Clinical Reasoning Cycle

Book Club: Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse. Pearson Australia.

Clinical Reasoning Cycle

Define reasoning as “the process by which nurses (and other clinicians) collect cues, process the information, come to an understanding of a patient problem or situation, plan and implement interventions, evaluate outcomes, and reflect on and learn from the process”.

“Clinical reasoning is often confused with the terms ‘clinical judgement’, ‘problem solving’, decision making’ and ‘critical thinking’. While in some ways these terms are similar to critical reasoning, clinical reasoning is a cyclical process that often leads to a series or spiral of linked clinical encounters” (pg.4 Levett-Jones, 2013).

Stages of the Clinical Reasoning Cycle

  1. Consider the patient
  2. Collect cues/information
  3. Process information
  4. Identify problems/issues
  5. Establish goals
  6. Take action
  7. Evaluate outcomes
  8. Reflect on process and new learning

Why is this book important?

For nurse training and education delivery, the stages of clinical reasoning can be incorporated into training sessions to discuss the clinical judgments and decision making during a care intervention and applying the ‘nursing process’.  Simulated nursing environments are an ideal educational approach to challenge clinical decision making and clinical reasoning skills. Nurses are the constant presence on the ward level, providing the monitoring and making judgments form the clinical reasoning encounters every shift over a patients hospital journey. Responding to complex and time critical events requires sophisticated abilities which expand further than pure theoretical knowledge, such as assessing and responding to clinical deterioration.

In the current economic drive for cost cutting measures across healthcare (nurses make up the majority of the healthcare workforce, so are often seen as a costly element), the drive to replace with lower skilled, trainees and eventually robots are factors for the nursing profession to consider. Nurses need to be able to understand and explain the role they play and have a voice to raise the profile of what it entails to be a nurse and the efficacy of such skills to maintain levels of care and safety.

Summary

Thinking on the go and decision making are skills to develop over time and with experience but need to be incorporated into nurse training. Nurses with effective clinical reasoning skills have a positive impact on patient outcomes (School of Nursing and Midwifery Faculty of Health, 2009). It’s important to remember, during all this consideration of the patient and reflective process that you (the nurse) are human and as such wont get everything correct all the time.

References

Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse. Pearson Australia.

Alfaro-LeFevre, R. (2015). Critical Thinking, Clinical Reasoning, and Clinical Judgment E-Book: A Practical Approach. Elsevier Health Sciences.

Interprofessional Ambulatory Care Unit. Clinical Reasoning User Manual. Edith Cowan University.

School of Nursing and Midwifery Faculty of Health (2009) Clinical Reasoning Instructor Resources. University of Newcastle.

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