Clinical Reasoning and Decision Making Assignment Sample

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Introduction to Clinical Reasoning and Decision Making Assignment

In advanced clinical practice, decision-making is playing a pivotal role in ensuring optimal patient care while navigating complex scenarios. According to HEE (2015) and Curtis (2024), “Advanced Clinical Practitioners (ACPs) must demonstrate advanced problem-solving and decision-making abilities, making decisions using critical thinking skills and judgement which in turn allow autonomous practice (Health Education England (HEE), 2015). Advanced Clinical Practice (ACP) should be underpinned by complex decision-making skills (HEE, 2015), using analysis and synthesis of complex problems to make appropriate, evidence-based judgements or diagnoses to improve patient experiences and outcomes (HEE, 2017).” This discussion also provides valuable insights for learners seeking guidance through Online Assignment Help UK, as it highlights the depth of analytical and critical thinking required within the ACP domain.

This assignment will be based on a specific case study that involves 35 years old female patient; Jane name has been changed to meet confidentiality. As per HCPC; it is the legal and ethical responsibility of healthcare practitioners and professionals to resect and protect the confidentiality of service users. Thereby, patient identify has been kept confidential in current case analysis (HCPC, 2024). Jane’s presenting compliant was suffering from a persistent urinary tract infection (UTI) symptom followed by antibiotic treatment. The assignment will focus on the decision to treat with further antibiotics or not. The assignment will consider the authors (a trainee ACP) process of decision making. It will examine the theories utilised by the author and their application to inform the authors clinical reasoning process. It will also consider the authors decisions surrounding

Prescribing further antibiotics while focusing on symptom resolution that requires systematic understanding of epidemiological concepts, diagnostic tests and different theories adhering with clinical decision-making. Furthermore, understanding psychological factors, ethical implication and professional responsibilities outlined in Health and Care Professional Council (2024) code of conduct is essential.

The present case study will emphasise on the procedure of clinical decision-making, influence of cognitive biases & personal traits in decision making and the nature of clinical uncertainties. The decision-making dilemma encountered in the case would be highlighted within focusing on alternative approaches.

Patient presentation and History

Jane was a 35 years-old-office worker suffering from the symptoms of UTI; she was experiencing urgency and dysuria along with lower abdominal discomfort. Historically, Jane did not have any significant past medical issues, there was no episodes of UTIs diagnosed in past two years. However, over the last three weeks Jane was experiencing UTI symptoms and she was diagnosed with UTI and was prescribed a three-day course of nitrofurantoin. Symptoms for Jane improved after treatment for a few days however, they are remerging and prompted Jane to seek further medical assessment.

During the assessment undertaken by the author, the author consider NICE guidelines (2024) Jane was asked about the onset, severity, and evolution of any Symptoms such as dysuria, new nocturia, frequency, urgency, suprapubic pain or tenderness. Sexual history and possibility of pregnancy. Vital signs where thus ruling out potential sepsis. A urine dipstick was undertaken in accordance with NICE guideline. There was no evidence of infection identified the second time despite persistent symptoms in Jane. The clinical scenario imposed careful examination based on potential differential diagnoses of such things as polynephritis, urethritis, STIs or even potential gynaecological malignancy. The author needed to consider whether there was a requirement to prescribe additional antibiotics or there was a need to adopt a watch and wait approach. (PHE, 2020)

Clinical Reasoning and Decision Making Assignment Sample

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Dilemma in decision-making

Dilemma in decision-making procedure creates significant barriers that influences patient health outcomes (Collen, 2024). In current case, core dilemma is around prescription of another course of antibiotics; the confusion arising whether the new prescription should be given or there is need to wait and observe to see if the symptoms disperse. However, decision has been further complicating due to the potential consequences of consistent use of antibiotics as this is resisting the risk of adverse drug effects (Sibson, 2024). Furthermore, ambiguity surrounding the diagnosis specifying that there is need to undertake thorough exploration of possible underlying causes such as interstitial cystitis, non-infection causes and bladder irritation. It is essential to focus on clinical dilemmas as these adheres with the challenges and factors comprised with patient diagnosis and prognosis. Therefore, specific focus should be implied in this context for resolving the complex factors while complying with evidence-based decision making.

Epidemiological Concepts and Diagnostic Tests

It is pivotal to understand the epidemiological context of UTI for making informed clinical decision; It is caused by bacterium which invades urinary epithelium cells that causes irritation and inflammation of these cells. UTI is common in females and the prevalence of UTI increases with age. UTI is considered as one of the most common infectious diseases; prevalence in the women aged above 65 is 20%, between 50% to 60% of adult women experience UTI in their life (Czajkowski et al, 2021). Anatomic and functional theories depicts that this phenomenon involves bladder dysfunction, urinary and faecal incontinence, prolapse and change within oestrogen status. Furthermore, major risk factor of UTI is catheter use; sexual intercourse and using spermicides and diaphragm increases the risk of UTI (Mancuso et al, 2023). The decision for treating UTI traditionally supported through positive urine cultures and distinctive clinical symptom. However, in jane’s case it has been witnessed that symptoms are persisting on consistent note and there is need to undertake standard treatment.

Urine Dipstick initially shown positive results for leukocytes and nitrites that indicated about the present of infection. However, at present it is showing negative; the urine culture test further indicated clear result, and no bacterial growth was identified. Dipstick result initially specified positive result while afterwards, it was showing negative and this becomes questionable aspect. The ambiguous test results questioning clinical judgement and specifying about following standardised procedure. There is need to undertake additional diagnostic evaluation for assessing other conditions contributing to Jane’s current discomfort. Hence, it can be said that results from diagnostic test questioning results and it is not adhering with evidence. Hence, there is need to focus on undertaking an in-depth critical evaluation and further test requires to be conducted as this supports in analysing whether antibiotics should be prescribed or not.

Theoretical framework related to clinical decision making

Shabana (2005) identifies that the phrases “clinical reasoning”, “clinical Judgment”, “Clinical decision making” and “critical thinking” are all interconnected and used interchangeably. Thompson et al (2017) highlights that the process of clinical reasoning may vary from clinician to clinician or case to case, it is reliant on the clinician’s experience, knowledge and understanding as well as the clinical environment. Levitt Jones et al (2010) suggests that clinical reasoning is the stage where clinicians gather and process information eg the consult and history taking. Whereas critical thinking is the cognitive ability needed to perform the task. Levett Jones developed the clinical reasoning cycle (see appendix one) which is a model/guide for clinicians to consider. There are multiple frameworks such as diagnostic reasoning, collaborative reasoning, hypotheticodeductive reasoning but the author will focus on the CRC framework for this assignment due to its flexibility. The CRC framework is an eight-phase cycle which includes consideration of facts from the patient or situation, collection of information, processing gathered information, identify the problems, establish goals, take action, evaluation and reflect. EHA (2020) suggests however that the eight phrases are a continuum and that a clinician may not necessarily move from one phrase to the next but may move backwards and forwards until an accurate assessment is obtained.

Thus, Clinical reasoning is expounded as a complex cognitive process that is vital for evaluating and managing patient’s medical complexities. It comprised with diagnosing patient complexity, undertaking therapeutic decision and estimating prognosis for patient. Levette Jones proposed clinical reasoning cycle; it assist nurses to take appropriate decision after analysing all factors. The stages or clinical reasoning cycle associates with considering patient situation, collecting cues, processing information, identifying problems, establishing goals and taking actions. Each stage is linked with each other and therefore, it needs to be followed through series.

Levett-Jones emphasised on acknowledging the boundaries between each stage that are not clear, furthermore, clinicians are guided to link all stages so they can acquire essential information (Levett-Jones et al, 2010). For addressing uncertain clinical landscape there are several decision-making theories that supports in understanding the situation and Levett-Jones theory providing the detailed landscape for understanding whole situation, in this theorical instance there are multiple models such as Kahneman (2011) dual process theory (see appendix two) which was also used in this case to make a decision. Dual process theory discusses how the brain has two distinct areas when it comes to decision making these are known as Type 1 and Type 2 decision-making has been highlighted (James, 2021). Type 1 is concerned with rapid and automatic response that is based on the experience. Heuristics are considered as mental shortcuts that facilitate problem solving along with probability judgements. Type 1 follows this pattern of thinking. On the other hand, Type 2 decision making comprised with analytical process in which deliberate and reflective process is undertaken (Levett-Jones et al, 2010). In current scenario, Type 1 response led me for prescribing another course of antibiotics based on persisting symptoms (James, 2021).

However, Type 2 approach aligns with examining evidence and considering alternative diagnosis and accordingly, ramifications of prolonged antibiotics use are weighted. Type 1 reasoning proves to be rapid as it generates diagnosis which has been formed in mind while Type 2 reasoning tends to be slower, conscious and analytical (Levett-Jones et al, 2010). In case author have approached Type 1 reasoning then without any evaluation antibiotics were prescribed to Jane. However, author preferred analytical reasoning and consequently, symptoms were assessed and decision regarding cystoscopy and lifestyle modification through patient education was taken.

Dual perspective enabled author to navigate the complexities of Jane’s case by utilising intuitive and analytical approaches while assuring comprehensive decision-making process entitled with evidence-based practices principles.

When the results of diagnostic test seem to be inappropriate then the reasoning cycle moves towards that stage in which information was allocated and processed (Braithwaite and Barcinas, 2021).

This supported author in understanding the whole situation and accordingly original cues was collected. When the test has shown negative results then the cycle moved back to that stage from where information was collected and processed. This time, it allowed correct identification of the problem via considering the assessment of symptoms, from the assessment it was specified that standardised procedure requires to be undertaken (Collen, 2024). The persistent symptoms of UTI in Jane have become the cause of concern at that stage author had varied thoughts- it might be due to lifestyle factors or any underlying condition (Levett-Jones et al, 2010). Despite taking antibiotics the symptoms were reoccurring. Author communicated with patient and asked about her daily routine and through this it was evident that there is need to develop awareness regarding maintaining hygiene in patient. However, patient asked for further antibiotics; this time the situation was critical and this led to develop an ethical dilemma for author. As per HCPC (2024) it is important to consider patient interest, in current case patient interest can lead to create negative influence on her health and therefore, it was raising ethical dilemma.

Author was in a critical situation under which patient autonomy was needed to be prioritised while taking evidence-based decision that enhances patient health outcomes. Therefore, Jane was involved in decision making process and she was made aware about her situation. Author explained her that despite taking antibiotics her symptoms are not improving and this is signifying about long-term UTI and for conforming diagnosis cystoscopy should be performed. Furthermore, relying on previous test results can harm patient health as at initial stage test has shown positive results while afterwards, it was showing negative results. Therefore, in-depth evaluation was needed.

From the literature it has been witnessed that cystoscopy enable healthcare providers to assess lower urinary tract for identifying complexities in urethra and bladder. If symptoms of UTI keep persisting then it is recommended to undertake cystoscopy as it helps in identifying underlying complexities such as bladder cancer and another cause of symptoms (Guldhammer et al, 2023). Considering the clinical evidences author provided information to Jane and accordingly, trust of patient was gained. By empowering patient and implementing consistent communication awareness in Jane was developed. Hence, this can be articulated that in current case symptoms of UTI were persisting and further urine test was not showing any kind of infection; hence, there was possibility that Jane was suffering from chronic [Long-term] UTI, this can be caused by the bacteria that entered in lining of bladder (Collen, 2024). Based on the information and cues, standardised procedure such as cystoscopy was considered for patient.

Kahneman proposed dual processing theory of cognitive thinking; in accordance with this theoretical instance humans have two systems that proceeds thinking. System 1 concerned with unconscious mindset that relies on shortcuts. On the other hand, system 2 is intentional and calculated; it takes time in taking decision however, it follow analytical approach before coming to a conclusion. In current case, system 2 was appropriate as this aligned with undertaking in-depth evaluation of symptoms and afterwards, decision was taken (Melnyk and Fineout-Overholt, 2022). By considering system 1 Author might lead to medical error as it relies on shortcuts that encourage for prescribing another dose of antibiotics despite of persisting symptoms (Collen, 2024). Through dual process perspective, Jane’s complexities were navigated by using analytical approaches; this led to ensure more comprehensive decision-making process that comprehends with principle of evidence-based practices. Author preferred system 2 for undertaking decision in Jane’s context; her test results and persisting symptoms significantly depicting about in-depth evaluation and therefore, focus was implied on this area and shortcuts were not preferred by author. By adhering with evidence-based practices and clinical guidelines system 2 was followed and further evaluation was considered so that serious complexity or any underlying disease can be identified (Melnyk and Fineout-Overholt, 2022). In this manner, significant insights were developed during decision-making process and author further learned that it is important to consider varied aspects that influence decision making process.

Both the theoretical instance providing detailed comprehensions for understanding the situation of patients and taking appropriate decision and therefore, I have considered this while analysing the complexities of jane. This supported me in developing significant insights which are important for understanding the situation and processing information. Clinical reasoning cycle supported me in taking appropriate actions and further assisted me in forming meaningful conclusion. By using both the theories author has taken decision; instead of preferring shortcuts analytic approach and thinking was encouraged in whole procedure and this further led to support author in terms of taking effective decision which is important for enhancing patient health outcomes.

Psychological influence, human factors and cognitive biases

Cognitive bias and personality traits often develop mental shortcuts and heuristics that impacts the ways in which individuals think and act. From the literature it is evident that there are approximately two hundred different cognitive biases that impacts clinical decision-making process (Zajac et al, 2021). The cognitive bias has been shaping my personality traits and this can further influence decision-making process. For example- if author possesses tendency towards confirmation bias then there are chances that author overly emphasis on Jane’s repetitive UTI symptoms while concluding that additional antibiotics are warranted. Further, there are chances that author neglect the possibilities of alternative diagnosis and misinterpretation of test results. Conversely, mitigating these biases requires an awareness of emotional intelligence and self-reflection as it allows for balanced perspective. Engaging in shared decision making with Jane and actively involving her in discussion supports in providing insights regarding her preferences in decision making process (Zajac et al, 2021).

This results in empowering patient and further develops sense of belongingness in Jane, it is pivotal to consider patient requirements while deciding treatment option. Before prescribing another dose or undertaking cystoscopy it is important to consult with Jane and the consequences should be explained to her. Creating awareness in patient enables her to understand the appropriate treatment option for her and therefore, I have implied significant emphasis on this area so that consistent support could be ensured to Jane. Hence, through this experience, I have realised that psychological influence and own traits has potential to impact decision making and therefore analytical approach requires to be undertaken instead of preferring shortcuts (Greenhalgh and Dijkstra, 2024). Despite taking medication Jane’s symptoms were recurring and further at initial stage test has shown positive results and afterwards it was showing negative results. This is signifying about the possibilities of chronic UTI and therefore, in such case cystoscopy is essential.

Ethical consideration

In the realm of clinical practice, ethics are playing pivotal role in assuring that patient welfare are upholding professional standards. In accordance with the Health and Care Professional Council (2024) code of conduct 5 “Respect Confidentiality” healthcare professionals and practitioners are accountable for keeping service user information confidential; the information should be only disclosed when healthcare professional has permission to disclose it, law allowing this, in case of service user’s best interest and public interest. Thus, maintaining confidentiality is a pivotal aspect in clinical procedure, thereby, author has emphasised on HCPC code of conduct and consequently, confidentiality of patient was maintained and no disclosure of personal information was done (Gopal et al, 2021). In Jane’s case it proves to be imperative to communicate transparently about the uncertainties surrounding diagnosis and treatment option of Jane. HCPC (2024) code of conduct 2 “Communicate appropriate and effectively” articulates that healthcare professional needs to be polite and considerate while communicating with service users and other staff members.

It is important to listen the opinion of service users and further important

information regarding their treatment procedure should be provided to them. The persisting symptoms of UTI in jane’s case and negative results from diagnostic tests signifying about underlying condition and therefore, it is the duty of author to communicate each component with patient. Before undertaking cystoscopy author interacted with patient and transparent communication was undertaken. The interest of patient lies with prescription of another dose of antibiotics; thereby, consequences was communicated with patient (Wilkinson, Gill and Hardy, 2024). Clear and transparent communication was undertaken and accordingly Jane was educated regarding complications. The importance of performing further evaluation through standardised procedure such as cystoscopy was explained to Jane.

Working within limits of own knowledge and skills are important; as per HCPC (2024) healthcare practitioners must only practise in those areas in which they possess appropriate knowledge and skills. Cystoscopy performed by urologist and therefore, author referred Jane to urologist. The importance of undertaking standardised procedure was communicated to patient and afterwards all the procedure was undertaken by healthcare experts. Hence, author performed practices while adhering with present knowledge and skills. By adhering with HCPC (2024) code of conduct “Be honest and trustworthy” healthcare practitioners and professionals should be honest and they must undertake reasonable steps. Author has focused on this context and consequently, honesty was maintained while ensuring support to Jane. Furthermore, author has ensured consistent respect towards Jane and her opinion was heard throughout the communication procedure. Specific emphasis was made on patient empowerment and consequently, Jane was involved in decision making process. This led to foster the motivation in patient and

further increased her engagement level.

Thus, there is no doubt in depicting that author has effectively performed mandatory ethics complying with HCPC standards and accordingly, support was ensured to patient and decision-making procedure was undertaken. Hence, ethics proves to be highly important while providing care services to patient (Brennan et al, 2024). Practitioners must focus on this area as this ensures integrity and dignity in decision making process. Author has followed all the mandatory ethics and this supported in providing consistent support to Jane. This experience enabled author to develop important insights related to ethical consideration in decision making process and this learning will be further used in future so that effective outcomes could be gain while ensuring support to patient (Brennan et al, 2024). There is no doubt in specifying that author has complied with HCPC standards which are crucial for taking evidence-based decision. Hence, this learning will be further use in future while taking decision in complex situations.

Decision making process in practice

In evaluation of decision-making process within Jane’s case author employed several critical steps. The starting was done with assessment of symptoms; clinical reasoning cycle by Levette Jones. Author has considered the patient symptoms and accordingly, symptoms were assessed. The comprehensive exploration of Jane’s symptomatology and influence on daily life was identified. Reflection on the diagnostic test was undertaken and discrepancies between symptoms and test results was identified. The cues and information were collected; previous test results of Jane were assessed and further the information was processed (Binstead and Sarantakis, 2024). Afterwards, core focus was implied on identifying the issues. In Jane’s case issue aligns with persisting symptoms of UTI despite taking antibiotics. This was determining about underlying conditions. Afterwards, goal related to undertaking standardised procedure cystoscopy was established and Jane was referred to urologist.

Based on the Jane clinical presentation and conditions beyond UTI evaluation of alternative diagnosis was considered. Author has adopted holistic approach and accordingly, psychosocial factors associated with Jane’s lifestyle were identified as these are concerned with the potential of impacting Jane. Patient was engaged in communication procedure and further she was made aware regarding consequences of further antibiotics and importance of cystoscopy (Binstead and Sarantakis, 2024). Hence, Jane was engaged in discussing treatment options such as supportive care, lifestyle medication and potential for antibiotic therapy. Dignity and autonomy of patient was maintained throughout the discussion procedure. Moreover, author underpinned professional obligation that assures that all the decisions were taken while considering Jane’s best interest.

The theoretical and practical components of decision-making emerging from Jane’s case study specifying about the importance of undertaking evidence-based decision making. This complies with following clinical reasoning cycle steps along with witnessing cognitive bias and traits that can impact decision-making process (Lowe et al, 2024). The cognitive biases underscoring multifaceted nature of clinical decision-making. The model proposed by Levett-Jones demonstrating about the significance of integrating varied strategies that encompassing intuitive and analytical thinking for mitigating potential errors and biases in judgement.

Complexities of diagnosis and managing persistent UTI symptoms signifying about the requirement of ongoing education and reflective practice within clinical setting (Waisbrod et al, 2021). Hence, author has learned that there is need to initiate discussion regarding patient autonomy and preferences as this lead to foster collaborative approach which supports in bridging gap between patient-centred care and clinical expertise.

The ethical dilemma was faced by author at a certain point as patient wanted to prescribe another dose of antibiotics. However, persistent UTI symptoms and test results were signifying about underlying condition and therefore, it was important to perform cystoscopy (Lowe et al, 2024). The author needed to maintain both the ethical domains; “patient autonomy” and “patient safety” which led to create an ethical dilemma. However, by informing Jane about consequences author managed to solve ethical dilemma and consequently, concept of informed consent was performed by author and support was ensured to patient. In this manner, consistent support was assured to jane and further patient was empowered and awareness regarding healthy lifestyle modification was developed as this results in improving the symptoms of UTI. Thus, by adhering with HCPC code of conduct author has taken decision which proves to be beneficial for enhancing patient health outcomes.

Conclusion

Conclusively; this can be said that Jane’s case provided significant opportunity in terms of reflecting on own decision-making process while focusing on the integration of epidemiological understanding theory and ethical consideration in clinical setting. Furthermore, cognitive biases, traits and human factors that influences decision making procedure was highlighted. System1 and System 2 system were identified by authors; System 2 was preferred as this is concerned with analytical thinking approach instead of shortcuts. Consequently, decision related to further evaluation and standardised test such as cystoscopy was taken and subsequently, patient was informed about this. I have complied with HCPC standards and this supported in performing mandatory ethics throughout decision making and care procedure system.

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