Clinical Reasoning Flashcards
Clinical Reasoning & Judgement (define)
Reasoning - the process by which the nurse observes a patient’s status, processes information, comes to an understanding of the patient’s problems, plans and implements interventions, evaluates outcomes and reflects on the process to improve future practice.
Judgement - the outcome of the clinical reasoning process in the form of a conclusion, decision or opinion about the patient’s problem, plan of action or evaluation of interventions.
10 Critical Thinking Attributes
- Holistic-contextual perspective – considering all aspects of the person including their situation, relationships, background and environment.
- Creativity – restructuring or generating new ideas and imagining alternatives.
- Inquisitiveness – using questioning/curious approach and exploring possibilities or alternatives.
- Perseverance – pursuing knowledge despite obstacles and alternatives.
- Intuition – forming insight through experiences and pattern recognition.
- Flexibility – adapting thoughts and behaviours to suit different situations.
- Academic integrity – committing to reach the truth through honest processes, even if results contradict initial beliefs/assumptions.
- Confidence – believing in own reasoning abilities.
- Reflexivity – recognising and critically evaluating assumptions/biases in own thinking and behaviour.
- Open-mindedness – being receptive to different views and aware of the limits of own knowledge.
Expert vs Novice Reasoning
a) Thinking – novice acts before thinking vs expert assesses and thinks before acting.
b) Rules – novice requires clear cut rules vs expert knows when to bend rules.
c) Resources – novice unaware of available resources vs expert aware of resources and knows how to utilise them.
d) Procedures – novice requires step-by-step procedures vs expert can integrate steps and focus on the ‘bigger picture’.
Why is clinical reasoning important?
a) Informs all aspects of the nursing process (i.e. ADPIE).
b) Nurses are responsible for clinical judgements
c) Nurses are required to respond to complex and dynamic situations
d) Nurses require both psychomotor skills and sophisticated thinking abilities
e) Failure to detect patient deterioration caused by poor clinical reasoning skills
f) Adverse patient outcomes associated with clinical reasoning errors
Five ‘Rights’ of Clinical Reasoning
- Right cues – appropriately recognising and clustering cues for early recognition and management of health issues.
- Right patient – identifying and prioritising patients at risk of critical illness/adverse event who require urgent intervention
- Right time – early identification of at-risk patients, early intervention and correct sequence of actions.
- Right action – selecting appropriate course of action from alternatives in accordance with accurate nursing diagnosis and risk assessment.
- Right reason – utilising correct process of reasoning to reach conclusions that are accurate, ethical, legal and professional.
8 Steps of the Clinical Reasoning Cycle
- Consider the patient situation
- Collect cues/information
- Process information
- Identify problems
- Establish goals
- Take action
- Evaluate outcomes
- Reflect and process new learning
Consider patient situation
List facts, context, objects and/or people to form initial impression – e.g. clinical handover, visual observation.
Collect cues/information
- Review current information – e.g. handover reports, patient history/charts, investigations/assessment results.
- Gather new information – e.g. patient assessments (vital signs, physical examination), patient/family interview.
- Recall knowledge – e.g. physiology, pathophysiology, pharmacology, epidemiology, ethics, law etc.
Process information
- Interpret – analyse cues to understand signs/symptoms and compare normal vs abnormal.
- Discriminate – distinguish relevant vs irrelevant information, recognise inconsistencies, narrow scope of information, recognise gaps in cues.
- Relate – identify relationships/patterns and cluster cues.
- Infer – interpret subjective and objective cues to form opinions that follow logically and consider alternatives and consequences.
- Match – current and past situations or patients.
- Predict – identify likely outcome.
Identify problems
Synthesise facts and inferences to reach nursing diagnosis.
Actual diagnosis - (1) a diagnosis; (2) a related statement that defines cause; (3) as evidenced by statement that lists defining characteristics.
Potential diagnosis - (1) a risk of diagnosis; (2) as evidenced by statement that lists risk factors/predisposing characteristics.
Take action
- Select – choose a course of action from available alternatives.
- Assign roles – decide who should perform interventions and who should be notified – e.g. delegation/supervision.
- Implement – perform actions in accordance with plan.
Evaluate outcomes
Evaluate effectiveness actions in relation to outcomes - i.e. has the situation improved, deteriorated or remained the same?
Reflect and process new learning
Contemplate lessons learned and implications for future practice - e.g. ‘I now understand that…’, ‘I should have done…’, ‘Next time I will…’
Why is evaluation important?
- Identification of changes in patient condition and un/successful interventions
- Modification of nursing care plan according to re-assessment
- Development of new/improved interventions
- Formulation of recommendations for future practice
- Individual/group learning through reflection and debriefing
Soft vs Technical skills
Soft skills - unique human traits and attributes that are difficult to replace with technology.
Technical skills – practical knowledge and expertise required to perform actions, tasks and processes of a job.
