Clinical reasoning and critical thinking help nurses in assessing, assimilating, evaluating, and/or discarding components of information in order to make a decision(s).
When making clinical decisions and planning care, nurses draw from many sources including their formal nursing education and/or from their experience gained over time in and outside of nursing practice. Critical thinking extends this identification and resolution of care problems to critique the potential solutions or options raised, and potentially the merit of current practice.
Clinical decision-making includes an assessment of a patient's status and their needs and the best way to meet these needs. Clinical decision-making can be analytical whereby the person making a decision uses a set of rules or guiding principles to progress information along a rational logical pathway until a decision can be made. Decision trees, often used in nursing practice, are a good example of this decision-making process.
Intuitive decision-making is a skill that may appear to be less structured. It is based on experience and includes recognition of similarities between comparable situations and their outcomes. This skill is developed over time with experience.
The context of the decision-making situation, knowing the person, interpretation and reflection also form an important part of a nurse’s decision-making process.
There are a number of frameworks available to guide clinical reasoning and decision-making in different contexts. Here we highlight two examples.
One clinical reasoning cycle that has been developed for nurses represents the ongoing and cyclical nature of clinical encounters and the importance of evaluation and reflection. It includes 8 steps or phases which often overlap:
Learning to think like a nurse
The ‘Why’ Framework was proposed to guide clinical reasoning in the palliative care context. In palliative care, as a person is deteriorating, the question ‘Why?’ arises when the person’s clinical course does not reflect the known or expected course of the illness. The first question becomes:
“Is the deterioration due to the progression in the life-limiting illness OR is the deterioration due to the effects of an acute problem with an easily reversible cause?”
To help answer this and work out whether something can be done, The ‘Why’ Framework next uses three screening questions to monitor and respond to change in the context of the whole person.
These three questions are:
The answers to these in turn prompt the question “Can we do something about the problem?” and before acting on this, consider whether it would be appropriate to do so in the current situation.
This information was drawn from the following resources:
Visit the information and videos on ClinEdAus website
Visit Australian College of Nursing - Thought Leadership - critical thinking
Access more Clinical Reasoning resources
Page created 23 September 2022