Transformative Clinical Practices


This case study is about episode of clinical patient deterioration(shortness of breath-Dyspnea).

Case Study B: Acute Nursing Management

For this assignment, you will utilize the Clinical Reasoning Process to think critically about an episode of clinical patient deterioration that you have encountered whilst on clinical placement. You will then write a report demonstrating a systematic approach to clinical problem solving.

Once you have chosen a case study you will need to follow the Clinical Reasoning Process and:

  1. Consider the patient
  2. Collect cues
  3. Process the information
  4. Understand the patient’s problem or situation
  5. Plan and Implement interventions
  6. Evaluate outcomes
  7. Reflect and learn from the process.

This assignment will enable students to:

Develop critical thinking skills by using a systematic approach to clinical problem solving.

Understand how evidence in the literature can inform and underpin nursing practice

Further develop and utilise skills in literature searching, academic writing, critical analysis, evaluation and referencing.

PART 1: Collecting The Clues

Choose a patient that you observed to have a “clinical deterioration” whilst on placement. It can be whilst on your Acute or Aged Care placement. Be wise in your choice of patient and do not choose a complex event as it will require complex discussion. Your discussion will be given in 3rd person using academic writing. Therefore you will not use “I” or “we” to discuss the case study.

  1. Introduction: (100 words) You will provide a brief introduction explaining the content of this report. The sensitive information of the patient must remain confidential, e.g. name, DOB and MRN and does not need to be discussed in the assignment.
  2. Consider the patient:  (150 words ) In this stage of the Clinical Reasoning Cycle you will discuss your initial impression: 

Describe or list facts about the patients reason for admission, including:

  1. Reason for Admission
  2. Patient History
  3. Social History 
  4. Collect Cues: (150 words) This will include collecting relevant information about the patient and summarising the clinical situation. This information may be sought from: Documented history, clinical documentation, medical and nursing notes, handover report or other available information.

Discuss the events that led to this clinical deterioration:

  1. Patient status at the commencement of shift
  2. Handover report from the previous shift
  3. Observations of the patient at the time of deterioration
  4. Process the information: (150 words) This will require you to carefully analyse changes from normal, recognise patterns and develop a hypothesis about the situation.

Discuss changes that you have observed:

  1. Changes in patient behaviour: Physically or mentally
  2. Changes in observations
  3. Understand the patient’s problem: This will require you to synthesize the information to identify the most important problem for this patient and support with evidence.

From your analysis, discuss the most important issue in the clinical deterioration.

This MUST be supported by evidence from the literature therefore in-text referencing will be evident in the discussion.

PART 2: Planning Care And Evaluating Outcomes

Plan and implement interventions:  The student will need to prioritise goals of care depending on the urgency.

Interventions must demonstrate patient-centred care and MUST be supported by evidence from the literature therefore in-text referencing will be evident in the discussion.

These goals can be related to Australian Nursing standards.

You must decide who is best placed to undertake the interventions, who should be notified and when.

Evaluate outcomes:  You must re-evaluate the situation once the patient has been stabilised.

Discuss how have the observations changed and whether the patient’s condition has improved.

Observe the patients current status in order to determine how effective the nursing interventions have been.

Reflect and learn from the process:  You must critically reflect on the situation to learn from the event.

Explore your understanding of what you did or the team did

Explore the impact that this event had on you.

Discuss your communication strategies and how effective they were.

This can be written in 1st person, e.g. “I felt that…”

PART 3: Quality Of Written Expression And Conclusion

Conclusion: Conclude the assignment by summarising the content of the assignment and the most important lessons learned in the process of clinical reasoning.

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