Clinical reasoning
Clinical reasoning is the cognitive process utilized by healthcare professionals to gather, analyze, and interpret patient information to enhance their physiological and psychosocial well-being. It encompasses the application of critical thinking skills to devise appropriate treatment plans, thereby facilitating informed decision-making in patient care. This process is particularly emphasized in nursing, where practitioners combine both cognitive and affective components—such as creativity, perseverance, and logical reasoning—to more effectively assess and diagnose patient conditions.
At its core, clinical reasoning involves several key steps: assessing the patient's situation, collecting relevant information, interpreting data, diagnosing issues, and determining treatment outcomes. An important aspect of this process is the identification and interpretation of cues, which can be either subjective, like patient-reported symptoms, or objective, such as observable signs of illness. Research shows that experienced nurses are generally more adept at recognizing these cues quickly and accurately, leading to more efficient clinical decisions. Conversely, novice practitioners may struggle with this initially but can develop these skills over time through deliberate practice and exposure to varied clinical scenarios. Overall, clinical reasoning is essential for providing quality healthcare and improving patient outcomes.
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Subject Terms
Clinical reasoning
Clinical reasoning is the thought process by which health-care professionals gather and analyze patient information, evaluate the relevance of the data, and identify potential actions that could improve the physiological and psychosocial conditions of patients under their care. It involves using critical-thinking skills to identify an appropriate treatment scheme that would result in improvement in a patient’s condition. Therefore, clinical reasoning can be thought of as the application of the process of decision making to the field of health care. This particular thinking process also aids health professionals in gathering, assessing, and making use of various types of information for patient care. While any health professional can practice clinical reasoning, it is most often discussed in the context of nursing.
Overview
Critical thinking is the process of analyzing, evaluating, and interpreting or applying information based on reasoning or evidence. It requires one to identify and examine any underlying assumptions or biases, and when applied to interactions with others, it may involve evaluating statements as either facts, opinions, or conclusions. In short, critical thinking is about understanding information rather than simply accepting it.
Critical thinking is a fundamental part of clinical reasoning. According to a study conducted by an international panel of nurses between 1995 and 1998, as reported in a consensus statement by Barbara K. Scheffer and M. Gaie Rubenfeld in 2000, critical thinking in nursing involves ten "affective components," or mental habits, and seven "cognitive components," or thinking skills. The affective components are "confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, open-mindedness, perseverance, and reflection," and the cognitive components are "analyzing, applying standards, discriminating, information seeking, logical reasoning, predicting, and transforming knowledge." Clinical studies have indicated that this combination of mental habits and cognitive skills enables health professionals to more quickly and accurately diagnose problems affecting patients.
At its most basic, clinical reasoning can be defined as the application of critical thinking at the point of care. Broadly speaking, the process involves, first, assessing a patient’s current situation; second, gathering information about the patient, both from medical records and from direct interaction with the patient, and supplementing that information with prior knowledge; third, using critical-thinking skills to evaluate and interpret the information and make logical inferences; fourth, using both facts and inferences to diagnose the patient’s problem; fifth, identifying the desired outcome of treatment; sixth, choosing a course of action that will achieve this outcome; seventh, evaluating the effectiveness of this action; and eighth, reflecting on the case as a whole and identifying what, if anything, could have been done differently.
An essential part of the information-gathering process is identifying cues. In nursing, a cue is a piece of either objective or subjective data that lends itself to making inferences. Examples of cues include the patient’s own description of their symptoms (subjective), the health professional’s observations of the patient’s behavior (objective), and any visible signs of illness or injury (objective). Identifying and interpreting cues is a skill that one develops with practice. In a 2014 article in the journal Rural and Remote Health, authors Monique Sedgwick, Lance Grigg, and Sharon Dersch cite several studies showing that more experienced nurses are able to quickly identify and interpret cues and come to sound clinical decisions based on those cues, whereas novice nurses who lack experience in clinical reasoning take longer to make cue-based decisions and, if confronted with a situation that requires them to make quick decisions, are often unable to explain the cues that led them to those decisions afterward. However, over time and with sufficient practical experience, novices who deliberately follow the steps of clinical reasoning may find that the practice becomes second nature.
Bibliography
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Benner, Patricia, Ronda G. Hughes, and Molly Sutphen. "Clinical Reasoning, Decisionmaking, and Action: Thinking Critically and Clinically." Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Ed. Hughes. AHRQ pub. no. 08-0043. Rockville: Agency for Healthcare Research and Quality, 2008. AHRQ Archive. Web. 15 Aug. 2016.
"Clinical and Diagnostic Reasoning." Carver College of Medicine, University of Iowa, medicine.uiowa.edu/internalmedicine/education/master-clinician-program/students/clinical-and-diagnostic-reasoning. Accessed 15 Aug. 2024.
Higgs, Joy, et al., eds. Clinical Reasoning in the Health Professions. 3rd ed. Boston: Butterworth, 2008.
Levett-Jones, Tracy, et al. Clinical Reasoning: Instructor Resources. Newcastle: School of Nursing and Midwifery, Faculty of Health, U of Newcastle, 2009. Clinical Reasoning Project. The University of Newcastle, Australia. Web. 15 Aug. 2016.
Papathanasiou, Ioanna V., et al. "Critical Thinking: The Development of an Essential Skill for Nursing Students." Acta Informatica Medica 22.4 (2014): 283–86. PubMed Central. Web. 15 Aug. 2016.
Scheffer, Barbara K., and M. Gaie Rubenfeld. "A Consensus Statement on Critical Thinking in Nursing." Journal of Nursing Education 39.8 (2000): 352–59. MEDLINE Complete. Web. 15 Aug. 2016.
Sedgwick, Monique G., Lance M. Grigg, and Sharon Dersch. "Deepening the Quality of Clinical Reasoning and Decision-Making in Rural Hospital Nursing Practice." Rural and Remote Health 14.3 (2014): n. pag. MEDLINE Complete. Web. 15 Aug. 2016.
Yazdani, Shahram, and Maryam Hoseini Abardeh. "Five Decades of Research and Theorization on Clinical Reasoning: A Critical Review." Advances in Medical Education and Practice, 27 Aug. 2019, doi:10.2147/AMEP.S213492. Accessed 15 Aug. 2024.