Clinical Reasoning and Nursing Practice

This assignment delves into the concept of clinical reasoning and its relevance to nursing practice. It discusses the clinical reasoning cycle, a framework that guides healthcare professionals in making informed decisions. The study focuses on the application of clinical reasoning in nursing, emphasizing the importance of critical thinking and effective decision-making in patient care. By understanding the clinical reasoning cycle, nurses can improve their ability to manage clinical risk, evaluate patient situations, and maintain ethical clinical practice.

CLINICAL REASONING

Table of Contents
INTRODUCTION...........................................................................................................................3
MAIN BODY..................................................................................................................................3
Phase 1: Consider the Patient’s Situation....................................................................................3
Phase 2: Collect cues/ Information..............................................................................................3
Phase 3: Process Information.......................................................................................................4
Phase 4: Identify Problems/ Issues..............................................................................................4
Phase 5: Establish Goals..............................................................................................................5
Phase 6: Take action....................................................................................................................5
Phase 7: Evaluating outcomes.....................................................................................................6
Phase 8: Reflection on processing and new learning...................................................................6
CONCLUSION................................................................................................................................7
REFERENCES................................................................................................................................1

INTRODUCTION
Clinical reasoning is referred to as the clinical judgement by which clinicians effectively
determine various signs, understand and examine the medical condition of the patient,
implementation of effective medical intervention, process of information, evaluation of outcomes
and learning from the entire process effectively (Langridge, Roberts and Pope, 2016). Clinical
reasoning is an effective measure that helps in interacting with patients and determining
optimum treatment. It helps in examining strategies which are necessary for optimum quality
clinical practice.
MAIN BODY
Phase 1: Consider the Patient’s Situation
This is the first stage in which a registered nurse examines the case of the patient and
identifies what he is currently suffering form, when, why, how and other preliminary aspects.
Phase 2: Collect cues/ Information
This is the second phase of clinical nursing where the registered nurse is expected to
carefully examine all the facts related to the patient’s case. It involves studying the past medical
history of the patient, different treatments that the patient took, what was effective and what was
not etc. apart from studying past history, the registered nurse is also required to observe the
current treatment plan of the patient and record the vital signs of the patient. All the data that is
collected is analysed by the registered nurse based on the learning i.e. the knowledge that the RN
has of pathology, pharmacology, culture etc. and such knowledge is then used to establish cues
and draw information (The Clinical Reasoning Cycle: The 8 Phases and their Significance,
2018). This stage of clinical reasoning can be directly linked with the Standard 1 of Registered
Nurse Standards for Practice which stated that an RN should ‘Think Critically and Analyse
Nursing Practice’ which instructs the registered nurses to critically analyse all the available
evidence and then use the best evidence available and experience to develop an appropriate
nursing practice. Further, they also need to ensure that the decisions taken by them fall within the
ethical frameworks that have been defined by the higher authorities and ensure that the registered
nurses maintain and document all the important decisions, assessments, actions etc. properly
recording every aspect that is associated with the patient.

Phase 3: Process Information
This is the next stage under which the registered nurse is required to perform the most
critical task. Based on correct clinical reasoning, the registered nurse analyses and processes the
data associated with the patient and tries to identify the existing pattern based on
pathophysiological or pharmacological patterns so that the correct one can be identified and the
patient can be diagnosed correctly. This stage also involves segregating the relevant information
out of all the available information and estimating the outcomes based on the decisions that are
being taken by the registered nurse. Further, this can be linked with Standard 2 which states that
a registered nurse should ‘ Engage in Therapeutic and Professional Relationship’ with the
patients so that they can be diagnosed in a better manner (PATEL, 2018). It states that an RN
should communicate effectively with the patients so that they can ascertain the correct decisions
regarding the medical treatment that need to be provided to the patient. The standards further
illustrate that an RN should foster those methods which are safer and help in achieving healthier
outcomes. While collaborating with other RN or medical professionals, they should ensure
proper exchange of information and develop patient centred approach for treatment. There are
various characteristics that an RN should adopt being honest regarding the well-being of patient,
maintaining the privacy and fulfilling confidentiality norms etc. in order to work within
regulatory guidelines.
Phase 4: Identify Problems/ Issues
After the stage of information processing gets over, it signifies that the registered nurse
has accumulated the relevant information which is then used to ascertain the actual reason behind
the disease or problem the patient is suffering through. Further, this stage also involves pointing
out the correct diagnosis for the patient and ensure that it is accurate i.e. it will help in actually
resolving the problem that patient is experiencing. Again, this phase can be linked with one of
the standards prescribed under the registered nurse’s code of conduct. Standard four i.e.
‘Comprehensively conducting assessment’ instructs the registered nurse to implement those
assessment procedures which generate wholesome information and are culturally appropriate as
well. It instructs them to work in a motivated manner and assess all the resources available so
that they can be used in planning for such resources appropriately (Adeponle, Groleau and
Kirmayer, 2015). This standard also details a range of techniques related to assessment of the
patients that these registered nurses can use in order to correctly identify the problems and also

collect that information which is relevant and accurate regarding the treatment of patient. When
this standard is linked to the phase, it can be adequately concluded that the registered nurse is
required to perform and implement through and adept assessment techniques that help in
identifying the correct treatment that the patient must be given based on valid reasoning
developed on the basis of symptoms identified of the patient.
Phase 5: Establish Goals
After successfully identifying the reason behind the patients current condition i.e. the
problems that the patient is facing, in the next stage the registered nurse is expected to establish
and determine those treatment goals that are suitable for the current situation faced by the
patient. While formulating the appropriate treatment plans, a registered nurse is expected to
formulate those plans that are time oriented and help in delivering the desired outcomes as
quickly as possible. This can be done only when a registered nurse knows what they have to do
based on their knowledge and past experiences so that the patient can be cured without losing
any time (Hruska and et.al., 2016). This phase can be linked with the Standard 5 which is ‘
Develop a plan for Nursing Practice’ which instructs the registered nurse to formulate
appropriate plans based on the assessment data and the best evidence that is available regarding
the patients situation. Time frame is a crucial aspect which is further emphasised in this
standards well urging the registered nurse to take quick and best actions.
Phase 6: Take action
This phase of clinical reasoning is associated with the effective practical and
communication skills, intellectual activity, etc. It helps nurses in selecting the specific course of
action which is available for taking necessary action without any delay. It helps in meeting an
action plan which is very useful in meeting the treatment goals of the patient. Nurses should
focus on providing comprehensive quality and safe practice in order to attain desired goals and
outcomes for the specific patient (Hunter and Arthur, 2016). Nurses should focus on effective
clinical practice by effectively delegating the role and responsibilities to the nurses in a
systematic and efficient manner. Proper supervision and timely direction helps in gaining high
quality patient outcomes. Nurses should focus on effectively identifying the potential risk and
must comply with necessary regulations and legislations for higher sustainable growth and
efficiency. Nurses should focus on appropriate and timely delivery of care to the patients which
in results in high quality care results for the patients. Health care practitioners should focus on

effective team player, communication and coordination in order to take desired results and
outcome in an efficient and systematic manner. Health care practitioners must immediately
respond to any unethical or unsafe practice in a clinic (Gee, Dalton and Levitt-Jones, 2015).
Nurses should keep a proper track of the resources requires to carry out the particular action
plan.
Phase 7: Evaluating outcomes.
This is an effective phase which helps in effectively evaluating the particular course of
action. It will help in effectively determining how well the particular action plan has been carried
out without any delay. It helps in determining whether the particular action plan has led to
improved results or has led to deterioration (Levett-Jones, Courtney-Pratt and Govind, 2019).
This is a very crucial stage as it helps in monitoring and evaluating the progress of the particular
action plan and desired goals. Nurses and health care practitioners should focus on revising a
plan based on the particular evaluation of the goal. They should also focus on documenting and
communicating further goals, priorities and outcomes with the particular relevant individual.
Nurses should involve patients in the discussion for effective evaluation of the plan. Patient
should focus on clear progressing and inter- professional collaboration and liasioning for better
care results and outcomes (Koivisto and et.al., 2018). There should be a set of benchmark in
order to effectively measure and evaluate the action plan. Measurements such as proper record of
documents, observed structural clinical assessment, progress towards recovery and evaluation of
relevant data helps in effectively measuring the various results and outcomes. Taking feedback
from the patients and interviewing the patient and their family members for higher quality health
care outcomes and evaluation (Dalton, Gee and Levett-Jones, 2015).
Phase 8: Reflection on processing and new learning.
This is an effective clinical reasoning phase which helps in reflecting on the new desired
skills for better care learning. Development of new and inter personal professional skills is very
useful in achieving set goals and outcomes. It is very useful in determining the necessary action
which is to be taken in the future by facilitating decision making and problem solving skills
among health care professionals. This in turn helps in providing the best quality care to the
patients. I would take into consideration feedback from various patients and family members in
order to deliver them the best possible care which in turn leads to better care results and
outcomes. Nurses should focus on critically reflecting on the development of various

professional skills in order to give better learning practice to the individual. I have improved
nurses ability to effectively manage clinical risk for patients. I will effectively evaluate the
patient situation, collect all necessary information, process data, identify the issue, establish goal,
male an action plan, evaluate outcomes and reflect on processing new information. I will focus
on keeping proper records and maintaining ethical clinical practice in a lawful and legal manner
for higher results.
CONCLUSION
From the above study it has been concluded that, clinical reasoning is an effective
measure that helps in interacting with patients and determining optimum treatment. It is very
useful in examining strategies which are necessary for optimum quality clinical practice. This
study helps in determining various clinical reasoning cycle in relation with the nursing practice
in order to attain better care outcomes.

REFERENCES
Books and journals
Dalton, L., Gee, T. and Levett-Jones, T., 2015. Using clinical reasoning and simulation-based
education to'flip'the Enrolled Nurse curriculum. Australian Journal of Advanced Nursing,
The.33(2). p.29.
Levett-Jones, T., Courtney-Pratt, H. and Govind, N., 2019. Implementation and Evaluation of the
Post-Practicum Oral Clinical Reasoning Exam. In Augmenting Health and Social Care
Students’ Clinical Learning Experiences (pp. 57-72). Springer, Cham.
Hunter, S. and Arthur, C., 2016. Clinical reasoning of nursing students on clinical placement:
Clinical educators' perceptions. Nurse education in practice.18. pp.73-79.
Gee, T., Dalton, L. and Levitt-Jones, T., 2015. Using Clinical Reasoning and Simulation based
education to flip the enrolled nursing curriculum. In Sustainable Healthcare
Transformation: International Conference on Health System Innovation.
Koivisto, J.M and et.al., 2018. Design principles for simulation games for learning clinical
reasoning: A design-based research approach. Nurse education today. 60. pp.114-120.
Adeponle, A.B., Groleau, D. and Kirmayer, L.J., 2015. Clinician reasoning in the use of cultural
formulation to resolve uncertainty in the diagnosis of psychosis. Culture, Medicine, and
Psychiatry. 39(1). pp.16-42.
Langridge, N., Roberts, L. and Pope, C., 2016. The role of clinician emotion in clinical
reasoning: balancing the analytical process. Manual therapy. 21. pp.277-281.
PATEL, J.F.A.V.L., 2018. Methods in the study of clinical reasoning. Clinical Reasoning in the
Health Professions E-Book, p.147.
Hruska and et.al., 2016. Working memory, reasoning, and expertise in medicine—insights into
their relationship using functional neuroimaging. Advances in Health Sciences
Education. 21(5). pp.935-952.
Online
The Clinical Reasoning Cycle: The 8 Phases and their Significance. 2018. [Online]. Available
through: < https://www.heartassociation.eu/the-clinical-reasoning-cycle-the-8-phases-and-their-
significance/>
1

2