Summary
Health care professionals are tasked with the role of managing health situations. In the changing medical environment, there is a need for nurses to ensure that adequate thought is applied in the process of managing patients. Clinical reasoning entails “collecting cues, processing the information, understanding of the patient’s situation, planning the intervention based on the understanding, evaluation of the outcomes, reflecting on the processes and learning from them’’ (Hughes, Benner & Sutphen, 2012, p. 27). Decision-making is a continuous interactive process in which nurses use the best available evidence to provide care. Sedgwick, Grigg and Dersch (2014) stated that decision making entails a combination of knowledge that stems from a nurse’s clinical expertise, the preferences of patients and the clinical evidence to make the right option for taking care of the patient.
Both the decision-making and clinical reasoning are aimed at providing the appropriate care for patients. The two approaches put into consideration the preference of the patient. Clinical reasoning is a cycle approach that considers the situation of the patient, collection of essential information, processing the information, and identification of issues that affect the specified patient. On the other hand, decision-making is a prescriptive approach that helps in the selection of the best option based on the available clinical evidence. Thus, clinical reasoning serves as the starting point for decision-making. According to Mookherjee and Chou (2011), clinical reasoning takes place within the social relationship. It involves the health care providers, family, and the patient.
Concept of Clinical Reasoning in Advanced Physical Assessment in Nursing
In advanced nursing, nurses are supposed to use salient cues and make clinical decisions quickly (Tanner, 2006). This is important in critical access hospitals. Physical assessment requires nurses to understand and utilize the valuable patterns of clinical reasoning by application of situational learning that leverages creative and reflective minds. Clinical reasoning helps nurses to apply the right skills in the assessment, planning, implementation, and evaluation of patient care in different contexts (Sedgwick et al., 2014). For example, when assisting a patient who has undergone total hip replacement surgery with ambulation, the involved nurse is supposed to gather the information that relates to the process of recovery, involvement of family and the willingness of the patient to take analgesics before trying to move. The assessment of the cues and the information helps the nurse to determine the factors that may hinder the recovery of the patient. Andersson, Klang and Petersson (2012) noted that the clinical reasoning approach helps health care professionals to design a care plan that has a probable outcome based on the preference of the patient and the involvement of the family members.
Clinical Example
Critical thinking entails the use of cognitive skills to ensure desirable outcomes in the care of patients. A study conducted by Amini et al. (2011) found that in the nursing practice, the difference between the novice and expert practitioners in the application of intuitive judgment in the physical assessment of patients. According to Hughes et al. (2012), critical thinking incorporates clinical reasoning and decision-making. For example, in the care of a surgical patient, a nursing assistant took the blood pressure of a patient, which was 90/60. The nurse recorded the pressure and took the rest of the vital signs. In the same case scenario, a registered nurse (RN) took the blood pressure. The RN went further to probe whether the patient could be hypovolemic, critically examined whether the patient could be heading to shock, and take vital signs such as the pulse, respiration, and temperature. The nurse analyzed whether there was an indicative pattern. The application of critical thinking ensured that the RN probed more issues, and hence designed optimal care. In the first scenario, the nurse did not think of the implication of the recorded blood pressure. The failure to exercise critical thinking, reasoning and judgment can lead to negative consequences on the condition of the patient.
References
Amini, M., Moghadami, M., Kojuri, J., Abbasi, H., Abadi, A., Molaee, N., & Charlin, B. (2011). An innovative method to assess clinical reasoning skills: Clinical reasoning tests in the second national medical science Olympiad in Iran. BMC Research Notes, 4(418), 1-7.
Andersson, N., Klang, B., & Petersson, G. (2012). Differences in clinical reasoning among nurses working in highly specialized pediatric care. Journal of Clinical Nursing, 21(1), 870-879.
Hughes, R. G., Benner, P., & Sutphen, M. (2008). Clinical reasoning, decision making, and action: Thinking critically and clinically. Pediatric Nursing, 22(1), 25-36.
Mookherjee, S., & Chou, C. (2011) Bedside teaching of clinical reasoning and evidence-based physical examination. Medical Education, 45(1), 519-520.
Sedgwick, M., Grigg, L., & Dersch, S. (2014). Deepening the quality of clinical reasoning and decision-making in rural hospital nursing practice. Rural and Remote Health, 1(14), 2850-2858.
Tanner, C (2006).Thinking like a nurse: a research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204-211.