Clinical Reasoning
Clinical reasoning is defined as the way in which clinicians think about the problems they deal with in clinical practice. This involves making clinical judgments and deciding what is wrong with the patient and undertaking clinical decision-making (deciding on what to do, how to do it and when to do it). Clinical reasoning is a logical process by which nurses and other clinicians:
Collect cues
Review current information (e.g. handover reports, patient history, patient charts, results of investigations and nursing/medical assessments previously undertaken).
Gather new information (e.g. undertake patient assessment).
Recall knowledge (e.g. physiology, pathophysiology, pharmacology, epidemiology, therapeutics, context of care, ethics, law, etc).
Process information
Interpret: analyse data to come to an understanding of signs or symptoms. Compare normal vs abnormal.
Discriminate: distinguish relevant from irrelevant information; recognise inconsistencies, narrow down the information to what is most important and recognise gaps in cues collected.
Relate: discover new relationships or patterns, cluster cues together to identify relationships between them.
Infer: make deductions or form opinions that follow logically by interpreting subjective and objective cues; consider alternatives and consequences.
Match current situation to past situations or current patient to past patients (usually an expert thought process).
Predict an outcome (usually an expert thought process).
Come to an understanding of the patient’s problem or situation
Synthesise facts and inferences to make a definitive diagnosis of the patient’s problem.
Plan and implement interventions
Describe what you want to happen, a desired outcome, a time frame.
Select a course of action between different alternatives available.
Evaluate outcomes
Evaluate the effectiveness of and actions outcomes. Ask: “has the situation improved now?”
Reflect on and learn from the process
Contemplate what you have learnt from this process and what you could have done differently.
Clinical reasoning is not a linear process but a cycle of linked clinical encounters, as the phases merge and the boundaries between them are often blurred. While each phase is presented as a separate and distinct element, clinical reasoning phase is a dynamic process, and nurses often combine one or more phases or move back and forth between them before reaching a decision, taking action and evaluating outcomes. These thought processes assist to guide safe and considered practices. A body of evidence has identified that clinical reasoning skills have a positive impact on patient outcomes, while conversely, nurses with poor clinical reasoning skills often fail to detect patient deterioration, resulting in a failure to rescue the deterioration. Clinical reasoning is an essential component of competence. The NMBA Registered Nurse Standards for Practice (2016) refer to clinical reasoning and assessments in Standards 4-7 and explicitly outline the importance of these when providing patient care.
Explain the purpose of the Clinical Reasoning Cycle.
The purpose is it a step to step course that nurses can run their decisions through which enables nurses to take the best course of actions for patient safety and the patients overall health.
Explain how clinical reasoning promotes patient safety.
It promotes patient safety because it encourages double checking which can prevent medication and diagnosis errors as well as it looks for solutions that keep patients the safest and the most comfortable which prevents unnecessary pain.