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    Cyril is a 58 year old labourer who lives within the travelling community. He smokes 20plus cigarettes a day and drinks approx. 22 units of alcohol a week to cope with his Anxiety disorder. During a routine blood pressure check with his local Pharmacist, Cyril was informed he had Hypertension. The Pharmacist made a clinical decision to advise Cyril to visit his GP for a consultation.

    Clinical decisions Life style choices
    Blood pressure checks with Pharmacist Excessive cigarette smoking
    Pharmacist advice for GP consultation Excess alcohol allowance
    Active monitoring by GP Lack of understanding of Anxiety disorder

    NPR1029 Exploring the Evidence Base for Nursing
    Case Study Assignment

    Aim: A case study exploring the evidence base for nursing in relation to decision making in practice.

    Cyril is a 58 year old labourer who lives within the travelling community. He smokes 20plus cigarettes a day and drinks approx. 22 units of alcohol a week to cope with his Anxiety disorder. During a routine blood pressure check with his local Pharmacist, Cyril was informed he had Hypertension. The Pharmacist made a clinical decision to advise Cyril to visit his GP for a consultation.

    Clinical decisions Life style choices
    Blood pressure checks with Pharmacist Excessive cigarette smoking
    Pharmacist advice for GP consultation Excess alcohol allowance
    Active monitoring by GP Lack of understanding of Anxiety disorder


    Part A
    ⦁ Your patient [Learning Outcome d] approx. 300 words in the 3rd person

    ⦁ Overview of the presenting complaint briefly outlining the relevant body system and the psychosocial factors to be considered.

    ⦁ Decision making theory and nursing process [Learning Outcomes a & c] approx. 1000 words in the 3rd person

    • Apply a decision-making theory and discuss the factors that could have influenced 1 clinical decision made during this episode of care.
    • Support this by exploring the evidence/literature/research to demonstrate an in depth understanding of the nursing process.

    ⦁ Lifestyle choices [Learning Outcome b] approx.1000 words in the 3rd person

    • Discuss at least 1 lifestyle choice from your case study.
    • Explain how this may have contributed to the current health problem within the case study.
    • Support this by exploring the evidence/literature/research that relates to this.
    • Consider the issues relating to quality of life, including physiological and psychological benefits and relevant compliance/concordance issues.

    Part B
    Reflection and Recommendations [Learning Outcomes e & f] approx. 500 words in the 1st person

    ⦁ Consider positive lifestyle recommendations for the person, involving the role of other health care professionals and organisations.
    ⦁ Reflect on undertaking this case study, discussing how it will influence your decision making for the future care of patients alongside your professional self-development.

    Conclusion – approx. 100 words in the 3rd person.
    A succinct evaluation of your main discussion points within Part A and Part B, which demonstrates your ability to synthesize this evidence.



Subject Nursing Pages 12 Style APA



Researchers have been able to establish that lifestyle choices have a direct impact on the health of an individual. The common lifestyle choices deemed harmful to one’s health and general well-being include among others cigarette smoking and alcohol consumption. The harmful of effects of these lifestyle choices are well illustrated in the chosen case, which involves a 58-year-old labourer called Cyril, who lives within the travelling and smokes as and drinks alcohol excessively. The present case study was thus chosen because it provides a chance to explain and understand how an individual’s lifestyle choices profoundly impacts their health. This paper is divided into two section; the first section (part A), will explain the physiology, appropriate clinical decisions making theories and nursing process for GP consultation. The second section (part B), will reflect on positive lifestyle recommendations that Cyril could consider to enhance his health.

Part A

The Patient (Cyril)

Cyril, the patient in this study, is a 58 years old man who stays within a traveling community. The complaint, in this case, is that the patient has a habit of consuming almost 22 units of alcohol and smokes more than 20 cigarettes every week. Cyril considers this habit as a way of managing his anxiety disorder however after going through a normal checkup it became evident that he is suffering from hypertension.

Relevant Body System

Determining that one may be suffering from high blood pressure is relatively challenging unless the individual goes for a checkup at a medical facility. Usually, most people would assume the underlying symptoms of hypertension, but some of the common indications include blood in urine, vision problems, nose bleeding, fatigue, and irregular heartbeat. In Cyril’s case, the most probable complaint that led him to a physician is chest pain owing to the number of cigarettes being smoked and alcohol consumed.

Damage caused by hypertension starts small but builds up over time. The more a patient stays with the condition for a long time without being diagnosed or controlling its effects, the more serious the risks get. When blood pressure increases, the artery walls get damaged. The damages start as small tears and bad cholesterol in the blood attaches itself to the tears. As more cholesterol builds up, the artery walls become narrow reducing the flow of blood. Improper amount of blood flow leads to damage of organs such as the heart, hence increasing the chances of heart attack (Scullin et al., 2017). The same damage of arteries in the heart can also occur in the brain arteries. Larger blockages of blood may occur in the brain leading to stroke, memory loss, and blindness. Hypertension can cause bone loss as the body increases the amount of calcium that will be discharged during urination.

Psychosocial Factors

The major contributing psychosocial factor that has led to Cyril’s hypertension is anxiety. High levels of emotional stress are common among adults. Researchers have established that 42% of adults are likely to develop anxiety disorders (Facts & Statistics | Anxiety and Depression Association of America, ADAA, 2021). Another factor that could have contributed to Cyril’s hypertensive state is race-related stress. Recent studies indicate that traveling communities face significant discrimination which can adversely affect their health (Kelleher et al., 2012). Discrimination can wear away from a person’s health through negative psychosocial and psychological responses.  

Decision-Making Theory

After going through a checkup, Cyril was advised to seek advice from his GP regarding the apparent condition. In this case, the most applicable decision-making theory that GP would use to determine his illness and the associated effects is the intuitive decision-making model. In normal cases, people tend to learn that when they make a decision instinctively or intuitively, they still follow a decision-making theory. Intuitive decision-making can occur almost instantly (Nibbelink & Brewer 2018). Nonetheless, this does not justify that they merely pop up into an individual’s brain. During this process, the brain is actively making rapid pattern recognitions by reviewing what has been learned in previous situations to aid in making a decision that will be effective in the current situation.

Scholars have realized that a pharmacist’s advice by using intuition yields good outcomes when one is dealing with areas that they are conversant with in terms of experience or expertise. However, depending on this model could be less efficient and effective when one is in an unfamiliar situation such as a new job (Miller & Hill 2018). This is mainly because of a lack of experience to immediately categorize the evident patterns. One interesting side to note when employing this theory is that when an individual thinks logically or rationally, they tend to be more intuitive.

One of the factors that instigate the use of pharmacist’s advice is time pressure. Increased levels of time pressure are linked to more reliance on intuition rather than the deliberative process as the latter is more time-consuming. The ability to undertake competent decision-making during curial moments is a vital as well as a fundamental facet of professional nursing. This is because timely decisions help to distinguish ancillary nurses from professional healthcare workers (Miller & Hill 2018). Moreover, the current health care surrounding has focused on placing more accountability as well as responsibilities on medical practitioners. The nursing team is always on the frontline of patient care, in most cases the first link in the causative chain between determining complications and the final treatment. This, conjoined with the increasing responsibilities accentuate the relevance of sound clinical perceptions and decision-making. Resorting to precise interventions appropriately is vital if medical practitioners aspire to save Cyril’s life. This is because, if the patient is not diagnosed on time, then the probability of his condition worsening is relatively high. 

Another factor influencing the pharmacist advice on GP consultation is the physician’s expertise. Extensive experience within the medical field enhances automaticity as well as a wide and well-organized knowledge base in recognizing specific issues. With the experience factor, medical practitioners will have to determine whether or not an individual has hypertension. Some of the concepts related to the physician’s advice include rational considerations, skills, tactical knowledge pattern recognition gut feeling, and discovering similarities, Researchers have suggested that these concepts cannot be separated as they work as an interaction (Melin-Johansson, Palmqvist & Rönnberg, 2017). Nurses’ intuition is mostly associated with the idea of having a “sixth sense.” In most cases, nurses rely on intuition as a diagnostic measure, and experiencing situations with patients’ health conditions aids in developing those instincts. 

Generally, nurses are required to have a high educational background in their areas of expertise (Nibbelink & Brewer 2018). When studying the anatomy of an individual nurses will be taken through all the changes that are expected to occur during different situations. In like manner, these nurses have to be well conversant with the conditions that instigate the prevalence of hypertension. By virtue that Cyril has an anxiety disorder and that he uses substances to manage his condition, it will be obvious that if his blood pressure is high, then the chances of him having hypertension would be high.

Nursing Process in Intuitive Decision Making

The origin of the intuitive decision-making process in offering advice to the patient is based on the rationalist perspective. Problem-solving is the aim of this theory and it relates to the patient’s experience for instance how the patient reacts to the defined illness, treatment process, and the proposed preventative measures. The theory correlates with five stages: assessment of the patient, nursing diagnosis, planning of the treatment, implementation of the intervention, and evaluation. The assessment relates to the patient’s information collected by nurses concerning his or her health condition, which is sorted and documented for future reference. Nursing diagnosis refers to the process of analyzing and critically scrutinizing the collected data, which helps nurses to identify the cause of the problem, associated risks, and resources needed by the patient to control or mitigate the problem (Melin-Johansson, Palmqvist & Rönnberg, 2017). Planning of the treatment indicates that a care plan has been formulated and the nursing interventions as well as targets are individualized and prioritized and are anticipated to generate positive results. Implementation refers to the stage where suggested nursing interventions are undertaken and documented. Evaluation is the stage where the objectives and anticipated results of the patient’s progress are examined and evaluated. In retrospect, the changes related to the patient’s conditions are analyzed, which can involve changes in the care processes required in continuing care. Some of the factors that can affect the result of the nursing process include personal qualities, experiences, and knowledge of the decision-maker or the nurse.

Despite the suggested effectiveness, intuition is not considered as a legitimate process nor a method in clinical practice of a practitioner’s decision-making process since it often relies on the conceptualization and skills of the nurse as compared to scientific evidence. Nevertheless, the nursing profession has always been considered as intuitive as opposed to rationality. This assertion has led to medical practitioners’ knowledge as well as decision-making to be considered explicitly emotional and feminine, while in the health profession, these faces have been deemed as being empirical and rational (Melin-Johansson, Palmqvist & Rönnberg, 2017). Ultimately, the characteristics of intuition in hypertension have hardly been reviewed by scholars in the context of healthcare or nursing through a mixed stud review. Respectively, critics suggest that more data on how medical practitioners implement intuition in the normal clinical process of high blood pressure would help in the understanding of how future nurses should go about this. In other words, intuition decision-making is worthy of a place in all evidence-based activities, where the model is an integral component linked to the nursing process.

Lifestyle Choices

The immediate causes of hypertension are not known, but researchers have established a number of causative factors such as stress, old age, genetics, chronic kidney, sleep apnea, diet, obesity, and adrenal as well as thyroid disorder. Respectively, other studies indicate that lifestyle choices such as alcohol consumption and cigarette smoking can cause hypertension. These two factors are deemed as indirect causes, but their effects are relatively adverse on an individual’s health.



Cigarette Smoking                                 

Various studies have indicated that cigarette smoking is a significant cardiovascular risk factor and cessation of smoking is the single most actual measure for the prevention and management of various cardiovascular ailments (Sohn, 2018). Despite being a recreational drug, cigarettes contain nicotine and tar which are relatively harmful to Cyril’s general health as they may be the leading cause of him being hypertensive.

In the middle of the 20th century, researchers had established that cigarette smoking presented a major health hazard, mainly contributing to high blood pressure, cardiovascular morbidity as well as mortality. The American Advisory Committee of the Public Health Service, in 1964, released the first warning to the general populace regarding the dangers of smoking cigarettes. The initial observational research conducted after World War II documented a higher death rate among smokers, especially those who preferred cigarettes, as compared to quitters and non-smokers (Wu et al. 2017). Other than bronchogenic carcinoma, the main cause of death among cigarette smokers was linked to cerebrovascular disease, coronary artery disease, and hypertension.

Many people relatively assume this factor, but excessive cigarette smoking leads to high blood pressure. The nicotine in cigarettes is a major problem for not only the lungs but also the blood. When absorbed into the bloodstream, nicotine raises both the heart rate and blood pressure. Also, it narrows the arteries and hardens their walls making the blood clot easily (Sohn, 2018). The major problem is that it can lead to cracks forming in the arteries whereby unwanted fats become trapped hence constructing the blood vessels. In turn, this stresses to heart when pumping blood as it will require more energy to accomplish a complete circulation in every heartbeat. The long-term effects of this situation are heart attacks or stroke and, at times, death.

Consumption of Alcohol

Clinical, preclinical ad epidemiological studies have established an association between high intake of alcohol and hypertension. Nevertheless, the mechanism through which the substance raises blood pressure remains vague (Puddey et al. 2019). Respectively, researchers have suggested that people who have more than three drinks in one session temporarily raise their blood pressure. In retrospect, repeated binge drinking leads to a long-term increase in blood pressure. This can easily be attributed to Cyril’s lifestyle choices considering that he drinks approximately 22 units of alcohol every week.

Alcohol, from fermented fruit juice, grain, and honey, has been consumed for thousands of years. The majority of fermented beverages that are consumed in the modern age can be traced to China during 7000 BC, Egyptian civilization, the Babylonian empire in 2700 BC, South America and Greece. During the 16th century, alcohol, commonly referred to as spirits, was largely used for medicinal purposes (Rehm et al. 2017). In the 18th century, spirits were mostly used in Britain. By the 19th century, a different attitude related to alcohol was introduced to the masses with a majority proposing for a moderation of the substance to be consumed by people. In 1920, however, the USA invoked a law prohibiting the production and consumption of alcohol owing to the negative effects it caused to the consumers. However, critics emerged with empirical studies suggesting otherwise. A majority of these researchers suggested that moderated consumptions were beneficial to one’s cardiovascular system as it reduces blood pressure. In other words, low to moderate drinking has been proved to reduce the effects of coronary heart disease and increases longevity. Irrespective of these suggestions, alcohol ingestion increases hypertension by decreasing the number of vasodilators such as Nitric Oxide in the vascular endothelium. This is because of inhibiting the component from reducing oxide or inflammatory injury to the endothelium. Also, alcohol is rich in sugar and calories, which can instigate an increase in body weight hence increasing the chances of hypertension.

Quality of Life

The best nursing care processes for hypertension is counseling patients about their lifestyle changes, being a translator for the medical practitioner, and blood pressure measurement. Researchers have established that when a nurse is part of a team with other medical professionals in disseminating care to a hypertensive patient, a drop in blood pressure is seen (Pérez Rivas et al. 2016). The general physiotherapist (GP) or nurse who will see Cyril during clinical visits for primary care will be assumed to possess a health-proportional, psychosocial, and holistic approach in helping him to attain blood pressure control. Psychologically, the patient will have reduced anxiety or stress disorders. This is instigated by the brain’s ability to induce hormonal balance. The patient’s mood will likely improve and the mental outlook will be positive-orientated. This hugely instigates by lifestyle changes, correct intake of medication, and frequent return visits to hospitals for check-ups and follow-ups. In this perspective, for Cyril, changing his lifestyle as well as taking medications will improve his health.

Apart from personal benefits, effective management of hypertension boost the economy of a community. Recent studies indicate that treating high blood pressure helps in bolstering the economic state of communities owing to the number of healthy individuals in the labor sector. The casual correlation between hypertension and the economy is rather complex. Even with this assumption, critics suggest that the probability of the suggested link is vague since medical practitioners may not possess economic knowledge to support it. However, the assumption that the present scholar possesses resonates with the number of healthy people in the community. A majority of individuals who are adversely affected by hypertension are adults. Considering that a majority of adults are in the economic sectors, a reduction of their participation will relatively reduce the production levels (Gheorghe et al., 2018). Therefore, effective management of the ailment would enable communities to boost their economic potential. In connection to this, researchers suggest that treating high blood pressure would reduce the costs of attaining medical resources for treatment. The cost of establishing treatment centers and purchasing equipment for managing hypertension is rather high. In most cases, both governments and private entities are unable to manage the increased levels of hypertension in the communities due to limited resources. However, if people can manage this condition the government and NGOs will use their funds to support other projects that would ultimately benefit the community, economy-wise.

Challenges of Treating Hypertension

One of the challenges that nurses would likely encounter in the treatment of hypertension is the fulfillment of the patient’s responsibility. Recent studies indicate that the general management of hypertensive diseases in the community is rather poor. During the 1970s merely 12% of patients with the ailment were treated effectively. In the 1980s the number increased exponentially moth more than 30% of the cases being managed fully. Within the next decade, the numbers started decreasing suggesting that it was solely linked to poor performance from nurses (Smolen et al., 2019). Hypertension cases ought to be approached effectively through teaching preclinical interventions to nurses. Another challenge is the non-adherence to the proposed treatment on patients. In certain cases, hypertensive patients tend to overlook the suggested interventions especially those related to life choices. For instance, some may revert to smoking cigarettes and drinking alcohol even after being convinced that they are the leading causes of the disease. If such patients would follow a physician’s suggestions, management of hypertension would be certain.   

Part B

Reflection and Recommendations

When I think about Cyril’s situation, it becomes even clearer that he has hardly consulted any physicians regarding his health issues. Cyril has anxiety issues but instead of seeking medical assistance, he has opted to use unconventional means to manage the condition (Crocq 2017). His option has turned out to be detrimental since he now has hypertension. Since he smokes more than 20 cigarettes and drinks 22 units of alcohol weekly, it is evident that he may be addicted to these substances. In some instances, one would assume that Cyril’s alcohol intake and cigarette smoking are relatively low but studies have proved that these substances are highly addictive and can cause other health issues, especially hypertension.

I would advise Cyril to consider changing his lifestyle choices, especially when it comes to alcohol consumption and smoking cigarettes (Farsalinos et al. 2016). Outwardly, desisting from these substances may be rather hard, especially when one is addicted, but the process is easy if he will be ready to undertake the challenge of withdrawal symptoms. I would suggest that Cyril should consider quitting smoking cigarettes by avoiding the triggers that increase his urge to smoke more. In terms of alcohol consumption, I think visiting a clinician or physiotherapist would suffice. A therapist will give him clear instructions and alternatives that will help to reduce the intake of alcohol.

In this case, I would suggest that Cyril should consider doing exercise as it will help him to not only become fit but also to deviate his attention from consuming alcohol or smoking cigarettes (Börjesson et al. 2016). Studies have proved that individuals who engage in routine exercise also observer healthy lifestyle choices such as eating nutritious meals and getting sufficient sleep. This is because routine exercise presents rewarding stimuli that induce activity in the brain’s mesocorticolimbic pathways. This is an assortment of connecting circuitry and structures that extend from the ventral tegmental region in the brain to various forebrain structures. The reward circuitry involved in this case responds to instinctive rewards that promote survival such as food or exercise. For instance, exercise and food increase the release of dopamine as well as other monoamines that instigate happiness. The dopamine that was initially produced when Cyril was smoking or consuming alcohol could be reciprocated by doing exercise or observing a good diet. Alternatively, I would suggest that Cyril should consider eating healthy foods that will help to reduce elevated blood pressure. Some of these meals include fruits such as berries, Kiwis, watermelon, and bananas. Leafy green vegetables and grains would also be effective.

By chance that Cyril would consider observing the proposed alternatives, I will be able to support my professional development in health care. I will use Cyril’s case to analyze his progress then develop a complete prognosis on how to help people that may be experiencing similar situations ad Cyril. Cyril’s case in terms of development will be a tangle of evidence that the proposed interventions are effective and applicable. Future researchers could use the case study as a base to develop other alternative interventions to help medical practitioners understand the underlying factors and how they could help an individual with similar conditions.

All in all, I would encourage health care professionals to decisively suggest measures that would be helpful to Cyril. Other than referring him to a general physician, clinicians should take a stance on helping such a person as soon as he or she visits the clinic. In some cases, patients who are referred to other practitioners would assume the suggested advice and resort to their usual lifestyle.


Cyril is a perfect example of an individual whose lifestyle choices appear to have negatively affected his general health. This individual has a habit of smoking more than 20 cigarettes and consuming roughly 22 units of alcohol weekly as a way of managing his anxiety disorder. His lifestyle choices have led to him being hypertensive. The decision theory which the local doctor considered as the most effective in determining Cyril’s condition was an intuitive decision-making model. The applicability of this theory depends on one’s experience or expertise to generate precise conclusions. Despite Cyril having anxiety disorder and hypertension, he could observe the following procedures to manage or reduce their effects; exercising regularly, eating healthy meals, and refraining from consuming alcohol and smoking cigarettes.



Adaa.org. 2021. Facts & Statistics | Anxiety and Depression Association of America, ADAA. (online) Available at: <https://adaa.org/understanding-anxiety/facts-statistics> (Accessed 15 June 2021).

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Crocq, M.A., 2017. The history of generalized anxiety disorder as a diagnostic category. Dialogues in clinical neuroscience, 19(2), p.107.

Farsalinos, K., Cibella, F., Caponnetto, P., Campagna, D., Morjaria, J.B., Battaglia, E., Caruso, M., Russo, C. and Polosa, R., 2016. Effect of continuous smoking reduction and abstinence on blood pressure and heart rate in smokers switching to electronic cigarettes. Internal and emergency medicine, 11(1), pp.85-94.

Gheorghe, A., Griffiths, U., Murphy, A., Legido-Quigley, H., Lamptey, P., & Perel, P. 2018. The economic burden of cardiovascular disease and hypertension in low-and middle-income countries: a systematic review. BMC public health, 18(1), 1-11.

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Melin-Johansson, C., Palmqvist, R., & Rönnberg, L., 2017. Clinical intuition in the nursing process and decision-making-A mixed-studies review. Journal of Clinical Nursing, 26(23-24), 3936–3949. doi:10.1111/jocn.13814

Miller, E.M. and Hill, P.D., 2018. Intuition in clinical decision making: differences among practicing nurses. Journal of Holistic Nursing, 36(4), pp.318-329.

Nibbelink, C.W. and Brewer, B.B., 2018. Decision‐making in nursing practice: An integrative literature review. Journal of Clinical Nursing, 27(5-6), pp.917-928.

Pérez Rivas, F.J., Martín‐Iglesias, S., Pacheco del Cerro, J.L., Minguet Arenas, C., Garcia Lopez, M. and Beamud Lagos, M., 2016. Effectiveness of nursing process use in primary care. International journal of nursing knowledge, 27(1), pp.43-48.

Puddey, I.B., Mori, T.A., Barden, A.E. and Beilin, L.J., 2019. Alcohol and hypertension—New insights and lingering controversies. Current hypertension reports, 21(10), pp.1-10.

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