Clinical Reasoning Cycle Applied to Mental Health Nursing
This paper applies the clinical reasoning cycle to a psychiatric nursing case study involving Emily, a 19-year-old presenting to an Emergency Department following a paracetamol and ibuprofen overdose. Working through each step of the cycle — from patient description and cue collection to goal-setting, intervention, and reflection — the paper identifies two core nursing priorities: empowering Emily as a patient advocate in her own recovery, and equipping her with emotional self-regulation tools. Drawing on the recovery model and evidence-based practice, the discussion emphasizes holistic, patient-centric care, community resources such as Headspace, structured activity, and the importance of addressing social determinants of mental health in young Australians.
- Introduction: Clinical reasoning, critical thinking, and case overview
- Step 1: Description of Patient Situation: Emily's ED presentation and overdose details
- Steps 2 and 3: Collecting Cues and Processing Information: Social history, self-harm, disordered eating, and assessment
- Step 4: Establishing Goals and Nursing Priorities: Patient advocacy and emotional self-regulation priorities
- Step 5: Taking Action: Structured gap year, physical activity, and pharmacological interventions
- Steps 6 and 7: Evaluating Outcomes and Reflecting on the Process: Outcome monitoring, reflection, and social determinants of health
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What makes this paper effective
- Uses a named, structured framework (the clinical reasoning cycle) as a scaffold, ensuring every analytical claim is tied to a specific step and grounded in the case facts.
- Balances biomedical data (vital signs, BMI, overdose quantities) with psychosocial context (family dynamics, finances, academic pressure), demonstrating holistic nursing assessment.
- Integrates peer-reviewed sources at the point of argument rather than clustering them, showing how evidence directly informs each clinical decision.
Key academic technique demonstrated
The paper exemplifies framework-driven case analysis: rather than narrating events chronologically, the writer maps patient data onto a standardized clinical model and then derives actionable nursing priorities from that mapping. This technique is common in health sciences writing and shows markers that the student can translate abstract frameworks into practical, patient-specific recommendations.
Structure breakdown
The paper opens with a theoretical grounding of clinical reasoning and critical thinking, then moves through each step of the cycle as discrete sections. The two nursing priorities are developed inside Step 4, with evidence-backed action plans elaborated in Step 5. Steps 6 and 7 close the cycle with outcome evaluation and reflective commentary on equity and advocacy. The reference list follows APA formatting conventions throughout.
Introduction
Clinical reasoning is linked to sound and evidence-based clinical judgment, to problem-solving and decision-making, and to critical thinking. Critical thinking in the nursing profession is defined as the "purposeful, self-regulatory judgment that uses cognitive tools such as interpretation, analysis, evaluation, inference, and explanation" of contextual variables (Benner, Hughes & Sutphen, 2008, p. 1). Therefore, clinical reasoning is central to promoting a high quality of patient care and to ensuring positive, goal-driven patient outcomes.
The clinical reasoning cycle provides a standard framework for critical thought in healthcare and can be used by nurses across every patient sector. This case study illustrates the importance of taking into account a multitude of variables in order to achieve patient outcomes in a holistic manner. The clinical reasoning cycle minimizes biases, assumptions, and prejudices, allowing healthcare providers to remain open to a range of different options and possibilities. The essential components of the cycle are: description of the facts at hand, collection of information, information processing, identification of main problems or issues, establishment of goals, taking action, assessing outcomes, and reflecting on the process. This critical appraisal applies the clinical reasoning cycle to the case study of Emily and identifies core nursing priorities.
Emily's case study highlights specific issues related to mental health and psychiatric care. Mental health issues do not occur in isolation from ancillary events, circumstances, or concerns. Social, physiological, and situational variables all impact a patient's mental health and externalizing behaviours. In this case, Emily demonstrates suicidal ideation, suicidal behaviour, anxiety, self-harm, and disordered eating. Rather than focusing on the symptoms of Emily's behaviour, a skilled mental health care worker would address the totality of Emily's experiences, including her healthcare background, her family and social history, and her physical health.
Emily's case also demonstrates that mental illness does not always occur as a singular event. Presenting symptoms may be misread or misunderstood, and confused with other physical or mental health issues. The rigidity of the medical model often entails leaping to conclusions before making a full investigation of the patient's background and current context. Emily's case therefore highlights how important differential diagnoses are for providing the highest possible quality of care. Particularly when working within the holistic nursing model, the emphasis should not be placed solely on initial presenting symptoms or prodromal presentation, but on problem-solving and solutions that address root causes and patient-centric goals. The recovery model of care must also be considered as the ultimate objective in healthcare treatment, offering nurses an effective framework for patient advocacy, autonomy, and self-determination.
Step 1: Description of Patient Situation
Emily is a 19-year-old female brought into the Emergency Department at 1700 by her parents and with her consent. Vital signs are normal and stable. Initial presenting symptoms indicate a high degree of anxiety or agitation, linked to her having taken an overdose of over-the-counter analgesics including paracetamol and ibuprofen. Emily is compliant and, although distressed, cooperative. However, her speech is agitated and she has difficulty completing sentences, speaking negatively and self-deprecatingly.
During the intake interview, Emily freely admitted she had taken an overdose of nine paracetamol tablets and five ibuprofen tablets at 1600 on the day of admission. Further questioning by the nurse revealed that Emily has a history of suicidal ideation and suicidal behaviour. For example, Emily stated that she had been considering the overdose for the past week and that she had made the decision to take the overdose that day if her end-of-semester results were not "good." When she was displeased with her academic results, Emily followed through with her decision to take the over-the-counter medications, which she had purchased the day before her admission. Furthermore, Emily admitted that her intention in taking paracetamol and ibuprofen was not actually to commit suicide per se, but to gain attention and to "make others know how she was feeling." Emily also stated that she felt "embarrassed" for having taken the drugs.
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