Gemma and the midwife

This is Gemma, a woman in her thirties who is 32 weeks pregnant with her first child. Gemma is meeting Carolyn the midwife for the first time.

The first stage of the clinical reasoning cycle is where you consider Gemma’s situation.

Now view the first video. (Please close the video dialogue box to continue after viewing.)

Gemma meeting Carolyn

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Stage 1: Consider the patient situation

Initial impressions

Can you think of any assumptions that you could make here, and how they might influence/bias your thoughts about Gemma’s nutritional health?

Stage 2: Collect cues/information

Carolyn asks Gemma about her nutrition.

Carolyn and Gemma discuss nutrition

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Review current information

Based on this consultation, what information do you have about Gemma’s nutritional health? Write it here.

Gather new information

What other cues do you need to get a better picture of Gemma’s nutritional health? Write these here.

Can you think of any other questions you could ask Gemma about her diet? If so, why do you think these questions would be valuable to ask?

Recall knowledge

Consider the knowledge you already have about pregnancy and nutrition.

Stage 3: Process Information

Gemma and Carolyn discuss Gemma’s diet

Gemma discusses food

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a. Interpret

The next step of the clinical reasoning cycle is to interpret the cues that you have collected about Gemma’s nutritional health in the previous stages. You need to carefully analyse these cues, and compare what is normal versus what is abnormal in pregnancy.

b. Discriminate

Based on the information you already have, narrow down the information to what you think is most important. Which cues do you believe are most relevant to Gemma’s situation? Write them here.

c. Relate

Try to cluster the cues together here and identify relationships between them, based on the information you already have. By clustering the cues, you will gain a more complete picture, and be able to find any patterns or relationships between the cues.

d. Infer

What can you infer about Gemma’s nutritional health from the information you already have?

Can you think of any alternative inferences that you could make from this information?

Are there any gaps in the information you have gathered about Gemma’s diet? If yes, identify these gaps here.

e. Predict

What could be a possible outcome if Gemma’s haemoglobin levels remain low? Write your response here.

f. Match

Have you ever come across a pregnant woman with the same signs and symptoms as Gemma? If so, what did you do to manage the situation? Write your response here.

Quick Recap

On the next screen you will be shown the answers you have supplied to the questions above.

If you have further insights, please edit your responses before proceeding.

Stage 4: Identify the problem/issue

Remember that Stage 4 in the clinical reasoning cycle is where you bring together all the information you have gathered and processed in order to make a diagnosis about Gemma’s nutritional health. This step enables you to identify the most significant nutritional health issues for Gemma.

Are there any changes or recommendations you might make about Gemma’s diet? If she was consulting you within your specific scope of practice (e.g. osteopathy, nursing, midwifery, occupational therapy, CEP), what referrals (if any) might you consider?

What are these and why would you recommend them?

Stage 5: Establish goals

Detail here what you would like to happen for Gemma and when?

Stage 6: Take action

What specific actions do you think would be most helpful for Gemma and why? Write your response here.

Stage 7: Evaluate

How might you determine whether your advice has made a positive difference to Gemma’s nutritional health situation?

Stage 8: Reflect

Reflect on your learning from this scenario and respond to the following questions in the spaces provided.

a) What are three of the most important things you have learned from this scenario?

b) On reflection, is there anything you would do differently?

c) Reflect on how you can take this experience into your future clinical practice.

d) Think back again to the cues that you found in the information-gathering stage. Can you think of any subtle cues that you may have missed during the consultation? What could have been the outcome of missing this/these cues?

e) [Could any of these missed cues have resulted in an adverse event or pose health problems later on?]

Recap

Let’s have a look at the answers you have supplied to the questions above.

If you have further insights, please edit your responses before proceeding.

Download and submit to grade centre

Click the ‘Download Answers’ button below to download your answers in a pdf.

Then upload the pdf to grade centre.

Finish