Overview
This lecture introduces the clinical reasoning cycle in nursing, detailing its steps and practical use in patient care to enhance critical thinking and prevent patient deterioration.
Definition and Importance of Clinical Reasoning
- Clinical reasoning is a systematic process guiding decision-making in complex or unpredictable clinical situations.
- It involves collecting cues, processing information, understanding patient problems, planning and implementing interventions, evaluating outcomes, and reflecting on the process.
- The aim is to develop nurses as critical thinkers, especially for preventing patient deterioration.
The Clinical Reasoning Cycle: Seven Steps
- 1. Consider the Patient Situation: Describe the patient, their context, and reasons for admission.
- 2. Collect Cues/Information: Review current and new information, and recall relevant knowledge from past experiences.
- 3. Process Information: Interpret cues, discriminate relevance, relate data, infer conclusions, match current with past situations, and predict outcomes.
- 4. Identify Problems/Issues: Synthesize information to form a nursing diagnosis (distinct from a medical diagnosis).
- 5. Establish Goals: Set SMART (Specific, Measurable, Achievable, Realistic, Timed) goals for patient care.
- 6. Take Action: Plan, document, and implement nursing interventions to prevent deterioration and promote recovery.
- 7. Evaluate Outcomes: Assess the effectiveness of interventions and adjust as needed.
- 8. Reflect on the Process: Learn from each case to improve future clinical practice.
Application Example: Case of Mr. Jones
- 74-year-old male admitted with shortness of breath, confusion, history of heart failure, hypertension, and gout.
- Vital signs: low blood pressure, elevated respiration, supplemental oxygen, and signs of edema.
- Ongoing assessments include falls risk, skin integrity, and pressure area care.
- Nursing problems identified: pulmonary edema, decreased mobility, anxiety, risk of infection, DVT, and sepsis.
- Goals: daily weights, fluid balance, orientation, skin care, maintaining safe oxygenation, and early mobilization.
- Actions: monitor vital signs, fluid output, collaborate with medical and social teams, and plan safe discharge.
Key Terms & Definitions
- Clinical Reasoning — The cognitive process nurses use to assess, diagnose, plan, implement, and evaluate patient care.
- Cue — A piece of information or data about the patient.
- Nursing Diagnosis — Identification of patient problems that nurses can address.
- SMART Goals — Goals that are Specific, Measurable, Achievable, Realistic, and Timed.
- Edema — Swelling caused by excess fluid in tissues.
- Pulmonary Edema — Fluid accumulation in the lungs, often due to heart failure.
- DVT (Deep Vein Thrombosis) — Blood clot in a deep vein, commonly from immobility.
Action Items / Next Steps
- Review and familiarize yourself with the clinical reasoning cycle steps.
- Observe the scenario video and identify use of each step.
- Practice applying the clinical reasoning cycle to your patient cases.
- Prepare for next clinical visit by using the cycle in patient presentations.