Clinical practices in health system require many thinking strategies that will allow nurses to practice high-quality service to a patient. In many health centers across the United States of America uses clinical reasoning and judgment to enhance the health service and to avoid adverse health effect to the patient. The ability of nurses to provide quality and safe care highly depends on the nurse’s ability to reason, think and judge, which sometimes is limited due to lack of experience (Victor-Chmil, 2013).
Then only characteristic that can identify a professional nurse is cognitive rather than using the psychomotor ability (Simmons, 2010). Clinical nursing practice requires a practitioner to make a sound judgment and critical decision in responding and recognizing patient sign and symptoms promptly to enhance patient outcome. Clinical errors and bad judgment in decision-making may have an adverse health effect on the patient; therefore, clinical reasoning skills play a pivotal role in the clinical judgment of a patient.
Clinical reasoning is the process through which nurses and other medical practitioner collect patient’s medical information, cues, analyses the data, understand the problem, plan for the medical interventions, implement, evaluate the patient outcome, and lastly, reflect on and learn from the whole process (Alfaro-Lefevre, 2015). Clinical reasoning is highly dependable to critical thinking and nurse’s attitude, philosophical perspective and lastly, the person preconceptions. The method of clinical reasoning is a series of events and therefore, is not linear and is an ongoing process especially in caring for a patient. Clinical reasoning is an essential skill in nursing since it influences positively on patient outcomes (Alfaro-Lefevre, 2015).Nurses with reduced or low clinical reasoning skills may fail to diagnose patient leading to deterioration of health “failure to rescue”.
Decision making in the healthcare environment is critical and dynamic process since it can affect patient outcomes. The nurse needs to think critically for them to make sound decisions. The decision they make should be self-reflective which allow nurses to develop the process further in the healthcare arena (Alfaro-Lefevre, 2015).Clinical reasoning and decision-making involve critical thinking process and strategies that nurses use to collect, understand data and to decide alternatives in identifying patient situation while preparing to carry out diagnosis and selecting health care outcomes and interventions. Nurses use different tools of clinical reasoning in planning, directing, performing and reflecting on patient care (Simmons, 2010).
In decision- making, nurses can assess alternative and make a right decision basing on watching, evaluating, recognizing, and using clinical reasoning. Through patient assessment data, nurses can understand and make a proper decision about patient problem and treatment. The nurse’s decision bases on clinical judgment or nursing diagnosis.
Both clinical reasoning and decision-making create a strong foundation that allows identification of common patient problems, this is the problem initially assessed and monitored by medical practitioners ( nurses) but later on treated by medicine (Simmons, 2010). It is now clear to state that clinical reasoning and decision-making supports nurse’s knowledge, therefore, closely related with therapeutic milieu concept of critical thinking. Critical thinking in nursing plays a significant role especially in clinical reasoning and decision-making process.
Contemporary learning and teaching methods in nursing do not lead in the development of clinical reasoning skills. While medical university show more commitment to educating nurses to work in complicated clinical setup, there is always complain from health service that the graduate is not “work ready”. Most nurses in the US have a good nursing knowledge and adequate skills, but they lack clinical reasoning skills, which is essential in emergency response. Clinical reasoning for advanced physical assessment in nursing arise from the nurse and patient engagement, general knowledge, and rational process, but not as a detached physical exercise.
Critical Thinking, Clinical Judgment, and Clinical Reasoning
Critical thinking skills are vital for a professional nurse; they help in examining the underlying assumption and question the validity of the situation or problem in a patient. However, critical thinking itself is not sufficient for the nurse who has to decide on how to act in a specific case to avoid harming the patient. Critical thinking generates new good health ideas for nurses to use in caring for a patient.
Critical thinking in nursing is the process through which nurses improve the quality of their thinking through skillfully taking charge of the things they are thinking about and impose intellectual reasoning upon them. Nurses ‘use critical thinking in raising questions about the patient problem so that they can clearly understand the situation (Victor-Chmil, 2013).Critical thinking embedded in nursing routine on a daily basis; nurses come to face situations in which decision-making is essential to patient care and every decision they make impact the patient outcomes. Nursing critical skills in thinking help in driving the process of decision-making, which directly affects quality care (Victor-Chmil, 2013).Clinical judgment involves the decision-making process where nurses choose data to collect about the patient, make an interpretation, and make the final diagnosis. The process that follows is nurses identifying appropriate nursing intervention, which include problem-solving, medical decision –making, and critical thinking. Nurses use clinical judgment to the patient to provide communication, help in diagnosis, and decision-making. Clinical assessment in nursing develops through regular practice, knowledge, experience, and continuous critical thinking.
Research has shown critical thinking in nursing involves the ability to think systematic, in a logical manner and is open to question, reflect on the reasoning process, which assures safe nursing process and care. Nurses need to respect and adhere to intellectual standards, proficiency in apply clinical reasoning, have a medical commitment to ensuring rational use of thinking skills and can apply sound clinical logic and decision making.
1. Alfaro-Lefevre, R. (2015). Critical Thinking, Clinical Reasoning, and Clinical Judgment E-Book: APractical Approach. Elsevier Health Sciences.
2. Simmons, B. (2010). Clinical reasoning: concept analysis. Journal of Advanced Nursing, 66(5), 1151-1158.
3. Victor-Chmil, J. (2013). Critical thinking versus clinical reasoning versus clinical judgment: Differential diagnosis. Nurse Educator, 38(1), 34-36.