The Importance of the Evaluation and Reflection Stages in the Clinical Reasoning Process for Nurses

While there are many similarities in how nurses and other professionals in the medical sector think, there are also significant differences. Unlike staff who perform their duties and leave, nurses and their patients often have therapeutic relationships that can last hours, days, weeks, or even longer. During this period, nurses have extended vigilance and engage in episodes of clinical reasoning for every patient in their care. They respond to the complexities of their patients’ illnesses in holistic, person-centered, and authentic ways. 

What is clinical reasoning?

Clinical reasoning is a cyclical and systematic process that guides clinical decision-making, especially in emergency, non-routine, or unpredictable situations, leading to informed and accurate clinical judgments. In nursing, this is the process by which nurses collect signals, process the signs, understand the situation of a patient, plan interventions, take action, evaluate actions, and learn and reflect from the process. 

Competence in clinical reasoning is viewed as a dynamic and unique process that facilitates in-depth analyses of patient’s health problems, leading to safe care in nursing. Therefore, the process of clinical reasoning is emphasized in nursing education. For example, the online MSN-AGPCNP program provided by the University of Indianapolis highlights the clinical reasoning abilities of nursing students as being vital in measuring learning outcomes. This education focuses on clinical reasoning competence and enhances nurse’s ability to cope with unstable and complex situations when handling patients. 

Stages of the clinical reasoning cycle

The clinical reasoning cycle involves several interconnected stages that guide nurses in decision-making. These stages help nurses gather information, make judgments, and deliver patient-centered care. 

Consider the patient’s situation

The first stage of clinical reasoning involves the nurse gaining an initial impression of the patient and identifying critical features of the situation. This first impression is also called, “noticing” which is essential, yet it can be influenced negatively by the professional’s biases, assumptions, and preconceptions. Therefore, nurses must be aware of any biases they might have and approach every situation with an open mind. This will make them think more about the situation of the patient and less about what they already presume to know. 

Collect cues of information

This stage plays a crucial role in the cycle since early clue that are subtle are more easily missed, thus, leading to adverse patient outcomes. During this stage, nurses collect and review relevant patient information. This information includes the patient’s social and medical history, electronic medical records, clinical documentation, and other available information. 

Consequently, nurses identify additional information such as a focused health assessment and vital signs. Most importantly during this stage, nurses focus on collecting specific cues relevant to the patient’s condition. Also, nurses must note how these symptoms affect other aspects of the patient’s life, such as their emotional well-being, mental health, and other physical pains they may experience. 

Ultimately, the nurse will recall the information related to the patient’s particular situation. Thus, a depth of knowledge is crucial for this stage of clinical reasoning. Unless the nurse deeply understands applied sciences, especially pathophysiology, their ability to make sense of and interpret cues correctly will be impaired. 

Process information

In this stage, nurses interpret the cues that have been collected and identify any significant anomalies. They group cues into meaningful clusters, identify patterns, and formulate inferences and hypotheses. An experienced nurse will recall their previous experiences and match the current situation. They will also think ahead and anticipate potential complications and outcomes depending on the inaction or course of action. Therefore, nurses are prepared for any unforeseen circumstances. 

Identify issues

The fourth stage involves nurses synthesizing and processing the collected information to identify the most appropriate nursing diagnoses. This process must be accurate since the diagnosis is utilized to determine the nurse’s proper care goals and subsequent actions. 

Establish goals 

Here, nurses classify and prioritize the goals of care depending on urgency. These goals must be Specific, Measurable, Achievable, Realistic, and Timely (SMART) and designed to address the previously identified diagnosis. Without these goals, the nurse will have difficulty determining the effectiveness of their actions. 

Take action

During the sixth stage, nurses select the most suitable course of action to achieve the goals of care and address the diagnoses. It is also up to the nurse to decide which team members need help, thus, interventions are set in place. 

Evaluate outcomes

Nurses will need to reassess the patient cues (subjective data) and the objective data. This reassessment helps determine the effectiveness of the interventions and whether the patient’s problem has improved. If the evaluation indicates the patient’s condition has not been enhanced, the nurse will reconsider the patient’s situation and search for a more appropriate course of action. Consequently, there may be a need to utilize a new clinical reasoning cycle at this stage. 

Reflect on the process

The cycle of clinical reasoning necessitates cognitive and metacognitive skills to facilitate the ability to think like a nurse—leaving the last step of the cycle to be reflection. This stage requires nurses to critically review their practice with a view to change, improve, and refine. This process is intrinsic to learning and allows nurses to process their experiences and self-evaluate their understanding of their actions, why they took action, and the impact it had on themselves and others. 

Why is clinical reasoning important?

Nurses who possess clinical reasoning skills have a positive impact on the outcomes of patients. Comparatively, a nurse who lacks clinical reasoning skills may fail to take note of a patient’s deteriorating state, which could lead to a failure to rescue. 

In today’s healthcare, the top causes of adverse patient outcomes are inappropriate management of complications, failure to diagnose patients properly, and failure to provide appropriate treatment. Each of these errors is a result of poor clinical reasoning skills. 

Therefore, nurses must develop adequate clinical reasoning skills to prevent these issues. Other benefits that arise from nurses developing reasoning skills include:

  • Accurate assessment – Nurses will be in a better position to conduct accurate assessments of a patient’s condition by gathering the necessary cues or information. 
  • Precision in diagnosis – Clinical reasoning will facilitate accurate diagnosis and identification of health problems or potential risks to the patient’s well-being. 
  • Enhanced planning – Better planning will inform personalized care plans, ensuring interventions are precisely aligned with a patient’s unique needs and circumstances. 
  • Optimized intervention selection – The planning and taking action stage guides the selection of appropriate interventions based on a comprehensive understanding of the patient’s condition. This ultimately maximizes the effectiveness of care. 
  • Effective implementation – As a result of better implementation, there will be execution of interventions in a timely manner, leading to better adherence and patient management. 
  • Efficient resource utilization – Proper planning and implementation will help efficiently allocate resources. This will optimize time, energy, and medical supplies to deliver the best possible care. 
  • Improved collaboration and communication – The evaluation stage enhances communication and cooperation among team members in a healthcare setting because it provides a structured approach to sharing patient information and coordinating care. 
  • Professional development – Reflecting on outcomes fosters ongoing professional growth and nurses can learn from various encounters. This leads to future improved practice. 
  • Patient-centered care – When nurses consider the patient, collect cues, process information, and reflect on the process, all these processes aim to prioritize patient needs and preferences. Ultimately, there is a holistic patient-centered approach that respects and acknowledges the values and beliefs of each individual. 
  • Positive outcomes – The complete clinical reasoning process leads to improved patient outcomes, better satisfaction among all involved parties, and a positive impact on healthcare. 

The role of evaluation in clinical reasoning

Evaluation, second to taking action, is a crucial step in clinical reasoning. It includes a nurse’s thorough evaluation of the patient’s reaction to the interventions to determine the efficacy of the care plan. This stage’s major goal is to determine whether the desired results have been obtained and whether any changes are required to improve patient outcomes. Here are some of the benefits that arise during this important stage of the clinical reasoning cycle:

Better effectiveness assessment

A lens through which nurses can evaluate the efficacy of care is provided by assessing effectiveness. Nurses are able to unveil the impact of care evaluation to determine whether the interventions have improved the patient’s health and whether the intended results have been achieved.

Care plans adaptation

Nurses can adjust and alter the care plan to better suit the patient’s particular needs based on the insights gained from the evaluation. If the initial plan did not produce the anticipated results, revisions might be made to improve its efficacy and better suit the needs of the patient.

Quality improvement

The role of ongoing quality improvement in patient care is indispensable. Thanks to evaluation, nurses can identify areas for improvement and make the necessary adjustments to raise the level of care by attentively analyzing the results of care.

Individualizing care

A critical evaluation component is ensuring the patient is the continued focus of care. This enables nurses to understand the patient’s reaction to care, allowing them to customize subsequent interventions to their particular needs and preferences, thus enhancing their overall contentment and well-being.

Communication and documentation to promote complete understanding

The patient’s reaction to care must be carefully documented for evaluation to be practical. Healthcare teams need this documentation to communicate effectively and thoroughly understand the patient’s condition and progress. It encourages collaborative decision-making and well-informed debates.

The importance of reflection in clinical reasoning

A crucial step in the therapeutic reasoning process, reflection entails nurses’ actions and experiences, and results in deliberate thinking. This self-reflective analysis includes a critical assessment of the care provided and its effects on the patient, and the nurse as a healthcare provider.

The importance of the reflection stage in clinical reasoning encompasses the following:

Improved critical thinking

Reflection is a trigger for improving critical thinking abilities. It encourages nurses to delve deeply into, examine, and evaluate their experiences. As a result, nurses are forced to reflect on their choices, judgments, and actions, which fosters a better understanding of their work and strengthens their analytical skills.

Building self-awareness 

Nurses can discover their strengths and flaws by reflecting. This is vital since the advancement of one’s career depends on having self-awareness. This helps nurses build on their strengths and create plans to address their areas of weakness, thereby promoting their development and effectiveness as healthcare workers.

Ethical and moral development

By encouraging nurses to think about the ethical ramifications of their acts and decisions, reflection aids nurses in developing ethical and moral character. It promotes adherence to moral standards and guidelines when treating patients, reiterating the significance of moral behavior in the healthcare industry.

Continuously gaining knowledge and skills 

Reflection aids in lifelong learning and development. Nurses can gain the necessary knowledge by reflecting on successful and complicated instances. Additionally, they can improve their methods and plans for treating patients in the future by using the knowledge they have learned to improve their practices constantly.

Understanding and empathy

Reflecting on contact with patients fosters empathy and a better comprehension of the patient’s viewpoint, feelings, and needs. The patient’s experience and outcomes can be improved by using this insight to direct future contacts and ensure that care is provided in a kind and patient-centered manner.

Integrating evaluation and reflection into nursing practices

Integrating evaluation and reflection in nursing practice is crucial for improving patient care. Following the implementation of care interventions, evaluation enables nurses to gauge the success of their efforts and modify care plans as necessary. It guarantees patient-centered treatment, conforms to quality standards, and encourages ongoing development. Comparatively, reflection improves critical thinking, reveals strengths and faults, and fosters empathy. Both procedures are essential for advancing one’s career and moral and ethical character. Therefore, healthcare organizations and governments should spend money on continual training, mentoring, and technical tools while building a friendly and open environment where learning and progress are valued to incorporate these procedures successfully.

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