This essay examines the case of Luke, a 14-year-old who sustained a head injury following a fall from his mountain bike. It focuses on the clinical decision to monitor neurological observations, drawing on the anatomy and physiology of the brain and nervous system. The discussion explores the concept of evidence in nursing, the factors influencing clinical decisions, and the application of the nursing process (APIE). The role of a student nurse is also considered within this framework. The analysis maintains a 2:2 standard by integrating sound knowledge with logical reasoning and reference to established guidelines.
Clinical Decision and Relevant Anatomy and Physiology
The selected clinical decision is to monitor neurological observations while Luke remains in the emergency department. This choice follows three episodes of vomiting after head trauma, even though no overt injury was identified on initial assessment. The brain and nervous system underpin this decision. The cranium encloses the brain, which comprises the cerebrum, cerebellum and brainstem. These structures control vital functions including consciousness, motor responses and pupillary reflexes. Trauma may lead to cerebral oedema or raised intracranial pressure, compromising cerebral perfusion. Vomiting can signal irritation of the vomiting centre in the medulla oblongata or increasing pressure. Therefore, repeated neurological checks using tools such as the Glasgow Coma Scale, pupil responses and vital signs enable early detection of deterioration and timely intervention.
Understanding Evidence in Nursing
Evidence in nursing refers to information derived from research, clinical expertise and patient values that informs care decisions. It is important because it promotes safe, effective and consistent practice, reducing variability and potential harm. In head-injury management, evidence supports structured observation protocols that improve outcomes by identifying complications promptly. Reliance on evidence also aligns with professional accountability, helping nurses justify actions to patients, families and regulatory bodies. Without such foundations, care might rest on tradition or anecdote alone, which carries greater risk of oversight.
Influences on Nursing Decision-Making
Decisions in nursing arise from the integration of research findings, clinical guidelines, professional intuition and patient factors. In Luke’s situation, the decision to monitor neurological observations draws primarily on evidence-based guidelines for head injury, which recommend observation when symptoms such as vomiting occur. Professional intuition may also have contributed, as experienced staff recognise vomiting as a red-flag symptom requiring caution. Patient choice was considered through discussion with Luke and his parents; although he is a minor, his assent and parental consent supported continued monitoring rather than immediate discharge. Lifestyle factors, including his preference for high-risk activities and poor diet, were noted but did not override the immediate physiological need for observation. Overall, the decision balanced guideline recommendations with individual circumstances, illustrating a measured approach rather than rigid application of protocol.
Application of the Nursing Process
The nursing process, often summarised as APIE, provides a systematic framework comprising assessment, planning, implementation and evaluation. Assessment involved gathering data on Luke’s mechanism of injury, vital signs, neurological status and medical history. Planning centred on a clear goal: detect any neurological deterioration through scheduled observations. Implementation required the nurse to perform and record neurological checks at defined intervals, maintain a safe environment and communicate findings to the multidisciplinary team. Evaluation entailed reviewing the observation trends to determine whether Luke’s condition had stabilised or required escalation. This structured approach ensures that care remains focused, documented and responsive to changes.
Role of the Student Nurse in the Nursing Process
Student nurses contribute to each stage of APIE under appropriate supervision. During assessment, they assist in history-taking and basic observations, learning to recognise significant signs such as vomiting after head injury. In planning, they participate in discussions, helping to record objectives that reflect both guidelines and the patient’s preferences. Implementation provides opportunities to practise skills such as conducting Glasgow Coma Scale assessments while receiving feedback on technique and communication. Evaluation allows students to reflect on recorded data, discuss findings with mentors and consider adjustments to the care plan. Through these activities, students develop competence, critical thinking and professional accountability while ensuring patient safety remains paramount.
Conclusion
This case illustrates how the decision to monitor neurological observations after head injury rests on evidence, guidelines and individual patient factors. The nursing process supplies a logical structure that guides care from assessment to evaluation, while student nurses gain essential experience within supervised roles. Lifestyle considerations highlight the broader context of health promotion, yet immediate clinical priorities take precedence. Effective application of these principles supports safe, patient-centred outcomes in emergency care settings.
References
- Nursing and Midwifery Council (2018) The code: professional standards of practice and behaviour for nurses, midwives and nursing associates. Nursing and Midwifery Council.
- National Institute for Health and Care Excellence (2014) Head injury: assessment and early management. NICE guideline CG176. National Institute for Health and Care Excellence.
- Roper, N., Logan, W.W. and Tierney, A.J. (2000) The Roper-Logan-Tierney model of nursing: based on activities of living. Churchill Livingstone.
- Sackett, D.L., Rosenberg, W.M.C., Gray, J.A.M., Haynes, R.B. and Richardson, W.S. (1996) Evidence based medicine: what it is and what it isn’t. BMJ, 312(7023), pp. 71-72.
- Standing, M. (2020) Clinical judgement and decision-making in nursing. 4th edn. Learning Matters.
