In contemporary nursing practice, the utilization of nursing models and clinical reasoning frameworks plays a vital role in providing holistic, evid

Introduction

In contemporary nursing practice, the utilization of nursing models and clinical reasoning frameworks plays a vital role in providing holistic, evidence-based care to individuals across diverse populations. This essay explores the application of the Roper-Logan-Tierney (RLT) Model and the Clinical Reasoning Cycle (CRC) to the case study of Rosie, an 80-year-old female living in rural Queensland, Australia. Through these frameworks, nurses can assess, plan, and implement person-centered care tailored to individual needs.

Applying the Roper-Logan-Tierney Model

Cameron, the practice nurse attending to Rosie, applies the RLT Model to gather information about Rosie's health status and needs. Two aspects of the RLT Model particularly applicable to Rosie are:

Activities of Living (ALs):

Rosie's ability to perform the 12 ALs outlined in the RLT Model will provide crucial insights into her overall health and wellbeing. Given her age and independence, Cameron would assess Rosie's capability in activities such as maintaining a safe environment, mobility, and communication. For instance, Cameron might inquire about Rosie's ability to manage her household chores, navigate her environment safely, and maintain social connections.

Influencing Factors:

Considering Rosie's age, living situation, and self-perceived health status, Cameron must explore the various influencing factors that may impact Rosie's ability to maintain her ALs. This includes assessing Rosie's biological factors such as any existing health conditions or sensory impairments, psychological factors such as her mental health and cognitive functioning, sociocultural factors including her social support networks and cultural beliefs, environmental factors such as her living conditions and access to healthcare services, and politico-economic factors such as her financial resources and healthcare coverage.

By systematically evaluating Rosie's ALs and influencing factors, Cameron gains a comprehensive understanding of Rosie's health status and can develop a tailored care plan to support her wellbeing.

Applying Stage 2 of the Clinical Reasoning Cycle

In Stage 2 of the CRC, Cameron collects cues and information to further understand Rosie's health needs. This involves gathering relevant data through various assessment methods. For Rosie, Cameron would:

Conduct a comprehensive health history interview, focusing on Rosie's past medical history, current symptoms, medications, and lifestyle factors.

Perform a physical examination to assess Rosie's vital signs, mobility, sensory functions, and overall physical health.

Utilize assessment tools specific to geriatric care, such as the Geriatric Depression Scale (GDS) to screen for depression or the Mini-Mental State Examination (MMSE) to assess cognitive function.

Explore Rosie's social support network and community resources available to her in her rural setting.

By collecting this information, Cameron identifies pertinent health issues and factors influencing Rosie's wellbeing, laying the foundation for effective care planning.

Applying Stage 3 of the Clinical Reasoning Cycle

In Stage 3 of the CRC, Cameron processes the collected information to identify patterns, problems, and potential health issues. Considering Rosie's case, Cameron notes several key findings:

Rosie's self-perceived good health may mask underlying health concerns or conditions, as older adults often underreport symptoms.

Living alone in a rural area may pose challenges for accessing healthcare services, raising concerns about preventative care and timely intervention.

Rosie's infrequent visits to her GP indicate a lack of proactive healthcare management, suggesting potential gaps in health literacy or awareness of preventative care measures.

By synthesizing this information, Cameron recognizes the need to address Rosie's preventive healthcare needs, promote health literacy, and ensure access to appropriate healthcare services.

Applying Stage 4 of the Clinical Reasoning Cycle

In Stage 4 of the CRC, Cameron identifies nursing diagnoses and formulates nursing care plans based on the assessed health issues. For Rosie, potential nursing diagnoses include:

Risk for Social Isolation:

Due to Rosie's age, rural residence, and limited social support network, she may be at risk for social isolation, which can negatively impact her mental and emotional wellbeing.

Deficient Health Literacy:

Rosie's infrequent visits to her GP and reliance on her son's suggestion for a check-up may indicate a lack of understanding of preventative healthcare measures, highlighting the need for health education and promotion.

Cameron would prioritize interventions to address these nursing diagnoses, such as facilitating social connections through community programs, providing education on preventive healthcare practices, and coordinating access to healthcare services.

Conclusion

In conclusion, the application of the Roper-Logan-Tierney Model and the Clinical Reasoning Cycle facilitates comprehensive, person-centered nursing care for individuals like Rosie. By systematically assessing Rosie's ALs, influencing factors, and health needs, nurses can develop tailored care plans to promote optimal health outcomes across the lifespan. Through the stages of the CRC, nurses identify health issues, formulate nursing diagnoses, and implement evidence-based interventions to address the holistic needs of individuals in diverse healthcare settings.

References

Assessment 3 Details: Case Study

The following information is to be used for this assessment:

Rosie is an 80 year old female who lives in rural Queensland, Australia. She lives on her own and considers herself to be in good health for her age. She has not had the need to visit a General Practitioner (GP) for five years now. Her son Michael, who lives overseas, suggested that she should go to her GP, just for a check-up and to confirm that she is in fact still in good health.

Cameron, who works at the GP clinic as a practice nurse, is present when Rosie arrives for her appointment.

Describe how Cameron would apply the Roper-Logan-Tierney (RLT) Model to find out information about Rosie. Consider 1 to 2 aspects of the Model that are applicable to Rosie.

Describe how Cameron would apply Stage 2 of the Clinical Reasoning Cycle (CRC) to Rosie.

Consider any information you have on Rosie to apply stage 3 of the CRC to Rosie.

Consider any information you have on Rosie to apply stage 4 of the CRC to Rosie.

You are NOT required to discuss beyond stage 4 of the CRC.

This is to be written as an academic essay, using evidenced-based nursing related literature to support your discussion. You may choose to use headings. For the purposes of this paper, while seminal work (early literature) may be referenced, contemporary nursing related literature (from within the last approximately seven years) is a requirement. Refer to the marking rubric for the amount credible and relevant references required in this essay. References cited should include a number of nursing related research articles (reflecting the higher levels of evidence).

Assessment 3 Submission Details

Due date:Submit before 0900 am AEST Wednesday 20th May, 2024 AEST

Length and/or format:1200 words +/- 10%

Purpose:Each student will submit an essay which demonstrates application of core theories of the unit to a case study. This piece will allow the student to demonstrate their developing skills of identifying health care priorities and person-centred nursing care.

Learning outcomes assessed:

LO1 - Describe the historical and contemporary role of nursing and how this role is both articulated within the current Australian healthcare system and within the regulatory frameworks which govern health care practice (GA5)

LO3 - Demonstrate a beginning understanding of professional values inherent in the discipline of nursing (GA1, GA5)

LO4 - Explain the contribution of competent, holistic evidence- based health care to clinical reasoning and decision-making in nursing practice across the lifespan (GA1, GA5)

LO5 - Apply the models of nursing in planning care for diverse populations across a range of settings (GA4, GA5, GA6)

LO6 - Apply the models of nursing to identify health care priorities, and initiation of health management and person- centred nursing care (GA4, GA5, GA6)

How to submit:Online on Canvas via the NRSG138 Assessment 3 link.This must be submitted as a Word document, that is, '.doc'.Other documents will not be accepted, such as 'pdf' or 'pages' documents. Assignments submitted in a format other than a Word document may be awarded a grade of zero, as the submission will not be able to be marked or downloaded. Pleasecheckyour submission once submitted.

Return of assessment:The assessment, feedback and grade will be returned via the Turnitin dropbox. As this is the final assessment item for this unit, the students results be available when final grades are released.

Assessment criteria:The assessment will be marked using the criteria-based rubric for Assessment 3.

Marking Ruberic:

Criterion 1: Structure (5 marks)

5 to >4.2 pts

High Distinction

The content in the essay matches the outline presented in the introductory paragraph. Most paragraphs are organised in a logical manner so that content flows from one paragraph to the next, and the essay ends with a rational conclusion.

Criterion 2: Mechanics Grammar, Spelling and Punctuation (10 Marks) 10 to >8.4 pts

High Distinction

Idea expressed clearly, concisely and fluently. There are no errors with grammar, spelling and punctuation and the meaning is readily discernible. Use of direct quotes on no more than two occasions for emphasis.

Criterion 3: Application of knowledge a) RLT- Application of RLT to case study (20 Marks) 20 to >16.8 pts

High Distinction

Demonstrates comprehensive identification and application of RLT Model, including how the nurse would assess the client, with consideration of at least 2 aspects from the RLT Model.

Criterion 4: Application of knowledge b) CRC Stage 2 Collect cues/information (20 Marks) 20 to >16.8 pts

High Distinction

Demonstrates comprehensive application of the second stage of the Clinical Reasoning Cycle in relation to the case study. Clear identification of all related issues.

Criterion 5: Application of knowledge c) Stage 3 Process information (20 Marks) 20 to >16.8 pts

High Distinction

Demonstrates comprehensive application of the third stage of the Clinical Reasoning Cycle in relation to the case study. Clear identification of all related issues.

Criterion 6: Application of knowledge d) Stage 4 Identify problems/issues (10 Marks) 10 to >8.4 pts

High Distinction

Demonstrates comprehensive application of the fourth stage of the Clinical Reasoning Cycle in relation to the case study. 1 to 2 correct nursing diagnose are presented and accurately articulated. Clear identification of all related issues.

Criterion 7: Knowledge and application of evidence supporting literature (5 marks) 5 to >4.2 pts

High Distinction

Ten (10) or more relevant and credible nursing related academic sources cited.

Criterion 8: Referencing Use of APA 7th Edition required. (10 marks) 10 to >8.4 pts

High Distinction

Accurate use of APA referencing style in all instances: in-text and reference list (no errors) A wide range of in-text citations has been used.

My research:

Quilliam, C., Crawford, N., McKinstry, C., Wong Shee, A., Harvey, P., Glenister, K., & Sutton, K. (2021). Building a rural workforce through identifying supports for rural, matureaged nursing and allied health students: A systematic scoping review.The Australian Journal of Rural Health,29(5), 643655. https://doi.org/10.1111/ajr.12788 - According to research (Quilliam et al., 2021) or According to Quilliam et al. (2021)

Undersupply of health professionals in rural and remote areas Nursing and allied health professionals is an ongoing Australian and international issue.

Shen, X., Wang, G., Kwan, R. Y.-C., & Choi, K.-S. (2020). Using Dual Neural Network Architecture to Detect the Risk of Dementia With Community Health Data: Algorithm Development and Validation Study. JMIR Medical Informatics, 8(8), e19870. https://doi.org/10.2196/19870 - (Shen et al., 2020) or Shen et al. (2020)

As cognitive impairment in a diagnostic criterion of dementia, cognitive assessment tools are used in primary care to screen clinically unevaluated cases. Among them, Mini-Mental State Examination (MMSE) is a common Instrument.

Conclusion the method has potential to serve as a tool to screen for elderly people with cognitive impairment and predict high-risk cases of dementia at the asymptomatic stage, providing health care professional with early signals that can prompt suggestions for a follow-up or a detailed diagnosis.

Symptoms can be subtle.

Health assessment contains 10 health assessments:

Mini-Mental State Examination assessment of cognitive impairment in older adults

Brief Pain Inventory Questionnaire Severity of pain and its influence on elderly people.

Elderly Mobility Scale (transition between sitting and lying, gait, timed walk, and functional reach.

Geriatric Depression Scale Measure of depression in older adults.

Mini-Nutrition Assessment to detect any decline in ingestion. Questions regarding apetite loss, weight loss, and psychological stress in last 3 months, Mobility and BMI.

Constipation Questionnaire frequency of evacuation, difficulty of evacuation, incomplete evacuation.

RLT-Based questionnaire - The results of the questionnaire can be used to determine the interventions required to enable elderly people to remain independent in activities of daily living.

Gross Oral Hygiene Assessment

Visual Acuity Assessment - Logarithm and Minimum angle of resolution.

Schnitzer, S., Blher, S., Teti, A., Schaeffner, E., Ebert, N., Martus, P., Suhr, R., & Kuhlmey, A. (2019). Risk Profiles for Care Dependency: Cross-Sectional Findings of a Population-Based Cohort Study in Germany. Journal of Aging and Health, 32(5-6), 352360. https://doi.org/10.1177/0898264318822364 - (Schnitzer et al., 2019) or Schnitzer et al. (2019)

Main focus or conclusion Physical activity and morbidity are significant in respects: Accessible and influential

Social determinats care and non-care dependent participants.

There is limited known facts on how patterns of morbidity, frailty, and social determinnasts are associated with care dependency (CD) in old age.

It is evident that number of CD persons is projected to reach around 3.4 million by 2030.

The persons requiring care in relation to their peer group, increases significantly with age.

In age group of 80-84 the ratio of CD of women is 4/3 times greater than the males of same age.

based on claims data, the authors identified old age, dementia, urinary incontinence, stroke, and cardiac insufficiency as being significantly associated with CD. And living without a spouse/partner in the household.

RLT model of nursing is based on health relevant activities of daily livingand related factors affecting them. Need of care can be derived.

Physical activities are a protective health factor in older adults

Royal Alexander Hospital. (3122, January 5). The difference between care and caring [Video]. https://youtu.be/wkf-WxMZVP8Showed difference between care and caring showing how having an emotional support at the time of hard times brings comfort to a person in palliative care.

Pain starts to subsdise.

Williams, B. C. (2017). The Roper-Logan-Tierney Model of Nursing. Nursing Critical Care, 12(1), 1720. https://doi.org/10.1097/01.CCN.0000508630.55033.1c - (Williams, 2017)

Or Williams (2017)

RLT is translated into many languages model of Nursing and is practice-centred theoretical model of Nursiing both in academic and clinical settings. It is prepared as a holistic patient assessment.

Nancy Rope developed this theory during 1980s based on commonalities in every patient.

RLT model is based on 5 main concepts:

12 activities of living (center point) (to assess patient)

Lifespan

Dependence/independence continuum (level of performance is marked with degree of independence)

Factors influencing activities of living

Individualising nursing (assessing, planning, implementing, evaluating) assess abilities. In each activity within context of lifespan and influential factors to create a plan of care.

RLT theory is based on several assumptions ADLs are based on patients health - Illness influences the patient's level of activity and all of the concepts within the model.

Develops and tests a hypothesis about outcomes of patient care with a nursing framework.

Mundy, L., & Hewson, K. (2019). Thinking outside the system: the integrated care experience in Queensland, Australia. Australian Journal of Primary Health, 25(4), 303. https://doi.org/10.1071/py18161 - (Mundy & Hewson, 2019) or Mundy and Hewson (2019)

One mechanism for healthcare reform is - Integrated care system in Australia has been slow to adopt, itt may be due to fragmented nature of funding and structure of healthcare.

Relationship building between acute and primary care to deliver an integrated, rather than episodic, model of care approach in Queensland.

Major drivers of health expenditure growth in Aus include a rapidly ageing population and increased prevalence of chronic and complex disease

People-centered care is provided, usually through a single point-of-entry, across all settings by coordinating multidisciplinary teams in partnership with primary care.

In 2016 A$35 million was provided to fund ICIF

Eley, R., Bush, R., & Brown, W. (2014). Opportunities, Barriers, and Constraints to Physical Activity in Rural Queensland, Australia. Journal of Physical Activity and Health, 11(1), 6875. https://doi.org/10.1123/jpah.2011-0312 - (Eley et al., 2014) or Eley et al. (2014)

The overall aim of the study was to collect data that would be indicative of rural Queensland. Facilities such as lawn bowls, tennis courts, swimming pools and golf are available for a town with population of 300 residents.

In Rural Queensland people are reliant on personal transport or limited school bus system.

People look out for each other in rural areas.

A limited culture of physical activity has been noticed, Little evidence of employment except from mining places.

Funding: The funds available for the council and club facilities have been well exploited hence the requirement to continuing program with local resources has challenged sustainability.

identified barriers to physical activity in rural areas. These include physical isolation, lack of resources and transport, fewer places to walk and fewer organizations to support physical activity Determinants such as access, while of importance in all locations, are influenced quite differently in rural locations by the physical environment and climate

Why did Rosie did not go to the GP? Is it just because she did not feel like it or the facilities or access is not there?

Daly, J., & Jackson, D. (2021). Contexts of nursing: an introduction (6th ed.). Elsevier Australia. - (Daly & Jackson, 2021) or Daly and Jackson (2021)

Not homogenous communities.

Socio-economic factor such as cost of delivering services is higher compared to cities, therefore resources are spread sparsely across large areas.

People of rural areas face challenges: fewer healthcare and educational opportunities,

rural people are more likely to delay seeking healthcare, are often more concerned about the stigma of illness, and are focused on practical problem solving in preference to help seeking. A recent systematic review of qualitative studies noted that stoicism, stigma and distrust were attitudinal barriers to mental health help seeking among people living in rural areas

funding deficit for aged care in rural areas is in excess of $500 million per annum

needing help at home can mean relocating away from family and friends either temporarily or permanently. Given the strong association with community and sense of place among rural people, moving away to supportive accommodation is particularly problematic

Australian Bureau of Statistics Australian Government Department of Aging, 2018.Australian Bureau of Statistics Australian Government Department of Aging : Fact sheet: Primary health care. Online. Available: https://www1.health.gov.au/internet/main/publishing.nsf/Content/Fact-Sheet-Primary-Health-CareAustralian Institute of Health and Welfare, 2018.Australian Institute of Health and Welfare : Australias health 2018: in brief. The 18th biennial health report of the Australian Institute of Health and Welfare, Canberra. Online. Available: https://www.aihw.gov.au/reports/australias-health/australias-health-2018/contents/table-of-contentsWillis, E., Reynolds, L., & Rudge, T. (2020). Understanding the Australian health care system (4th ed., Vol. 1). Elsevier Australia. - (Willis et al., 2020) or Willis et al. (2020)

traditional healers, who have received special tools and training from their grandparents

people often engage in health-promoting practices that are determined by their own cultural values and beliefs. Rather than asking people to choose, optimum health outcomes may be achieved by facilitating collaborative responses

Levett-Jones, T. (2018). Clinical reasoning: learning to think like a nurse (2nd ed.). Pearson Australia.

What is clinical reasoning? systematic and cyclical process that guides decision making, particularly in unpredicatbale, emergent and non-routine situations.

CRC Collect cues take vital signs review current info, gather new info and recall knowledge

While processing Interpret analyses cues, discriminate relevant and irrelevant info to narrow down, Relate by identifying relationships, Infr make decisions, Match current situation to past, and predict an outcome.

Identify the issue by synthesise facts and inferences and give ex.

Provide person centered care what person can do and what are inabilities using past life and history in care.

Values of a person Clinical decisions can not be separated from whole person.

Person-Centered Care Who is Rosie? People in in age gets similar diagnosis Know whole aspect of a person.

Cultural safety.

Tollefsen, J. (2022). Clinical psychomotor skills: assessment tools for nurses (8th ed.). Cengage Learning Australia. - (Tollefsen, 2022). Or Tollefsen (2022)

Using templates such as ISBAR can help to document and communicate with the other clinical team.

Good verbal and non-verbal communication skills are imperative.

Do not assume a level of previous knowledge.

Generally, a person in hospital may have barriers to effective learning nervousness, emotional response to new diagnoses, malaise or lack of focus due to condition

Planning work with the person to clarify and develop strategies to individualise treatment guidelines, to implement continuing education and improve communication skills, in order to assist the person to achieve behavioural change.

Jarvis, C. (2021). Jarviss health assessment & physical examination (3rd ed.). Elsevier Australia. - (Jarvis, 2021) Or Jarvis (2021)

Cilinical reasoning is analysing health information and drawing conclusions to identify health issues or problems. (it is based on a scientific method)

Identify available cues (data) from a range of sources. > discriminate between rlevant and irrelevant data. > draw conclusions by making inferences/predictions/hypothesis > diagnosis (analysing the data/cues > Goals are determined > Interventions selected > outcomes of interventions.

Developing critical thinking skills -all healthcare decisions are based on information yo gather during assessment.

It takes time and practice to achieve proficiency.

Prevent complications through vigilant monitoring.

To be an effective critical thinker following attributes are needed (for clinical reasoning cycle 8 steps)

Holistic and contextual perspective the whole person is considered, as well as their entire situation including background, relationships and environment.

Creative capability of generating, discovering or restructuring ideas and being abe to imagine other options.

Inquisitiveness careful questioning and investigation of a range of possibilities.

Perseverance dedication to trying to understand the persons situation.

Intuition recognition of patterns based on past experiences.

Flexibility ability to adapt thinking and behaviours

Reflexivity thoughtful review of assumptions, thinking and approaches to ensure understanding.

Confidence belief in ones abilities.

Open mindedness open and sensitive to other views.

Daly, J., & Jackson, D. (Eds.). (2021). Contexts of nursing: an introduction (Sixth edition). Elsevier Australia.

OToole, G. (2020). Communication: core interpersonal skills for healthcare professionals (4th ed.). Elsevier Australia. - (OToole, 2020) or OToole (2020)

Ineffective communication in healthcare can result in fatalities. Ineffective communication has legal implications.

Effective communication develops the therapeutic relationship and provision of effective healthcare. In contrast, ineffective communication produces emotions and thoughts that could potentially negatively affect health outcomes.

Effective communication decreased complaints.

Self-awareness is necessary requirement -

Ali, M. (2018). Communication skills 2: overcoming barriers to effective communication. Nursing Times, 114(1), 40-.

Barriers to effective communication including time constrainsts, environmental issues such as noise and privacy, pain and fatigue, embarrassment and anxiety, use of jargon, values and beliefs, information overload.

Competing demands and pressured workplace may neglect the quality of communication

Preparing ground for difficult communication.

In absence of patients full attention, consider whether the message could be broken down into smaller conversations so there is less to digest in one go.

Embarrassment can result in awkward encounters that may hamper effective communication. Anticipating potential embarrassment, minimising it and using straightforward, open communication can ease difficult conversations.

Be aware of your own and patients assumptions as it can be offensive Eg an Asian patient will not speak good English or a male nurse cannot be a midwife.

International Council of Nurses (ICN). (2021). The Code of Ethics for Nurses.

https://www.icn.ch/system/files/2021-10/ICN_Code-of-Ethics_EN_Web_0.pdfNursing and Midwifery Board of Australia (NMBA). (2022). Code of Conduct for Nurses.

https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards.aspxNursing and Midwifery Board of Australia (NMBA). (2016). Registered Nurse Standards for Practice. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx