Clinical Reasoning Cycle in Nursing: A Critical Analysis

Running head: NURSING
NURSING
Name of the Student
Name of the university
Author’s note

1NURSING
Introduction
Clinical reasoning cycle is an important part of nursing for proving a patient centered
care due to the fact the process is dependent on the knowledge and the intuition for influencing
the decision making for the circumstances of the individual clients (Australian Learning and
teaching cycle. 2018). The experience and the knowledge of the health care professional is an
extremely important step in the consolidation of the clinical reasoning (Saposnik et al. 2016).
Medical errors are common in 1.7-6.5 % of all the hospital admissions causing about 100,000
unnecessary deaths per year. The medical errors lead to unnecessary medical costs (Saposnik et
al. 2016). Most of the errors in the clinical reasoning is because of the inadequate knowledge or
incompetence but to frailty of the human perception under the conditions of complexity. Half of
the involved errors are because of the reasoning or decision quality. Such clinical errors are
highly preventable and can be easily avoided (Norman et al. 2016). In most of the cases, clinical
reasoning error occurs at the time of history taking and clinical examination. Clinicians are found
to use these data subconsciously for framing or contextualising the problem of the patient. The
patient of concern is a 52 years old female patient, who had been referred to a laparoscopic
cholecystectomy, removal of the gall bladder. On admission she was given Pregabalin 150 as the
premedication. At the time of the procedure the patient had become hypotensive and the heart
rate of the patient was also found to be higher. Being a nurse I had missed to obtain records the
history of the patient (Norman et al. 2016). The patient complained of light headedness,
dizziness and the dressings on the wounds were oozed. The patient was shivering when she came
back from the theatre. Hence the two clinical encounter that I had perceived are- I had missed the
history taking and had forgot to note that the patient was shivering and I had failed to consider

2NURSING
the alternative reasons for the clinical conditions. The two clinical reasoning error types that
have been identified in this clinical procedure are- the ascertainment bias and premature
closure. This assignment would critically analyse as for why did the clinical reasoning error took
place and what the outcomes that it brought to the patient. Finally, the assignment would
conclude with a self-reflection to improve my future learning practice, such that such mistakes
does not occur in my professional career
Discussion
Premature closure is type of cognitive error in which a physician fails to consider the
reasonable alternatives after the intimal diagnosis. It can be considered to be one of the cause of
delayed diagnosis and misdiagnosis due to a faulty clinical decision making process. Clinical
decision making in emergency circumstances might manifest either heuristic thought drawing on
the clinical experience and knowledge. It is evident from the case study that the patient
complained about dizziness or light-headedness (Jones et al. 2013). Light-headedness and
dizziness can be due to the hypovolemic shock due to fluid loss from dehydration, but there are
several other reasons for the dizziness and light headedness. Dizziness or light-headedness can
occur as side effects after ambulatory care anaesthesia. It has also been stated that low blood
pressure in the patient is due to the prolonged fasting. It should be mentioned that low blood
pressure is also one of the symptom of septic shock, which is a life threatening condition of
bacterial infection. As per the cues collected it is evident that the patient might have incurred
dehydration after the surgery. Dehydration might facilitate the occurrence of septic shock. Hence
it is necessary to assess the conditions before coming to any kind of conclusions. Again, as
evident from the case study and the clinical cues, it is understood that the patient had been
administered with Pregabalin as the premedication. Dizziness or light-headedness is one of the