The Clinical Reasoning Method : Is It The Sound Choice Of Teaching Future Healthcare Personal?

To enhance my clinical knowledge I take time to understand why I am doing a task a particular way

Alfaro-LeFevre, R. (2013). Critical thinking, clinical reasoning, and clinical judgment : A practical approach (Fifth ed.).

Arthur Kelinman developed the explanatory model of illness which incorporates a series of questions that is unique to a patient’s illness to develop a treatment plan. This model assesses how patient illnesses are associated with the environment and the culture around them, while also “seeking the how, why, what, when, where, and what next of illness, disease, and health experience” (“Explanatory Model”). Asking the patient what is their opinion on what caused their illness and how they believe it should be treated will help identify their beliefs and help when planning an intervention.

This review is to discuss an overview of this case study with a clinical reasoning model and all contributing factors of this event. Then, the critical analysis of three articles relating to the factors with the reasons for the selection and their evaluation will be presented.

160) Knowledge elevates the power of critical thinking. Critical thinking is very essential to work in areas such as Intensive Care Units, Emergency Care Units. Assessment, diagnosis, planning, implementation and evaluation are best done by a BSN than an ADN because of the power of critical thinking. The skills of critical thinking, better problem solving, and development of clinical judgment are important for increase patient acuity. Since BSN is better in critical thinking and evidence based practice, they lower mortality rate significantly. (Aiken, 2003)

Nurses often have to make quick decisions, usually without adequate time to consider the entire situation. Have you ever wondered, how a person knew what to do, seemingly without ever thinking about it? Barbara Carper, was able to answer this question in detail with her “Ways of Knowing Concepts”, which she developed particularly for the nursing profession (Zander, 2011). A few of her concepts will be compared to a clinical situation, personal to this author. The above question will be explained in multiple ways so the reader will better understand Carper’s concepts and how they may apply to their own situation. This will be accomplished by: describing the clinical situation, observing applicable concepts and then relating them to the situation, visiting how an understanding of her concepts explains interventions and critical thinking, and how evidence affects critical thinking and knowing.

Differential diagnoses are developed by a clinician upon learning of the chief complaint. One must begin to develop the possibility of potential diagnoses mentally to guide the care provided to the patient. These potential diagnoses are developed by the care provider and are often based on one’s past clinical experiences, awareness of the illness and a clear understanding of the patient’s complaint (Goolsby & Grubbs, 2014). The care provider with experience may develop these diagnoses independently and others with less experience may utilize evidence-based resources and clinical guidelines to aid in this process (Goolsby & Grubbs, 2014). The process for reaching a final diagnosis requires further investigation and use of physical assessment

Underlying both the clinical decision-making process and the nursing process is the skill of critical thinking. Critical thinking has been described as the ability to gather and process data in such a way as to arrive at the best conclusion using the filters of prior knowledge, experience and external resources to overcome personal emotions, biases, and assumptions. (This description was developed during NUR/300 class, University of Phoenix, S. Colorado, March 16, 2006) Note that critical thinking is described as a

Clinical reasoning can be defined as, ‘the process by which nurses (and other clinicians) collect cues, process the information, come to an understanding of a patient’s problem or situation, plan and implement interventions, evaluate outcomes and reflect on and learn from the process’ (Levett-Jones & Hoffman 2013, p.4). It requires health professionals to be able to think critically and ensures better engagement and results for the patient (Tanner 2006, p.209). The Quality in Australian Healthcare Study (Wilson 1995, p.460) discovered that ‘cognitive failure’ resulted in approximately 57% of unfavourable clinical events involving the failure to produce and act correctly on clinical information. It also recognises that often nurse’s preconceptions and assumptions can greatly affect patient care and by going through such a process, one can take into account the holistic nature of the patient and provide the best, most appropriate care.

I just wanted to add a bit more to the discussion of clinical grasp, as I find it quite an interesting concept to deliberate. The concept of clinical grasp should be carefully considered. Clinical grasp is associated with modus operandi thinking or “detective-like thinking” (p. 29). This type of thinking occurs when what was originally seen by the clinician is inaccurate and a new intervention is implemented instead. An interesting consideration pertaining to clinical grasp is that despite how developed best practice guidelines or clinical reasoning may be, when “clinical puzzles “(p.30) arise the issues cannot be solved without the use of clinical grasp or reasoning. I think the risk of blindly following best practice guidelines can be brought

Due to threatening from chronic disease and functional declines as part of age-related changes that affect to the well-being of older adults, nurses have a vital role and opportunity in caring for them. Indeed, nursing care plan and clinical reasoning has been associated along with nursing process, as it seen to be a guide for making judgments and decisions that involves with patient’s care. Moreover, Johann in this case study who living alone and is experiencing the symptoms of Parkinson’s disease such as tremor. This could be dangerous for him at home as it affects his self-management in caring during his treatment (Suzman, 2005). Hence, this essay will discuss two priorities of care including increased falls and injury risk and medication assessment and management by using two theoretical nursing frameworks, Levett-Jones’s Clinical Reasoning Model (2013) and Miller’s

Critical thinking and clinical reasoning are terms often used interchangeably throughout the history of nursing. However, they are not the same, and distinguishing the difference amongst them is important. The purpose of this paper is to define critical thinking and clinical reasoning, discuss each concepts similarities and differences, as well as share this author’s perspective on how critical thinking and clinical reasoning have developed and evolved throughout my own career, guiding my clinical practice decisions.

What an awesome question and I am glad you asked me that!!!! We just had this same issue at my job over the new implementation of a medical curriculum and we had some resistance from teachers refusing to implement it because they felt they would have a high failure rate of students. So, there could be many barriers that may be preventing this stakeholder from making a good decision. According to Cole (2008), several factors can affect the way a person makes a decision. These barriers are attitudes and beliefs, expectations, lack of understanding cultural differences, and institutional practices that prevent a stakeholder in making a poor decision about a student education (p. 20). As in any good decision-making process, I would get the fact first because this could just be a disagreement between two colleagues about their techniques. For this issue, I would use the open decision-making approach. This model has been known to handle a situation like this, and it is the best method to use when making a decision in an organization about people in such a quick amount or time. This model help gets buy-in from the people in the organization because they believe they are making the decision. The steps to this mode are "collect input widely, facilitate a consensus, announce the decision clearly, and do not reconsider the decision unless there is significant new information" (Stanford University, 2008). In the Navy when you become a senior enlisted leader you attend a

Diagnosis: Knowing the futility of treating the symptoms, a clinician begins with a list of observable symptoms and uses cause and effect to seek out the underlying common cause for all of them, the “disease” or core problem.

Mukherjee (2015) talks about the three laws of medicine however these are his personal laws that may or may not be followed by other health professionals. He explains each law that he had learned through personal experiences with patients. The first law is ‘A strong intuition is much more powerful than a weak test,’ explains that there may be some hidden variable when diagnosing a patient that could be crucial in life or death situations. A variable could be the environment that a person lives in or their lifestyle and this chapter notes to know when to look for small clues that could possibly help. The second law is ‘”Normals” teach us rules; “outliers” teach us laws, ' talks about how normal cases teach and build the rules of what should be done on a regular basis of patients, what is normal. Outliers are the cases where it may untreatable but has the chance to reshape and even advance medicine. The third law is 'For every perfect medical experiment, there is a perfect human bias, ' talks about how we hope for a medical treatment that can help treat a disease but it is biased because it either works or doesn’t work despite a few anomalies. These are laws Mukherjee has learned from experience and applies throughout his career, they may not be followed by all health practitioners.