Clinical Reasoning Frame Work -

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Nursing Question

Case Study: You are working in a hospital that services a number of remote Aboriginal communities. You are contacted by a community nurse from a remote Aboriginal community about John, a 19-year-old Aboriginal man who has been brought to the clinic by his relatives because he is acting strangely. He has not been sleeping and this irritates the relatives he is staying with because he moves around their house at night. He has been noted to talk to himself and has been inappropriately angry with his relatives at times.

You obtain a history that John has not had previous episodes of psychiatric illness that the clinic is aware of. John has been a petrol sniffer in the past and recently has been smoking cannabis regularly. His cousin committed suicide by hanging himself in the community two weeks ago and John started sniffing petrol again shortly after this event. He also had an uncle who committed suicide a few years previously after a period of acting strangely. With specific questioning, John does not appear depressed and does not appear to have any ideas that are out of context with his culture. He does appear to giggle to himself at times and on one occasion, was noted to put a small stone in both ears as if he was trying to block out sound.

You request that a relative who is acceptable to the young man accompanies him to the hospital to assist with “cultural familiarity issues” and translating, if necessary, as the hospital may have Aboriginal translators but they may not be proficient in the young man’s traditional dialect. In some Aboriginal communities in the Top End of the Northern Territory, there may be five spoken traditional languages, as well as a range of dialects.

Problem-based learning (PBL) is a teaching and learning strategy, which emphasizes a student-centered approach, and encourages student to be self-directed in their learning. PBL problems come from clinical cases, and are the learning triggers for group discussion. Through minimal guidance from a tutor, learning issues related to case problems are generated via a brainstorming discussion process. In the process of problem-solving, students learn to gather patient-related information, interpret objective and subjective results, and develop individualized care plans on a patient-centered basis.

Analysing a case requires a framework for critical thinking and reasoning, and we help you do this through the use of the FILA approach. FILA stands for Facts, Ideas, Learning issues, Action plan. Engaging in the FILA process in turn assists the development of your clinical reasoning and decision-making skills.

Refer to the attached documents and complete the blank FILA table for the above case study as you plan the care of your patient.

Nursing Solution

FACTS	IDEAS	LEARNING ISSUES	ACTION PLAN
John is a 19 years old male of aboriginal origin and exhibits the history of cannabis addiction and petrol inhalation. He lives with his relatives and most of the times at night tracked roaming around his relatives’ premises. John has no history of previous psychiatric problems.	The pattern of consistent drug addiction disrupted the personal as well as family life of the patient and considerably impacted his psychosocial profile across the community environment. Usually, the aboriginal males found engaged with drug addiction and suicidal tendencies across the community environment.	The patient has no specific underlying health issues as evident from the provided scenario. However, he is affected by his cultural norms, customs, tradition and social isolation that considerably impact the state of his mental health. Evidence-based research literature advocates the adverse manifestations of cannabis addiction and petrol sniffing on the social and family lives of aboriginal individuals (Richmond, et al., 2013). The illicit use of drugs leads to the induction of criminal activities, workplace instability and violence that reciprocally disrupt the health and safety of the individuals of the aboriginal community.	The nurse professional and the healthcare team require organizing health promotion sessions in the context of elevating the level of awareness of the patient in relation to the adverse manifestations of the drug abuse. This scenario requires the administration of cognitive behavioural intervention for influencing the thought process and behaviour of the patient while motivating him to quit the cannabis use and acquire a healthier lifestyle.