaints. The type 2 diabetes patient highlighted that they frequently felt fatigued and even experienced instances of loss of vision. The third phase of the clinical reasoning cycle was to process the gathered information, which indicated that the patient was adhering to the right insulin dosage and frequency (Young et al., 2020). Considering the information that the patient provided, any cases of poor glycemic control were therefore related to the lifestyle behaviours of the patient. The fourth phase of the clinical reasoning cycle included identification of a problem which included poor lifestyle behaviours, including lack of physical activities and consumption of a diet that contributed to high blood sugar for the patient, such as frequent consumption of fast food and soft drinks (Gummesson et al., 2018). The 5th phase of the outcome-based style of clinical reasoning involved the establishment of different goals related to the client, which included control of their blood sugar through a combination of a healthy diet, improved physical activity, and insulin therapy adherence. Controlling the patients’ blood sugar through physical activity, insulin therapy, and a healthy diet would therefore take at least six weeks. The 6th phase of the outcome-based style of clinical reasoning was the action phase which included referring the patient to a nutritionist and recruiting a community healthcare worker to continuously work with the diabetes patient in improving their diet (Leoni‐Scheiber et al., 2019). The community health worker also assisted the patient to perform adequate physical activities. The sixth step of the clinical reasoning cycle included evaluating the diabetes patient’s blood sugar control. Through consistent blood sugar assessments. The final stage of the clinical reasoning cycle included reflection. In the case study of diabetes, patient reflection included considering the different patient education approaches that were utilized during the treatment of the patient and considering which of the approaches would be effective for use among future patients (Gruppen, 2017).

The best client intervention based on the information that was available for the 65-year-old diabetes patient included recommending a diet made up of fruits and vegetables and requesting for the patient to improve their physical activity, for instance, by taking light activities such as walking.

Include relevant external and internal cues and hypotheses

The relevant external cues and hypotheses related to the 65-year-old diabetes patient included their environment. The patients lived on their own and therefore found it hard to prepare healthy meals for themselves. This contributed to taking fast foods and other unhealthy foods that contributed to poor health.

Discuss the outcomes based, iterative cycle of clinical reasoning you applied after the initial intervention to select the next best interventions appropriate for the particular situation based on client needs.

After the initial intervention, the outcome-based iterative cycle of clinical reasoning that was utilized to select the next best interventions for the diabetes patient included evaluating the patient’s status for improvements, establishment goals and taking action (Gummesson et al., 2018). A slight improvement in the patient’s blood sugar control was observed after evaluation. The patient also showed a lot of interest in their new diet but was not consistent in their exercise. The best interventions for the 65-year-old patient with diabetes included working consistently with a personal trainer to improve their physical activity and joining a local physical activity club.

Rationales and evidence based findings were included to support choices for the next best interventions

According to Borse et al. (2020), physical activity is as important as taking a healthy diet in a bid to manage the blood sugar levels of diabetes patients. Patients who are not actively involved in physical activity might therefore struggle to control their blood glucose levels. A combination of a healthy diet made up of fruits and vegetables, insulin therapy, and physical activity is the most effective approach in enhancing glycemic control in diabetes patients. According to Borse et al. (2020), healthcare practitioners should consistently emphasize diet, physical activity, and insulin therapy as the main interventions to help in glycemic control among diabetic patients.

 

References

Borse, S. P., Chhipa, A. S., Sharma, V., Singh, D. P., & Nivsarkar, M. (2020). Management of Type 2 Diabetes: Current Strategies, Unfocussed Aspects, Challenges, and Alternatives. Medical Principles and Practice30(2), 109–121. https://doi.org/10.1159/000511002

Gruppen, L. (2017). Clinical Reasoning: De ning It, Teaching It, Assessing It, Studying It. Western Journal of Emergency Medicine18(1), 4–7. https://doi.org/10.5811/westjem.2016.11.33191

Gummesson, C., Sundén, A., & Fex, A. (2018). Clinical reasoning as a conceptual framework for interprofessional learning: a literature review and a case study. Physical Therapy Reviews23(1), 29–34. https://doi.org/10.1080/10833196.2018.1450327

Leoni‐Scheiber, C., Mayer, H., & Müller‐Staub, M. (2019). Measuring the effects of guided clinical reasoning on the Advanced Nursing Process quality, on nurses’ knowledge and attitude: Study protocol. Nursing Open6(3), 1269–1280. https://doi.org/10.1002/nop2.299

Young, M. E., Thomas, A., Lubarsky, S., Gordon, D., Gruppen, L. D., Rencic, J., Ballard, T., Holmboe, E., da Silva, A., Ratcliffe, T., Schuwirth, L., Dory, V., & Durning, S. J. (2020). Mapping clinical reasoning literature across the health professions: a scoping review. BMC Medical Education20(1). https://doi.org/10.1186/s12909-020-02012-9