Nurse Burnout is defined as a phenomenon characterized by a decline in nurses' energy
manifested in emotional exhaustion, feeling of being frustrated, lack of motivation, and low work
efficacy. One of the general types of topics covered in the assignment two journal issues is the
Role of the Work Environment and Working Conditions. For instance, stress has been linked as a
stimulus or as an antecedent. Every individual's cognitive appraisals, interpretation, and thought
provide the event meaning and foster the determination of whether the occurrence is viewed as
positive or as a threat. The second topic covered is the Influence of Leader Empowering
Behaviors, Work Conditions, and Demographic Traits. For example, the power generally
profoundly influences or controls the person's attitude and behavior in the working environment.
Leadership empowering is the ability to props, control resources, organize, support, and provide
general information to facilitate organizational objectives. My rationale for choosing the
Burnout, published on June 27, 2019, the journal's issue number, volume 68, Issue 1, P14-25,
January 01, 2020 article is that the majority of nurse Burnout treatment and preventions are vital
in maintaining quality -high care and this should encourage the inspiring and nursing leaders to
prioritize their knowledge and skills learned in the school to positively come up with ways of
addressing or to remedy this pervasive distress. Therefore, the Burnout article explicitly several
stress in the workplace by individuals.
Clinical Reasoning Cycle
Clinical reasoning is how clinical competence is examined in the individual who
encounters the patients in different encounters, whether in simple or complex situations. The
process of clinical reasoning involves the use of clinical and investigative data, which is, in turn,
used to generate a prioritized list of different diagnoses from the phenomena under investigation,
hence informing the management plans and decisions that are settled on finally (Carvalho et al.,
2017). Clinical reasoning is rich in information and has proposed training methods to be applied
to the trainees on all levels in their practice. Through clinical reasoning, the reasoning ability
used in the programs is assessed to ensure that the information provided is applicable both in the
learning field and in the workplaces where the trainees and learners are headed to.
Nursing education and practice rely heavily on critical thinking to help in the daily
activities that the trainee nurses and practicing ones face. Nurses are always in situations where
they are required to think and make decisions that will remain relevant to the problems they face
and those that will remain appropriate and effective in the future. Therefore, the nurses are
equipped with tools to help them to make sound decisions even in the face of danger and
emergencies through the clinical reasoning process of critical thinking, which requires them to
assess the situations that they face through the necessities of the moment and those of the future,
hence ensuring that the decisions arrived at concerning patients is useful in the present and will
not bring about any undesired side effects in the future. Therefore, clinical reasoning and critical
thinking are synonymous and must be emphasized for their effectiveness during their practice.
Clinical reasoning is the process of thinking and making decisions associated with and
related to the nursing practice. Therefore, this process involves the recognition of patterns, the
use of intuition, and calculating probabilities. These skills are essential to the nursing profession
since the nurses are expected to apply them in every situation on account of different patients
having different requirements in terms of the treatment plans to be used and the decisions on
treatment methods to apply to other patients. There are also instances where the patients do not
show any physical signs of disease, yet they have the symptoms. Therefore the nurses will be
required to use clinical reasoning to investigate the cases to the core so that they can be able to
save the patients' health.
Therefore, the educators and trainers responsible for the nurses' teaching should engage
in teaching processes to effectively assess the trainee nurses' needs since different trainees have
different requirements for their practice. Other fields of nursing require equipment with different
clinical reasoning skills. For example, nurses undertaking psychiatric services would have
different clinical reasoning skills than those undertaking physical nursing cases. Therefore, the
training should give the nurses the general information required and the specific ones as per their
areas' needs if specification.
Although the script theory and the dual-process theories have been the most used among
medical educators, many critical reasoning theories have been suggested. The script theory
argues that trainee nurses can generate the symptoms of patients and the findings of studies of
the same conditions in their mental capacities by forming networks of recent and newly-acquired
information, that is, scripts, of the diseases presented by the patients. Closely linked to the script
theory is the dual-process theory, which states that trainees and practicing nurses' decision-
making processes are based on two sets of thinking processes. The first set of thinking is based
on intuition, recognition, and the nurses' experiences to make decisions concerning the different
situations that they experience in the course of their practices. The second set of thinking is
based on the scientific facts and factoring in the history of the condition and the patient involved
in the cases. Therefore, the second set of thinking is based on the patients' needs and therefore is
more objective and reliable. However, a nurse would be insufficiently equipped if they relied
only on the scientific angle of the findings without using the first set of thinking to arrive there.
The use of patient management problems is also another set of skills required under the
critical reasoning stage. The nurses in charge need to think critically about how the patients'
issues deterred them from accessing the medical intervention's healing processes. Therefore, the
nurses would conduct patient management to establish why the patient is not responding to the
medication and intervenetions they are put under.
Part A. Collect Cues and Recall Knowledge
Smoking contributes to the severity of Asthma witnessed in Mr. Smith. This is because
smoking causes further damage to the patient's lungs, yet Asthma means that the lungs cannot
support normal breathing activities. The smoke from cigarettes makes the airways, and the lungs
irritated and make them swollen and become dangerously narrow. Additionally, the smoke also
makes the lungs and airways fill up with sticky mucus, making the breathing process even more
labored. Therefore, smoking accelerates the effects of Asthma, which results in more danger to
the patients concerned.
Additionally, the lack of exercise contributes to the additional risk factor in Mr. Smith.
This is because the lack of exercise leads to obesity, which increases the patient's risk of
suffering from Asthma. However, the practice should be conducted in a manner that will not
cause unnecessary strain to the lungs, which will result in asthma attacks. Finally, the lack of an
asthma action plan increases Mr. Smith's susceptibility to suffering from an asthma attack.
Asthma action plans are essential in reducing the possibility of flare-ups and attacks. Therefore
the lack of such a plan exposes the patient to the chance of experiencing an asthma attack and
suffering from the effects.
From the symptom whereby the patient is talking in short sentences, it signifies shortness
of breath. Shortness of drag comes from blockage and inflammation of the airways and lungs,
which results in the patient breathing rapidly and needing to speak in short sentences as a coping
mechanism for the short supply of air in the lungs. The productive cough experienced in the
patient also signifies the body's attempt to expel the excess phlegm from the lungs and to clear
the airways. Additionally, the patient's sleep apnea and wheezing are a sign of a blocked chest
cavity and lungs, which represents the need for the patient to go through an asthma action plan,
which will help fight the possibility of a severe asthma attack. The patient could have possibly
inherited the complication from his father. This is because the chronic obstructive pulmonary
disease that killed his father has characteristics similar to those experienced in Asthma.
Therefore, while Mr. Smith may not have inherited chronic obstructive pulmonary disease, he
may have inherited a milder form of it, that is, Asthma. Thus, this shows that the risk of parent to
child transfer of diseases is high. Therefore children should be tested early enough for the
possibility of having inherited any disorders from their parents.
Part B. Identify Problems, Establish Goals, Take Action and Evaluate Outcomes
Asthma is a chronic disease; it is a long-term complication that patients need to manage
as they seek long-term solutions. The condition causes narrowing and inflammation of the lungs
and airways. In some cases, the narrowing and inflammation may be going on even without
knowing the patients involved. When left untreated, asthma attacks will occur in the different
stages of the life of the patients. Asthma's acute symptoms come from the bronchospasm that
asthma patients experience, and they may be forced to undertake bronchodilator therapy to help
relax the constricted airways and lungs (Abbas et al., 2014). The acute and chronic inflammation
of the lungs and airways will contribute to the airways' caliber being negatively affected in their
functioning. Bronchial hyperresponsiveness will also be negatively affected due to the chronic
and acuteness of Asthma. The acute characteristics of Asthma may result in chronic ones. This is
because the lungs and airways' short-term inflammation will become a long-term problem,
mostly when it happens continuously. Other underlying issues will also contribute to the asthma
attack experienced being acute or chronic. Topics such as the inheritance of a parent's
complication will make the disease to be considered chronic since it may take time for the
condition to be discovered in the patient in question. The lifestyle choices, such as lack of
exercise and engaging in alcohol intake and smoking, will also increase the disease's acute
characteristics, leading to the long-term effects of the disease.
One smart goal that can be applied towards salvaging Mr. Smith's health is the
intervention to help him quit smoking. Smoking plays the most significant role in the blockage of
the patient's airways and lungs, and therefore the patient in question should be helped quit
smoking. In terms of the SMART approach to solving problems, quitting smoking is relevant.
With the patients' collaborative work and the needed healthcare professionals, it will achieve the
said goals. The goal's specificity is that the patient needs to quit smoking since smoking is a
major contributing factor. Therefore, the purpose, in this case, is not to reduce the number of
cigarettes smoked but rather to completely stop smoking. The specificity will help the parties
concerned to formulate ways that will help to quit smoking. The goal's measurability is to reduce
the number of smoked cigarettes from 30 pieces per day to zero. The measure will help the
parties involved in employing measures that will ensure the process's success. The achievability
of the goal is there since the patient can overcome the challenge by using the necessary
frameworks and approaches and the influential people's support in their life. The goal is realistic
since the methods to be applied have been used before, and they have worked, hence bringing
hope to the possibility of the process being completed. Finally, the project's time-boundedness is
the goal of having the patient entirely quit smoking within 24 months.
Nurses have a significant role to play in the cessation of smoking. Therefore, the nurses
can apply different intervention methods to help the patient to quit smoking, which will, in turn,
help to save their health. The most relevant intervention that should be used in this case is
nicotine replacement therapy. Nicotine replacement therapy seeks to provide the patient with
alternative means to take in nicotine without smoking it. At the same time, they work out to
reduce their nicotine dependence, eliminating the need for any nicotine in the body. Nicotine
replacement also helps deal with the withdrawal symptoms that the patients can experience once
they stop smoking. Therefore, the patients can be taken through the different methods available
for nicotine replacement to help them cope with the effects of being taken off the nicotine that
their body had come to depend on heavily. However, nicotine replacement should not be used
alone, but rather be used alongside cessation programs and interventions such as group and talk
therapy to reduce their mental attachment to the cigarettes. The nicotine replacement intervention
can use nicotine gums or nicotine patches. The nicotine gums are chewed and provide mild
nicotine to the patient's body, reducing the urge to smoke. On the other hand, nicotine patches
provide nicotine to the patient through nicotine dispensation via the skin, resulting in reduced
cravings to smoke.
The first way the intervention technique is chosen can be measured by testing the
intervention's objectives against the results. In the case of interventions to help Mr. Smith quit
smoking, the program's effectiveness will be checked against the intervention's ability to help the
patient quit smoking after the set period of two years. Therefore, the program should record the
progress achieved from the first day when the intervention is started and show the progress in
terms of the patient's ability to stay without smoking. An initial reduction in the number of
cigarettes smoked would be considered a step in the right direction, although the ultimate goal
would be to quit smoking altogether. Therefore, the effectiveness should be measured against the
different intervals when the tests are done on the patient.
Additionally, the effectiveness should consider the amount of struggle and withdrawal
symptoms displayed by the patient. The harder the patients' resistance during their journey to
quit smoking, the more the intervention program performs poorly. Therefore, the program will be
useful if the patient has a smooth transition from smoking to becoming a non-smoker, and little
or no withdrawal symptoms are experienced. When there are little or no withdrawal symptoms
experienced, the intervention method will be considered significant and suggested for other
Part C. Contemplate/Reflect On New Learning
Nurses' most crucial role in the self-management of chronic illnesses is providing
information and education on the diseases and the patient's part in the management of the
diseases. The patients have a direct role in managing their conditions since chronic illnesses may
need to be dealt with from their homes while carrying on with their normal lifestyle
Abbas, A., Shahid, S., Sabah, A., Berg, A. E., Ahmed, F. R., Sidra Tanwir, S., … & Qidwai, M.
A. (2014). The clinical complications of Asthma and its pharmacotherapy. J British
biomedical Bulletin, 2(1), 2347-5447.
Carvalho, E. C. D., Oliveira-Kumakura, A. R. D. S., & Morais, S. C. R. V. (2017). Clinical
reasoning in nursing: teaching strategies and assessment tools. Revista