CNA344: Becoming a RN: Practice consolidation
Practice Portfolio of Evidence PART B: Clinical Encounter Analysis
Consider the patient situation/context
Provide an overview of the encounter. What happened, how it occu
ed, etc what was it that alerted you to that fact that you needed to take action in the encounter.
(150 words)
Review: what key information was already available to you and how did this influence your thinking? (eg: handover, history, charts, result of test, assessments, medical orders
etc.).
(150 words)
Gather:
What was the new information you gathered from additional assessment?
(150 words)
Dot points are fine for this section
Recall:
Recall and apply your existing knowledge to the above situation to ensure you have a
oad understanding of what is/may be occu
ing before proceeding with the rest of the cycle.
What was telling you that the encounter was presenting you with a problem that required resolution?
(200 words)
Use scholarly, evidence-based literature/clinical guidelines and/or policy/NSQHS materials to substantiate your discussion
Review:
Relevant medications (where relevant): (not included in word count)
Gather:
Recall:
Process Information
Interpret, relate and infer from the information gathered to demonstrate an overall understanding of the clinical encounter to determine the two main nursing problems.
(400 words)
Predict
What could/would have happened in your encounter if you were to have taken NO action and why?
(100 words)
Use scholarly, evidence-based literature/clinical guidelines and/or policy/NSQHS materials to substantiate your discussion
Interpret, Relate and Infer:
Predict:
Identify the Problem/s
List in order of priority two key nursing problems that required resolution (not included in word count)
Problem 1
Problem 2
Establish Goals & Take Action
Work through the two nursing problems identified and establish one goal and then rationalise with scholarly, evidence-based literature/clinical guidelines and/or policy/NSQHS materials the related nursing actions you did/would undertake (125 words for each rationale section). Other sections not included in word count.
Problem 1
Goal
Related nursing actions
Rationale
Problem 2
Goal
Related nursing actions
Rationale
Evaluate outcomes
Evaluate the outcomes of your clinical encounter including effectiveness of the care provided with supporting evidence-based literature
(100 words)
*Do not ‘reflect on new learning’ in this section. This will occur in your next assessment (Part C).
References:
2
Please note: The work undertaken in this assessment task (part B), also contributes to following assessment task (part C). Therefore, please ensure your choice of clinical encounter enables you to complete both assessment tasks. The aim of this assessment task (part B) is to assist you with the application and consolidation of your clinical reasoning skills by demonstrating your capacity to think like a registered nurse through each stage of the clinical reasoning cycle up to and including the ‘Evaluation’ stage. Directions: Choose a clinical encounter from your cu
ent professional experience placement that you were actively involved in and apply to the clinical reasoning cycle using the template provided. A clinical encounter should be chosen that in some way directly challenged your clinical ability and highlighted to you the importance of being able to ‘think like a registered nurse’. The following could be considered examples: Recognising a deteriorating patient (Professionally) challenging a directive Communication challenge (patient or staff) Missed cues Patient advocacy It is important that your choice of encounter allows you to adequately question your professional performance and be applicable to the requirements of Part C otherwise this may impact on your capacity to meet the criteria adequately.
Assessment Criteria
Criterion 1 Provides an overview of an appropriate clinical encounter for exploration. Criterion 2 Demonstrates the capacity to apply clinical reasoning to gather cues, process information, identify problems, establish goals, take action and evaluate outcomes at a level expected of a beginning level registered Criterion 3 Appropriately utilises evidence-based literature /clinical guidelines /the Australian National Safety and Quality Health Service Standards XXXXXXXXXXto support evaluation of outcome/s from clinical encounter. Criterion 4 Uses appropriate scholarly literature to substantiate findings throughout. Uses Harvard referencing style. Criterion 5 Writes in a clear and concise academic style that is succinct, logical and coherent. Part C: Clinical reasoning discussion paper Task Description This task requires you to draw on your exploration of Part B and consider the clinical reasoning e
o
s made (or could have been made) and complete the clinical reasoning cycle from Part B through your reflections on the process and new learning generated. Reflect on your analysis of the clinical reasoning process undertaken in Part B and identify where you encountered the ‘challenge’ in your clinical reasoning process. Select from the list two (provided through unit content) of the 9 clinical reasoning e
ors and that best explain how that challenge may have occu
ed. Explore the e
ors and how it both occu
ed and was eventually remedied and discuss how you would have approached your clinical reasoning process differently in order to mitigate these e
ors from occu
ing if faced with the same clinical encounter again. Reflect on your overall experience (from and subsequent academic exploration) of your clinical encounter and discuss how this has informed new learning and strengthened your capacity to think like a registered nurse.
Student Resource PART B
The below information aims to add some further depth and detail to that provided in the unit outline as well as a
ief overview of the preparations and expectations for the assessment.
What is the aim of the clinical encounter analysis?
The aim of this task is to assess how, and to what level you are ‘thinking like a registered nurse ‘using the clinical reasoning cycle as a guiding framework.
How do I best prepare to undertake this assessment task?
A clear understanding of the clinical reasoning cycle is important.
You have been exposed to this model of higher-order thinking throughout the degree, but it also is featured amongst Module
one content in this unit.
Choosing your clinical encounte
It must be an encounter that highlighted for you,as a regulated health professional, the importance of being able to (or the need
to) think like a registered nurse. There are no limits to what you choose to explore as long its achievable within the word count and addresses the intention of the assessment.
It is however, important to select an encounter that is reasonably succinct to allow you provide the focus that needs to be demonstrated.
Some examples include:•
Unexpected drop in Blood pressure
•
Sudden behavioral change
•
Low urine output
•
Spiking temperature
Choosing an encounter along these lines should allow you to adequately ‘unpack’ the encounter into the template. What happened, why did it happen, what was/was not done? etc.
If you were to choose something like ‘patient with multi-organ failure’
as your encounter, this is highly complex and you would not be able to ‘unpack’ this to a level that demonstrates your thinking within the existing word count. Therefore, your choice of clinical encounter really does
need some considered thought to ensure that it will allow you to meet the requirements of the assessment.
In the unit outline, it also details options such as communication challenges with staff, etc.
Please be mindful that if you were to choose an encounter like this, the patient still needs to be visible. What was the reason/assessment/cue that prompted the conversation in the first
place, what were you wo
ied about? We are still required to see the necessary patient information within the template.
Most importantly,the intention in choosing your encounter is not looking for that ‘textbook’ perfect scenario.It is about choosing something where within the process something was missed ordidn’t go to plan or could have been done betterthat affected (or could have affected) the outcome.
-This is what we are wanting you to explore further in Part C. For now, you are setting the scene, explaining what happened, why and how.
Student Reource Part C
The aim of this assessment task (Part C) builds on the previous assessment task (Part B) to ‘close-off’ the clinical reasoning cycle from the exploration of that encounter.How do I best prepare to undertake this assessment task?A clear understanding of the clinical reasoning cycle remainsimportant.
In your previous written assessment task in this unit, you were required to explore a clinical encounter up to and including the ‘evaluation’ stage. In this paper, the focus is on extending your‘evaluation’ phase of the cycle within that encounter and ‘reflect on new learning’ to close
the cycle. Therefore, revisiting your clinical reasoning encounter analysis (Part B) is strongly advised.
Additionally, within Part B, you were required to select an encounter where something didn’t go to plan or was missed, etc. In this paper (Part C) you are going to explore ‘why’ it didn’t go
to plan by selecting TWO of the nine clinical reasoning e
ors
that potentially contributed to this as identified by Levett-Jones. -The clinical reasoning e
ors are detailed in the final module for this unit and will also feature in the week 9 workshops.
Writing your paper.
Introduction
Provide a very
ief overview of your clinical encounter that highlights where the e
o
challenge/missed opportunity occu
ed (300 words).
Body (700 words)
Upon reviewing the module content and your previous paper,identifyTWO clinical reasoning e
ors that best aligned to,
or potentially could have occu
ed during your encounter that
contributed to why thatencounter was challenging or perhaps did not go to plan.
Describe thoseTWO clinical reasoning e
ors chosen and discuss how these may have occu
ed and why. How were the e
ors eventually remedied? how could they have been mitigated?
How could it have impacted on patient outcomes if the e
or was not identified? In this section you may have to recall elements/assessment data from your clinical encounter to contextualise your discussion.
Conclusion (500 words)
‘Reflect on and process new learning’ From your exploration, consider your future nursing practice. What did you learn? what would you do differently next time? What strategies will you use?
How has this enhanced your clinical reasoning