Blog

Clinical Reasoning in Healthcare Sample Paper

Clinical Reasoning in Advanced Health History and Physical Assessment Skills

Clinical reasoning exploits the clinician’s background knowledge in making judgments in clinical situations. The thinking behind clinical reasoning requires proper translation of information into knowledge and finally, wisdom. Clinical reasoning does not necessarily rely on evidence-based practice and past experiences. The purpose of this paper is twofold, first, to describe the application of clinical reasoning in developing advanced patient history taking and physical assessment skills and second, to explain the use of the nursing process in enhancing critical thinking, clinical reasoning, and clinical judgment while providing clinical examples.

Clinical Reasoning

Clinical reasoning is a critical skill that is useful in gathering relevant clinical data from the patient and making decisions for further care based on this data. It is applied in all cadres of care by nurses and doctors. To achieve clinical competency, the nurse must be able to process several clinical data and investigative results to develop differential diagnoses that would inform further plans of care and referral. Various theoretical concepts have explained clinical reasoning among clinicians.

The dual processing theory espouse that a clinician may make decisions based on the intuitions, through recognition of patterns, or based on previous experiences or heuristics. Otherwise, the clinical reasoning may be analytical and involves a stepwise approach to achieve a clinical decision. While the nurse cannot use the two concepts of decision-making at the same time, they can always switch their model of reasoning based on the type and complexity of the clinical situation (Thampy, Willert, & Ramani, 2019). A more experienced clinician would make decisions in a shorter time compared to a just graduated nurse who is yet to gain more experience and skills in the clinical setup.

Nonetheless, a graduate-level nurse should be able to take a clinical history and perform a physical clinical examination. In the clinical setup, the bulk of work may require that a lot of such clerkship is done in limited time duration. Therefore, the nurse would require their clinical reasoning skills to collect appropriate, focused, and relevant information that would guide their physical examination concepts. According to Barratt (2018), one can assess a nurse’s level of competency based on the kind of information collected and the outcome of the nurses’ decisions made based on such data. A more experienced nurse would perform a physical examination while taking the history in some cases. Clinical reasoning skills usually sharpen with time just like other learned skills such as surgical skills.

The Nursing Processes

The nursing process is a universal practice that involves specific steps in providing holistic patient care. The nursing care steps include assessment, diagnosis, care outcomes, implementations, and evaluation (American Nurses Association et al., n.d.). The nurses start by gathering the subjective and objective data from their clients in the assessment step. Based on the objective and subjective data, the nurse then makes the nursing diagnosis and differential diagnoses (Falcó-Pegueroles et al., 2021). This forms the basis of the expected outcomes or goals of the care. The nurse then administers and evaluates the planned care according to the patient improvement or adjustment in status.

The process described requires the appropriate nursing critical thinking, clinical reasoning, and clinical judgment. Wong and Kowitlawakul (2020) note that the process entirely involves problem-solving. The nurse applies their critical thinking abilities to identify possible differential diagnoses. Clinical reasoning is required in prioritizing the most likely diagnosis out of the differential diagnoses. Clinical judgment and clinical reasoning would be useful in choosing the best care methods for the patient. The nurses are obliged to follow the nursing process to ensure the best outcomes for the patient. In so doing, they enhance their critical thinking, clinical reasoning, and clinical judgment skills with time. Their experience and competency levels advance with improvement in the above skills. Arguably, graduate-level nurses practice these skills during their training programs (Wong & Kowitlawakul, 2020) and are expected to translate the same in their professional practice.

Clinical Example

A patient presents to a busy outpatient clinic with a 2-week history of postprandial epigastric pain and 2 episodes of hematemesis last week. The nurse takes a full history and conducts a full abdominal exam but admits the patient for further inpatient care. Before admission, the nurse administers painkillers while awaiting esophagogastroduodenoscopy for the patient. She then informs the gastroenterologist on call that day to come and review this new admission. The nurses make differential diagnoses but chooses to relieve the patient’s pain before offering further care. This demonstrates clinical reasoning and judgment. The referral to a physician portrays her collaborative care skills, clinical judgment, and communication capabilities after realizing that this is a complicated case requiring more advanced care. Critical thinking enabled her to make differentials and to make the decision of managing pain over the medical diagnoses.

Conclusion

In sum, clinical reasoning, critical thinking, and clinical judgment are essential skills that a graduate nurse must be acquainted with to ensure higher competency levels. The skills are related and their application in the nursing process is intertwined. Their relationship with the nursing process is mutual and their absence causes disorganization in the patient’s care. The described clinical example exposes the nurse’s exquisite skills that ensured safe patient care requiring collaborative care approach.

References

• American Nurses Association, American Nurses Credentialing Center, & American Nurses Foundation. (n.d.). The Nursing Process. Nursingworld.Org. Retrieved March 17, 2021, from https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/the-nursing-process/
• Barratt, J. (2018). Developing clinical reasoning and effective communication skills in advanced practice. Nursing Standard (Royal College of Nursing (Great Britain): 1987), 34(2), 37–44. https://doi.org/10.7748/ns.2018.e11109
• Falcó-Pegueroles, A., Rodríguez-Martín, D., Ramos-Pozón, S., & Zuriguel-Pérez, E. (2021). Critical thinking in nursing clinical practice, education, and research: From attitudes to virtue. Nursing Philosophy: An International Journal for Healthcare Professionals, 22(1), e12332. https://doi.org/10.1111/nup.12332
• Thampy, H., Willert, E., & Ramani, S. (2019). Assessing clinical reasoning: Targeting the higher levels of the pyramid. Journal of General Internal Medicine, 34(8), 1631–1636. https://doi.org/10.1007/s11606-019-04953-4
• Wong, S. H. V., & Kowitlawakul, Y. (2020). Exploring perceptions and barriers in developing critical thinking and clinical reasoning of nursing students: A qualitative study. Nurse Education Today, 95(104600), 104600. https://doi.org/10.1016/j.nedt.2020.104600