NRSG138 Module 9 Tutorial: Thinking like a Nurse - CRC Stages 5-8

NRSG138: Transition into Nursing - Module 9 Tutorial: Thinking like a Nurse

This tutorial focuses on stages 5-8 of the Clinical Reasoning Cycle (CRC) and its application with the Roper-Logan-Tierney (RLT) Model for Nursing, incorporating academic writing and source utilization.

Tutorial Learning Objectives

  1. Introduce and discuss stages 5 - 8 of the CRC.
  2. Apply the Clinical Reasoning Cycle (CRC) (stages 1-4) and the Roper-Logan-Tierney (RLT) Model for Nursing to case studies.
  3. Incorporate academic writing, including locating sources to support discussions.

Supporting Resources

  • NRSG138 unit materials (Canvas, Reading list)
  • ACU library > databases
  • Google Scholar
What to Check for Credibility
  • Authors
  • Type of source
  • Location
  • Year
  • Relevance
Referencing
  • In-text citations
  • Reference list
  • APA 7th style referencing
Where to find evidence and referencing help:
  • Academic Skills Online

Jim Laverty Case Study

Recap

Jim Laverty, a 65-year-old male, lives on a property one hour from the hospital with his 85-year-old mother. He fractured his wrist and tore the meniscus in his right knee after a fall. He has a cast on his left wrist and a knee brace. He is at the local hospital for a short stay before returning home.

CRC Stage 1
  • Medical history: Smokes, osteoarthritis, cholecystectomy (1988), r/o melanoma (2009), no medical checkup for years.
  • Family history: Father died from a farming accident 20 years ago.
  • Vital signs: Within normal limits for age.
  • Pain: Pain management regime, increased pain with mobilization.
  • Concerned about his elderly mother.
  • Rural isolation.
  • Moderately deaf (new concern raised).
  • Statements about the meaning of this information must be supported with evidence. Ie. In-text citations.
CRC Stage 2
  • Impact of smoking on health.
  • Impact of poor diet.
  • Impact of living rural/isolation.
  • Pain management, risks if knee is not rested sufficiently.
  • Hearing loss, what this could mean.
  • Statements about the meaning of this information must be supported with evidence. Ie. In-text citations.
CRC Stage 3
  • At risk of pain due to injuries.
  • At risk of further injury to knee due to excess mobilization.
  • Several other actual and at risk nursing diagnoses related to nutrition, mental health, caring requirements, geographic isolation.
  • Statements must be supported with evidence, where required. Ie. In-text citations.
CRC Stage 4

CRC Stage 2 & 3 Practice with Jim Laverty

Focus on:

  • Ongoing pain in the right knee following a farm injury and meniscus repair.
  • Living in a rural area.
  • Considerations for additional information gathering.

CRC Stage 4 Practice with Jim Laverty

Focus on:

  • Ongoing pain in the right knee following a farm injury and meniscus repair.
  • Living in a rural area.

CRC Stage 5: Establish Goals

  • Clarify and prioritize goals of care.
  • SMART framework.
  • Address previously identified nursing diagnoses.

CRC Stage 6: Take Action

  • Select the most appropriate action to achieve goals (stage 5).
  • Determine who should undertake interventions.
  • Determine who should be notified and when.
  • Re-examine patient cues.
  • Consider the effectiveness of nursing interventions.
  • Evaluate patient improvement.
  • Assess the need for a new CRC cycle.

CRC Stage 7: Evaluate the Outcomes

CRC Stages 5-8 Recap

Example: Jim will be discharged without crutches.

CRC StagesTips
5. Establish goalsSMART framework.
6. Take actionReview and administer prescribed analgesic medications. Include physiotherapist in education.
7. EvaluationWere the interventions effective? What worked? What could be improved for next time?
8. ReflectionWhat have I learned?

Case Study: Jasmin Ventura

Introduction

Jasmin is a 20-year-old female, in her first year of the Bachelor of Nursing at university.

Situation

She has presented to the GP today for her annual flu vaccine. Jasmin is reluctant to get the flu vaccine, as she is worried this will make her sick and will put her further behind with her university assignments.

Background

Jasmin has not been to the GP for many years, so the GP asks the RN to complete a health assessment. The following information is gathered:

  • Vital signs:
    • RR 18 breaths/min
    • HR 68 bpm
    • BP 110/70mmHg
    • BMI 27 (overweight category)
  • Social:
    • States concern about keeping up to date with university.
    • She has been so busy recently with university that she has not had time to eat healthy food or go to the gym.
Assessment
  • Find out more information from Jasmin.
  • Education about flu vaccine.
Recommendation

CRC Template: Jasmin Ventura

  • CRC Stage 1
  • CRC Stage 2
  • RLT Model
  • CRC Stage 3
  • CRC Stage 4
  • CRC Stage 5-8: Not required for AT3

Summary of Today’s Class

  • Application of CRC and RLT
  • Academic writing
  • Supporting discussions with academic sources
  • CRC Stages 5-8