Describe the Caritas Processes and discuss where and how they relate to the Clinical Reasoning Cycle in the scenario

Question

1. Identify the key aspects of the clinical scenario

2. Describe the Caritas Processes and discuss where and how they relate to the Clinical Reasoning Cycle in the scenario

1. Q2 you discuss CRC + scenario + the caritas applicable up to the ‘establish goals' part of the CRC.
2. write up to the "establish goals" step of the Clinical Reasoning Cycle (CRC) - need to do up to ‘establish goals’ of the CRC in order to do Q3.
3. consider what key aspects were identified in Q1, then select and describe (some) of the Caritas Processes applicable, as you work through the CRC. -Don’t need to discuss all 10 Caritas Processes. Only discuss the Caritas Processes that are relevant/ would apply to each part of the CRC. Discuss the most important ones. ie. 6 is one.
4. Eg. For step 1 of the CRC - Consider the patient’s situation, which processes will you apply to do this effectively? Embracing humanistic-altruistic values by practice of loving-kindness, compassion and equanimity with self/others - as we need to connect, listen receptively, accept others. You could also look at number 2, 4 and 5 etc.
5. You then find the list of 10 processes and pick out which ones are relevant for whatever part of the CRC you are using.
6. Establish goals and take action would use Process 6 - using creative scientific problem-solving methods for caring decision-making and creative solution-seeking.
7. eg. #2 (Mr Esposito, 81 Male, was admitted for dehydration from suspected gastro, now experiencing visual disturbances)….. think about; What are the Caritas Principles that can be applied to this scenario while keeping the CRC in mind......so possibly, principle 4 - helping, trusting caring relationship - how that might be applied while while collecting cues from the patient, etc.

3. Describe how the Caritas Processes and Clinical Reasoning Cycle could be used to achieve solutions to address the care needs for Shawn.

1. implementing the goal/s you identified in Q2.
2. eg - one of the goals may be to help Shawn with his substance abuse. look at how to help Shawn from a Caritas Perspective. eg. might research substance abuse rehabilitation from a caring theory perspective, or caring science and drug programs or nursing and so on…..
3. With this information discuss plans including the Caritas Processes that are relevant to the discussion.
4. From the scenario, identify some solutions which could be applied (this is the CRC part- setting goals) and what Caritas principles could you use to achieve them...
5. Q3 is about the setting goals/evaluating/reflecting section of the CRC.
6. Q3 is about how you are going to implement the goals you set/identified in Q2 to help Shawn. Think about what interactions a nurse might do, what caritas processes are being used? The focus is on the caritas processes as you do this.

You are the nurse caring for Shawn on the morning shift.

Shawn Bolton is a 25 year old mal who self presented to ED with fevers (temp of 39oC).

He has an infected abscess on his left arm from injecting heroin.

He has been admitted to your ward for observation and prescribed IV antibiotics.

Shawn was released from prison six weeks ago for a drug related offence.

He was released without accommodation, support or money and has been sleeping rough.

Due to Shawn’s drug use and criminal history, some nurses on your ward are reluctant to care for Shawn.

One nurse said they hope he discharges himself so someone more deserving can have his bed.

The handover from your night shift colleague said Shawn didn’t sleep at all last night.

He’s highly agitated , complaining of severe stomach cramps, demanding pain relief and wants a cigarette.

Your colleague said Shawn swore when told he was only charted paracetamol for his pain and the hospital had a no smoking policy.

Shawn was told his behaviour was inappropriate and your colleague walked out the room to let him calm down.

Staff on your ward have been told to limit contact with him because of his drug seeking behaviour and criminal record. Security has been notified and will monitor his behaviour.

Although you are not sure what’s happening with Shawn, based on the handover, you are concerned about heroin withdrawal and his risk of endocarditis.

(The following shortened clinical scenario is taken from Goodhew , M . , & Robinson , T . ( 2023 ) . Caring for a person· with substance· dependence· and complex post-traumatic distress· syndrome . In T . Levett-Jones (Ed.), Clinical reasoning: learning to think· like a nurse (3rd ed., pp. 190-191). Pearson Australia.

Answer 1

Key Aspects of the Clinical Scenario:

Patient Information:

Shawn Bolton, a 25-year-old male.

Self-presented to the emergency department with a fever (39°C).

Infected abscess on his left arm from injecting heroin.

Admitted to the ward for observation and prescribed IV antibiotics.

Recently released from prison with no accommodation, support, or money, and has been homeless.

History of drug-related offenses.

Some nurses are reluctant to care for him due to his drug use and criminal history.

Presenting Issues:

Fever and infection from the abscess.

Potential heroin withdrawal symptoms.

Agitation, severe stomach cramps, and pain.

Desire for a cigarette.

Disruptive behavior and swearing.

Limited contact and security monitoring due to drug-seeking behavior and criminal record.

Nurse's Concerns:

Suspected heroin withdrawal.

Risk of endocarditis.

Caritas Processes and Their Relation to the Clinical Reasoning Cycle (CRC):

Assessment (CRC Step 1 - Consider the Patient's Situation): During the assessment phase, nurses can apply Caritas Process #1, which emphasizes cultivating a loving presence. This involves connecting with Shawn, listening receptively, and accepting him without judgment. It promotes an authentic understanding of his condition, including his physical and emotional needs.

Diagnosis (CRC Step 2 - Collect Cues/Information): Caritas Process #4, which focuses on developing and sustaining a helping-trusting caring relationship, can be applied during this phase. Nurses build trust with Shawn to gather information about his medical history, substance use, and social circumstances. This trust facilitates a more accurate diagnosis.

Planning (CRC Step 3 - Identify Issues and Problems): In the planning phase, Caritas Process #6, which involves using creative scientific problem-solving methods for caring decision-making and creative solution-seeking, is applicable. Nurses consider Shawn's complex needs, such as addressing potential heroin withdrawal and managing pain, within the context of his challenging background.

Intervention (CRC Step 4 - Establish Goals): At this point, the focus is on establishing goals. Caritas Process #6 continues to be relevant, as it guides nurses in using creative problem-solving to set meaningful and holistic goals for Shawn's care. For instance, goals might include addressing his physical pain, managing withdrawal symptoms, and providing emotional support.

Describing How Caritas Processes and CRC Achieve Solutions for Shawn (Up to Establish Goals):

Goal 1: Manage Pain: The Clinical Reasoning Cycle's goal is to address Shawn's severe stomach cramps and pain. Nurses can apply Caritas Process #6 to creatively find ways to alleviate his pain. This may involve administering appropriate pain relief measures, such as medication, and ensuring he is comfortable.

Goal 2: Assess and Address Heroin Withdrawal: Recognizing Shawn's risk of heroin withdrawal, nurses can utilize Caritas Process #4 to establish a trusting relationship. This relationship is vital for assessing the severity of withdrawal symptoms and implementing withdrawal management strategies, which may include medication, counseling, and emotional support.

Goal 3: Emotional Support: Given Shawn's agitated state and history, emotional support is crucial. Caritas Process #1 emphasizes a loving presence, which can help nurses provide emotional care and validation, helping Shawn cope with the stress of his situation.

Goal 4: Address Smoking Habit: While the hospital has a no-smoking policy, nurses can collaboratively work with Shawn to address his desire for a cigarette. Caritas Process #4 comes into play here as nurses strive to build a trusting relationship and engage in open communication to find alternative coping mechanisms for him.

By integrating Caritas Processes with the Clinical Reasoning Cycle up to the "establish goals" step, nurses can develop a comprehensive care plan that addresses both Shawn's physical symptoms and his psychosocial needs in a compassionate and patient-centered manner. In the next step (implementing the goals), additional Caritas Processes will be applied to achieve these goals effectively.