Evaluating Clinical Decision Making Using the Reasoning Cycle

This report delves into the critical process of clinical decision-making within healthcare settings, emphasizing the vital role of nurses. It uses the clinical reasoning cycle as a framework to evaluate a specific clinical decision involving an 80-year-old patient, Mr. Charles Smith, diagnosed with colon cancer. The report outlines the eight stages of the clinical reasoning cycle: considering the patient situation, collecting information, processing data, identifying issues, establishing goals, taking actions, evaluating outcomes, and reflecting on the process. It examines how each stage influences decision-making, using Mr. Smith's case to illustrate the application of these principles. The analysis includes gathering patient history, assessing symptoms, and applying existing knowledge to determine appropriate interventions, such as monitoring weight and cognitive status. The report also highlights the importance of registered nurse standards for practice and the creation of a professional work environment to enhance patient care and organizational performance. The report concludes by recommending effective professional practices for nurses, emphasizing the significance of clinical decision making in providing quality healthcare services.

Clinical Decision Making
1

Clinical decision making is the process by which health care professionals determine needs
of patients. Nurses play important part in clinical decisions on every day basis and their decisions
makes impact on the service users and the actions of the healthcare professionals (Schmoll and et.al,
2012). The present study is based on the clinical decision making and to understand its importance,
an example of a clinical decision is taking into the consideration. The aim of this investigation is to
apply the clinical reasoning cycle to evaluate a selected clinical decision.
In health and social care organizations, nurses have required effective reasoning skills
because it has made positive impact at the time of delivery of care services to the patients. In the
case of poor clinical reasoning skills, carers become fail to find out the requirements of sick person.
In this context, caregivers should use a clinical reasoning cycle which represents the ongoing and
cyclical nation of clinical interventions (Zia and Inadomi, 2010). It is very important in order to
evaluate and reflect the clinical work in various situations. The following framework contains the
eight stages.
Diagnosis plays important role in identifying the nature of illness and other health issues of
patients on the basis of signs and symptoms of service users. It is one of the important practice
which are used by clinical care. CDR Computerized Assessment System, medical, differential and
retrospective are important methods of diagnosis. Major tools which are used by clinicians are
DELTA, DXplain and rating scale.
The eight phases of clinical reasoning cycle are considering patient situation, collecting
information, process that data, identify issues, establish goals, take actions, evaluate outcomes and
reflect on process and new learning. These all stages have contained various factors that influence
the clinical decisions of a nurse. At considering patient situation point, it affects by some
constituents such as enlisting of facts, context, objects or people. On the basis of this, a caregiver
can take decisions to analyze the current situation of a sick person. If these facts have not
considered then it definitely affects the end results of care services (Majid and et.al., 2011). The
second phase of clinical reasoning model is collection of information which influences by three
major elements: review present data, gather new information and recall knowledge. The
combination of these three factors has highly influence the clinical decision making process of
carer. In review current information, it includes different kinds of data such as handover reports,
patient charts, patient history, outcomes of diagnosis etc. Along with this, gather new information
section covers sick person assessment to know the actual health issue of him. Further, by recall
existing knowledge, attendant can take decisions how to treat the patient by following all code of
conducts and ethics (HYPOVOLAEMIA & DEHYDRATION, 2016).
On the other hand, process information phase encloses many features like interpretation,
2

discriminate information; find out the relationship between different information patterns, matching
of current situations to past conditions etc. These all factors have highly influenced the clinical
decision making process of a nurse at the time of providing the care to the patients in several health
issues. In addition to this, identify problems stage refers to synthesise facts and inferences to make a
definitive diagnosis of a sick person health problem (Croskerry, 2013). So, it can be said that the
right amalgamation of numerous information assists the caregiver to easily find the health issues of
health care service users. Next stage of clinical reasoning cycle is establishing goals where an
attendant develop some goals related to the current situation of patient. This clinical decision
influences by the description of circumstances and the outcomes of previous stages of following
model. Further, six point of the cited framework is take actions where a nurse find out the several
course of actions and chose one of them so that a right clinical decision can be taken. In this
context, the selection of alternatives between two or more options has the factor that may influence
the clinical decision in relation to all of the eight stages of the clinical reasoning cycle.
Further, the next step is of clinical reasoning cycle is evaluation of outcomes where
effectiveness of the actions assesses. On the basis of this, caregiver tries to find out that his or her
actions actually make any kind of improvement in the patient health or not. Therefore, it can be said
that outcomes of selected alternatives is the influencing factor of clinical decision of attendant. The
last phase of the following model is reflection on process and new learning from the work. The
reflection over the experience can be considered as an element that may be affected the clinical
decision making of a nurse at the time of delivering the health care services to patients ( Elwyn and
et.al., 2012).
Mr Charles Smith is an 80 years old man who diagnosed with cancer of the colon. This
disease has diagnosed after the rectal bleeding. Along with this, he has also a partial colectomy and
formation of a colostomy. This is the current situation of the patient. From the gather information, it
has found that he has also a problem of anaemic and he had a family history of bowel cancer. It has
also explored that Mr. Smith has treated with colonoscopy that revealed left sided colon cancer and
a bowel resection (Bradbury and et.al., 2010). In addition to this, some other information also
gathered after the monitoring of the patient such as current body temperature, pulse rate, respiratory
rate, blood pressure, oxygen saturation level, hourly urine output in average form etc. Further, from
the assessment of Mr. Smith, it has been determined that there is a nil appetite, only liquid food is
giving, cognitive state is restless and anxious and the patient reports extreme level of thirst after the
treatment. On the basis of existing knowledge, it has determined that these activities have changed
the well being and fluid status of Mr. Smith. By considering the backgrounds to the case including
current and related patient information, I have taken clinical decision. I have stated to measure the
3

daily weight of that person along with this checking of cognitive status regularly.
Clinical reasoning model has helped in taken the right clinical decisions in different medical
situations. From this framework, I have learned that the eight stage of this has assisted in taking
correct pronouncement for the patients. I have gained the knowledge that at the time of considering
the Mr. Smith health situation; it has needed to over various things such current blood pressure rate,
successful rate of surgery, dressing over the operated area, oxygen therapy etc. In this case, I have
looked all these things to take clinical decisions. After this, I have explored that it has essential to
collect all kind of information so that it becomes easy to get to know about what is the right
condition of patient. In the situation of Mr. Smith, I have gathered both current and new data to
actually determine the present health. For this, I have also recalled my knowledge to resolve the
newly occurred health issues. Next phase has related to process of information where I have gained
the knowledge that it has required to interpret the data to come up with an understanding of signs
and symptoms. At the time of dealing with Mr. Smith, I have interpreted the information but not
discriminated it i.e. recognize the gap in cues collected. On the basis of this, I have not able to
define the relationship between the previous and gathered content. On the other hand, in
identification problem, I have learned that combination of different facts of patient has assisted in to
make a definitive diagnosis of his health problem. Although, I have got the success in find Mr.
Smith issue with this stage and these have restless, anxious and extreme level of thirst after the
treatment. I have acknowledged from critical reasoning cycle that to achieve every desired outcome,
it is important to establish goals for it. By considering this, I have set my some objectives related to
how to deal with health issues of patients within the limited time frame. Therefore, on the basis of
this, I have taken clinical decision for Mr Smith compute their daily weight along with examine
cognitive status on regular basis.
By considering the above reflection, I have acknowledged that the other actions could have
been taken differently in order to resolve the health issues of Mr. Smith. As a nurse, I could take
decision to monitor haemodynamic status closely of patient. By changing position of him on regular
basis, it could help in dealing with the health problems. Along with this, by increasing fluid intake, I
could take better clinical decision for Mr. Smith.
It is recommended that a nurse should be effective and professional while handling the
patients. It is the duty of the nurse that they should adopt appropriate methods and activities for
operating their patient. This helps them to overcome the challenges faced by them during
performing treatments for curing the individuals of their hospital. For this, they must follow the
standards defined by the hospitals and government bodies. It is vital that such they should assess
and implement the standards which are determined for them. This would improvize their
4

performance and ability of working which is highly useful for them in getting improvement and
encouragement. On the other hand, this will support the team of the organization to develop a good
image and loyalty within the sector (van Ryn and et.al., 2011).
Registered nurse standards for practice, 2016 is one of the best set of activities determined
for a nurse in which a specific and clear structure of guidelines are defined. By following such
standards a nurse is able to gain proper values and develop skills to perform better and effective
functions while treating and operating the patient to overcome the present stage of deficiency. The
registered standards helps the nursing organisation in developing a code of conduct for all the
nurses working in their management. This structures a set of plan which are to be strictly followed
and adopted by the nursing staff members. Along with this, the process of implementing
standardization in the firm allows them to develop a strategic action plan to overcome the values
and ethics determined by the organisation (Rokos and et.al., 2010). Hence, to adopt development
activities and procedures for developing professional practices among the nursing staff.
In addition to this, it is also recommended that the organisation should develop professional
environment of working and performing the duties of the nursing staff. It has been evaluated that
the process of creating professional environment would support the hospital and their team to attain
better results from their practices and operations. For this, the managerial aspects needs to develop,
shape and design professional boundaries and ethics that are to be maintained by them in order to
gain appropriate form of benefits. They should consider the set of standards characterized under the
Registered nurse standards for practice, 2016 (Nursing standards, 2016). Thus, the professional
boundaries and ethics can be easily developed by evaluating the stated standards. This would
support them in building good endurance and image among the sector so that they could position
themselves as one of the most crucial organisation in operating and treating the patients to address
improvements (Lundgrén-Laine and Salanterä, 2010).
From the above report, it has been concluded that the clinical decision making is highly
significant for the organisation in executing and placing various actions and operations. The
structure for conducting the process of making decisions is specified which helps the nursing staff
members to place effective measures and practices to overcome the values and determination of the
organisational task. It is the responsibility of the nursing staff to adopt specific and clear set of
functions for addressing better and effective direction of operating their patients. Along with this,
the report is also providing information regarding the recommendations and changes that are to be
considered by the nursing staff in gaining results and goals as desired by the organisation.
5

REFERENCES
Books and Journals
Bradbury, A. W., & et.al. (2010). Bypass versus Angioplasty in Severe Ischaemia of the Leg
(BASIL) trial: a survival prediction model to facilitate clinical decision making. Journal of
vascular surgery. 51(5). 52S-68S.
Croskerry, P., (2013). From mindless to mindful practice—cognitive bias and clinical decision
making. N Engl J Med. 368(26). pp.2445-2448.
Elwyn, G., & et.al. (2012). Shared decision making: a model for clinical practice. Journal of
general internal medicine. 27(10). 1361-1367.
Lundgrén-Laine, H., & Salanterä, S. (2010). Think-aloud technique and protocol analysis in clinical
decision-making research. Qualitative Health Research. 20(4). 565-575.
Majid, S., & et.al. (2011). Adopting evidence-based practice in clinical decision making: nurses'
perceptions, knowledge, and barriers (EC). Journal of the Medical Library Association. 99(3).
229.
Rokos, I. C., & et.al. (2010). Appropriate cardiac cath lab activation: optimizing electrocardiogram
interpretation and clinical decision-making for acute ST-elevation myocardial
infarction. American heart journal. 160(6). 995-1003.
Schmoll, H. J., & et.al. (2012). ESMO Consensus Guidelines for management of patients with colon
and rectal cancer. A personalized approach to clinical decision making. Annals of
Oncology. 23(10). 2479-2516.
van Ryn, M., & et.al. (2011). The impact of racism on clinician cognition, behavior, and clinical
decision making. Du Bois review: social science research on race. 8(01). 199-218.
Zia, J. K., & Inadomi, J. M. (2010). Clinical Decision Making. Yamada's Textbook of
Gastroenterology, 639-650.
Online
HYPOVOLAEMIA & DEHYDRATION. (2016). [PDF]. Available
through:<https://www.newcastle.edu.au/__data/assets/pdf_file/0011/86537/Clinical-
Reasoning-online-case-study-example.pdf>. [Accessed on 28th September 2016].
Nursing standards. (2016). [Online]. Available
through:<http://journals.rcni.com/doi/pdfplus/10.7748/ns2004.05.18.36.47.c3614>.
[Accessed on 28th September 2016].
6